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pathophysiology > Week 3: Ch. 4- Pain > Flashcards

Week 3: Ch. 4- Pain Flashcards

1
Q

What is pain?

A

Unpleasant sensation - Discomfort caused by stimulation of pain receptors

Body defense mechanism - Warning of a problem

Complex mechanisms - Many not totally understood

Subjective scales - Developed to compare pain levels over time

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2
Q

What are some causes of pain?

A
  • Inflammation
  • Infection
  • Ischemia and tissue necrosis
  • Stretching of tissue
  • Stretching of tendons, ligaments, joint capsule
  • Chemicals
  • Burns
  • Muscle spasm
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3
Q

SOMATIC VERSUS VISCERAL PAIN

A

Somatic pain
* From skin (cutaneous)
* Bone muscle
* Conducted by sensory fibers

Visceral pain
* Originates in organs
* Conducted by sympathetic fibers
* May be acute or chronic

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4
Q

_______________ (pain receptors) are free sensory nerve endings

A

Nociceptors

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5
Q

Nociceptors may be stimulated by:

A

*Temperature - extremes

*Chemicals - acids, bradykinin, histamine, prostaglandin

*Physical means: pressure

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6
Q

Define pain threshold

A
  • Level of stimulation required to elicit a pain response
  • Usually does not vary among individuals
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7
Q

Define pain tolerance

A
  • Ability to cope with pain
  • Culturally related
  • Varies among individuals
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8
Q

Describe pain fibers

A
  • Afferent fibers
  • Myelinated A delta fibers
    -Transmit impulses very rapidly
    -Acute pain
    -Sudden, sharp, localized
  • Unmyelinated C fibers
    -Transmit impulses slowly
    -Chronic pain
    -Diffuse, dull, burning, or aching sensation
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9
Q

Dermatome

A
  • Area of skin innervated by a specific spinal nerve
  • Somatosensory cortex → “mapped” - Corresponds to source of pain stimuli
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10
Q

Reflex response

A
  • Involuntary muscle contraction away from pain source / to guard against movement
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11
Q
  • Spinothalamic bundle in the spinal cord

Neospinothalamic tract VS Paleospinothalamic tract

A
  • Neospinothalamic tract → fast impulses; acute pain
  • Paleospinothalamic tract → slow impulses; chronic, dull pain
  • Spinothalamic tracts connect with reticular formation of brain
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12
Q

Somatic sensory area in the cerebral cortex located in the _________ lobe

A

parietal

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13
Q

Describe Gate control theory

  • Control systems, “gates” built into normal pain pathways
  • Can modify pain stimuli conduction and transmission in the ________________________________________
  • Gates open - Pain impulses transmitted from ______________ to brain
  • Gates closed - Reduces or modifies the passage of _______________________
A
  • Control systems, “gates” built into normal pain pathways
  • Can modify pain stimuli conduction and transmission in the spinal cord and brain
  • Gates open - Pain impulses transmitted from periphery to brain
  • Gates closed - Reduces or modifies the passage of pain impulses
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14
Q

Describe pain control method of ice

Impulses from _________________________ close _______.

A

Impulses from temperature receptors close gates.

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15
Q

Describe pain control method of Transcutaneous electrical nerve stimulation (TENS)

A

Increases sensory stimulation at site, blocking pain transmission

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15
Q

Describe pain control method of Opiate-like chemicals (opioids)

A
  • Secreted by interneurons of the CNS (endogenous)
  • Block conduction of pain impulses to the CNS
  • Resemble morphine - Enkephalins, dynorphins, beta-lipoproteins
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15
Q

How do infants respond to pain?

A

physiologically
* Examples: tachycardia, increased blood pressure, facial expressions

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15
Q

Describe signs & symptoms of pain

A
  • Pallor and sweating
  • High blood pressure, tachycardia
  • Nausea, vomiting, fainting. dizziness - May occur with acute pain
  • Anxiety and fear - Frequently evident in people with chest pain/trauma
  • Clenched fists or rigid faces
  • Restlessness or constant motion
  • Guarding area to prevent stimulation of receptors
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16
Q

Describe referred pain

A
  • Source may be difficult to determine
  • Pain may be perceived at site distant from source
    -Characteristic of visceral damage in the abdominal organs
    -Heart attack or ischemia in the heart
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17
Q

Describe phantom pain

A
  • Usually in adults
  • More common if chronic pain occurred
  • Can follow an amputation - Pain, itching, tingling
  • Usually does not respond to common pain therapies
  • May resolve within weeks - months
  • not fully understood
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18
Q

Pain tolerance may be increased by ___1___
~May be reduced because of _______2________

A

1- endorphin release

2- fatigue or stress

19
Q

Response to pain is influenced by :

A

personality, emotions, and cultural norms

20
Q

Describe acute pain

  • Usually sudden, severe, _______________
  • Indicates _____________ damage
  • May be localized or ______________
  • Initiates physiologic stress response ↑ Blood pressure and heart rate; cool, pale, moist skin; ↑ respiratory rate; ↑ skeletal muscle tension
A
  • Usually sudden, severe, short term
  • Indicates tissue damage
  • May be localized or generalized
  • Initiates physiologic stress response ↑ Blood pressure and heart rate; cool, pale, moist skin; ↑ respiratory rate; ↑ skeletal muscle tension
  • Vomiting/ strong emotional response may occur
21
Q

Describe chronic pain

Occurs over extended time; may be recurrent
Usually more difficult to treat than ________ pain
Often perceived to be ___________
Individual may be fatigued, irritable, depressed
Sleep disturbances common
Specific cause may be ______________________.
Appetite may be affected > weight gain/loss
Frequently affects ____________________________
Periods of acute pain may accompany chronic pain conditions.
Usually reduces tolerance to additional pain

A
  • Occurs over extended time; may be recurrent
  • Usually more difficult to treat than acute pain
  • Often perceived to be generalized
  • Individual may be fatigued, irritable, depressed
  • Sleep disturbances common
  • Specific cause may be less apparent.
  • Appetite may be affected > weight gain/loss
  • Frequently affects daily activities
  • Periods of acute pain may accompany chronic pain conditions.
  • Usually reduces tolerance to additional pain
22
Q

Cause of migraines

A
  • Abnormal blood flow and metabolism in the brain
23
Q

Intracranial headaches : Increased-

A

pressure inside the skull

24
Q

Headache [central pain] is caused by:

A

dysfunction or damage to the brain or spinal cord

25
Q

Headache [Neuropathic pain] is caused by:

A

trauma or disease involving the peripheral nerves

26
Q

Headache [ischemic pain] results from:

A

a profound, sudden loss of blood flow to an organ or tissue

27
Q

List which analgesic drugs are used for mild VS moderate VS severe pain

A

Mild- NSAIDS, acetaminophen

Moderate- Codeine, Oxy, Perc, Vicodin

Severe- Morphine, oxy, methadone

28
Q

Local anesthesia is Injected or applied to:

A

skin or mucous membranes

29
Q

Spinal or regional anesthesia blocks pain from:

A

legs or abdomen

30
Q

General anesthesia causes:

A

loss of consciousness (gas or injection)

31
Q

Neuroleptanesthesia:

Patient can respond to commands.
& is relatively :

A

unaware of procedure, no discomfort

32
Q

The impulses related to acute pain are usually transmitted by:

A

myelinated A delta fibers.

33
Q

In which structure do pain impulses ascend the spinal cord?

A

Spinothalamic tract

34
Q

According to the gate-control theory, passage of pain impulses may be naturally blocked:

A

at the synapse by entry of other sensory impulses.

35
Q

What is the term used to describe the degree of pain that is endured before an individual takes action?

A

Pain tolerance

36
Q

What is the definition of endorphins?

A

Opiate-like blocking agents in the central nervous system

37
Q

Pain perceived in the left arm during the course of a heart attack is an example of:

A

referred pain.

38
Q

A headache that is related to changes in cerebral blood flow is classified as a/an ________ headache.

A

migraine

39
Q

What is a common analgesic administered to control a moderate level of pain?

A

Codeine

40
Q

Spinal anesthesia -

The drug is injected into _______________________________ of the spinal cord.

A

cerebrospinal fluid (CSF) or the epidural space

41
Q

What is the role of nociceptors? They are:

A

pain receptors that are stimulated by thermal, chemical, or physical means.

42
Q

Intractable pain is best defined as:

A

severe pain that cannot be controlled by medication.

43
Q

Young infants typically respond to pain with :

A

tachycardia and increased blood pressure.

44
Q

Ibuprofen is classified as an NSAID and is particularly useful in treating:

A

pain caused by inflammation.

45
Q

Which analgesics acts to reduce pain at the peripheral site?

A

Acetaminophen

46
Q

Cancer-related pain has been broken down into three basic categories: pain caused by the advance of the disease and resultant damage to the body, pain that is the result of a coexisting disease unrelated to the cancer, and:

A

pain associated with the treatment of the disease.

47
Q

Pain that is caused by trauma or disease involving the peripheral nerves is referred to as:

A

neuropathic pain.

48
Q

Pain resulting from a profound, sudden loss of blood flow to an organ or tissues in a specific area of the body is referred to as:

A

ischemic pain.

49
Q

Which of the following is a characteristic of chronic pain?

It is more difficult to _______________ than is acute pain.

A

diagnose and treat

pathophysiology (23 decks)

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