Clinical Management of Pain--Blake Flashcards
(43 cards)
What is the IASP definition of pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
What are 4 of the main effects of chronic pain on a patient? What does each mean?
Physical functioning–activity level, sleep
Psychological morbidity–depression, anxiety, anger
Social Consequences–relationships, sex
Societal Consequences–health care costs, lost work days.
What are the 4 categories of pain when it is categorized in an etiology-based manner?
Nociceptive
Neuropathic
Cancer
Psychogenic
What are the 2 main types of nociceptive pain & what does each refer to?
Somatic Pain–arises from bone, muscle, ligament, skin
Visceral Pain–arises from organs
What is neuropathic pain?
pain arising from a lesion or disease affecting the somatosensory system.
What is mixed pain?
combo of nociceptive & neuropathic, usu seen in cancer
What type of pain are these examples of?
cholecystitis
nephrolithiasis
visceral pain (nociceptive pain)
What type of pain is this an example of?
chest wall pain from lung cancer
mixed pain
What type of pain are these examples of?
radiculopathy, CRPS
neuropathic pain
What type of pain are these examples of?
ankle sprain
arthritis
somatic pain (nociceptive pain)
Why is it that a person w/ 9/10 chronic pain can roll over & go to bed?
b/c chronic pain just operates differently than acute pain. need to think of the 9/10 as the amount that the pain is taking over their lives.
What are the 4 pain assessment scales used?
Verbal Pain Intensity Scale
Visual Analog Scale
0-10 Numeric Pain Intensity Scale
Faces Scale
What is the estimate for the total number of people in the U.S. experiencing neuropathic pain (excluding back pain)?
1, 765, 000.
What are the 3 components of a comprehensive treatment plan?
biological approach
psychological intervention
social/rehabilitative issues
What are the 2 main sympathetic blockade techniques?
stellate ganglion block
lumbar sympathetic block
What is the usu nociceptor structure & what are the 2 main types?
unmyelinated axons w/ small cell body diameter
2 types: C-fiber & A delta fiber
What are the 2 functional properties of nociceptors?
- encode stimulus intensity into a noxious range
2. primary afferent sensitization: increase in excitability due to endogenous mediators & factors
What are the 4 events that are necessary for the nociceptor to convey info to the CNS about noxious stimuli?
- Signal Transduction
- Signal Transformation
- AP propagation
- Signal Transmission
What happens during signal transmission?
AP initiates release of NT on the 2nd order neuron
Which receptor is important in nociceptor signal transduction & depolarization of the peripheral terminal?
TRPV1 receptor
Describe the characteristics of peripheral nociceptor sensitization.
increased excitability lower threshold for activation sometimes ongoing spontaneous activity main cause of hyperalgesia can cause central sensitization
What does it mean to have an increase in excitability of peripheral nociceptors?
increase in excitability = increased response to noxious stimuli
What is hyperalgesia?
increased pain produced by the stimulation of the site of injury
What is central sensitization?
an increased excitability of central neurons
