Pain

Question 1

Carry Pain

Answer 1

Small Diameter Fibers

Question 2

Inhibit Transmission of Pain Impulses

Carry non-painful stimuli

Answer 2

Large Fibers

Question 3

NOCICEPTION

Answer 3

Physiological processes related to pain perception

Question 4

4 parts of Nociception

Answer 4

1. Transduction
2. Transmission
3. Perception
4. Modulation

Question 5

Transduction

Answer 5

1st step in experience of pain

• Nociceptors activated by exposure to noxious stimuli (mechanical, chemical, or thermal)
• Nociceptors spark electrical impulse that is conducted along nerve

Question 6

3 segments of Transmission

Answer 6

1. Pain impulse travels from peripheral nerve to spinal cord
2. Transmission from spinal cord and ascension to brain stem and thalamus
3. Transmission of signal between thalamus to somatic sensory cortex, where pain perception occurs

Question 7

2 parts of the pain assessment

Answer 7

1. Pain History (Subjective)
2. Observation (Objective)

Question 8

unpleasant sensory and emotional experience associated with actual or potential tissue damage, or it is described in terms of such damage

Answer 8

International Association for the Study of Pain

(def of pain)

Question 9

drug injected into nerve pathway

blocks transmission of impulse

Answer 9

Nerve block

Question 10

Cordotomy

Answer 10

last resort for intractable pain

Question 11

usually on cervical nerve roots

Answer 11

Rhizotomy

Question 12

used to reverse effects of narcotics

Answer 12

NARCAN

Question 13

Rectal

Answer 13

• Suppository
• Good for patients with nausea/vomiting

Question 14

Common Side Effects of Opioids

Answer 14

• Constipation
• N/V
• Sedation
• Respiratory depression
• Pruritus
• Urinary retention

Question 15

Pain

Answer 15

• complex phenomena with NO simple definition
• Highly subjective –Individual & Personal
• difficult to assess

Question 16

4 Categories of Pain

Answer 16

1. Location
2. Duration
3. Intensity
4. Underlying mechanism

most patients do not fit neatly in single category

Question 17

Acute Pain

Answer 17

• Begins suddenly
• Usually sharp
• mild to severe
• moment to 6 months
• Relieved when underlying cause eliminate

If unrelieved, may become chronic

Question 18

Chronic Pain

Answer 18

• Prolonged duration
• Interferes with functioning
• Recurrent/ longer than 6 months
• Persists when injury has healed
• May have w/o injury or evidence of damage

Question 19

Intractable pain

Answer 19

• Resistant to relief
• Difficult to relieve
• Try multiple interventions
• Affects quality of life

can’t treat on own…. Interferes with ADL

Question 20

Nociceptive Pain

Answer 20

Most pt’s, manageable

• Intact, functioning nervous system
• signal that tissues are damaged
• Requires attention and proper care

Question 21

Subcategories of Nociceptive Pain

Answer 21

1. Somatic Pain
2. Visceral Pain

Question 22

Somatic Pain

Answer 22

intensity and location match type and extent of injury

• Originates in skin, muscles, bone
• Highly organized

Question 23

Visceral Pain

Answer 23

• Activation of nerve fibers from **organs or hollow viscera
• Poorly localized**
• Cramping, throbbing, aching
• Associated with diaphoresis or nausea

Question 24

Neuropathic Pain

Answer 24

• Damaged/ malfunctioning nerves
• Difficult to treat
• Burning, electric shock, tingling, dull, aching

Question 25

3 Types of Neuropathic Pain

Answer 25

1. Peripheral 2. Central 3. Sympathetically Maintained

Question 26

Peripheral Neuropathy

Answer 26

– Pain felt along peripheral nerves – Diabetic neuropathy Peripheral Neuropathy

Question 27

Central Neuropathic Pain

Answer 27

* Caused by lesion or dysfunction of CNS * Post-stroke pain * MS

Question 28

Sympathetically Maintained Pain

Answer 28

Abnormal connections between pain fibers and sympathetic nervous system Becomes chronic and neuropathic Phantom limb pain

Question 29

Hyperalgesia

Answer 29

heightened response to painful stimuli Severe pain from paper cut

Question 30

Allodynia

Answer 30

nonpainful stimuli produce pain Contact with wind, linens

Question 31

Dysesthesia

Answer 31

unpleasant abnormal sensation, there are bugs under my skin, my skin is on fire

Question 32

5 dimensions of pain

Answer 32

1. Physiologic 2. Sensory 3. Affective 4. Behavioral 5. Cognitive

Question 33

Transmission 3 segments

Answer 33

1. Pain impulse travels from peripheral nerve to spinal cord 2. Transmission from spinal cord and ascension to brain stem and thalamus 3. Transmission of signal between thalamus to somatic sensory cortex, where pain perception occurs

Question 34

Perception

Answer 34

* become conscious of pain * Opiates work well here * shapes character, intensity, and meaning of pain to individual

Question 35

Three key factors of preception

Answer 35

1. **Threshold:** point which identifies pain 2. **Distractibility:** degree can ignore pain 3. **Tolerance:** point at which act to stop pain

Question 36

Modulation

Answer 36

* Descending system * Neurons in _thalamus and brainstem_ _send signals down spinal cord_ * Neurons release substances (Endogenous opioids) inhibit pain impulses

Question 37

Endogenous opioids

Answer 37

serotonin, norepinephrine