Pain Flashcards

(53 cards)

1
Q

• Pain is protective
– Brings into consciousness the awareness of tissue damage
• Pain doesn’t feel protective
– It is accompanied by motivational and behavioral responses:
• Crying,Fear, Withdrawal

A

Physiology of Pain

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2
Q
– Mechanical nociception
• Mechanical damage to body tissue
– Thermal nociception
• Damage due to temperature exposure
– Polymodal nociception
• General category
• Pain triggers chemical reactions from tissue damage
A

(pain perception) NOCICEPTION

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3
Q

conveys information about the senses to and from the brain[all motor nerves to skeletal muscles]

A

Somatic nervous system

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4
Q

convey info about the sense organs to the CNS

A

Afferent (sensory) neurons

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5
Q

convey info from CNS to muscles, organs, and glands

A

Efferent (motor) neurons

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6
Q

connect sensory to motor neurons

A

Interneurons

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7
Q

all motor nerves to smooth and cardiac muscles, galnds

A

autonomic system

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8
Q

Nociceptors in peripheral nerves first sense ____

A

injury

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9
Q

In response, release chemical messengers

which travel to spinal cord and brain ,____ neurons

A

afferent

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10
Q

Brain regions identify the site of the injury and

send messages back down spinal column, ____ neurons

A

efferent

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11
Q

• Leads to muscle contractions, helps block pain
• Changes in other bodily functions, such as
breathing

A

nociceptors

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12
Q
  • Acts in spinal cord

* Involved in the transmission of pain impulses from peripheral receptors to the CNS

A

Substance P

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13
Q
  • Acts in spinal cord
  • Amplifies pain signal transmitted from spinal cord to brain
  • Implicated in chronic pain
A

– Glutamate

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14
Q
  • Released by tissue damage

* Prolong the experience of pain by continued stimulation of nociceptors

A

Bradykinin & prostaglandins

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15
Q
  • Released by the immune system to signal the nervous system
  • Produce responses such as decreased activity, increased fatigue, increased pain sensitivity
  • May sensitize structures in the dorsal horn of the spinal cord to promote the development of chronic pain
A

Inflammatory cytokines

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16
Q

Head and neck pain is directly transmitted to

brain via the 12 ____ nerves

A

cranial

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17
Q

For the rest of the body, the peripheral nervous

system must send impulses to the brain via ___ ___

A

spinal cord

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18
Q

small, myelinated fibers that transmit sharp
pain
• Especially mechanical or thermal pain
• Regulate sensory aspects of pain by projecting onto areas of the
thalamus and sensory areas of the cortex

A

A-DELTA fibers

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19
Q

– large, myelinated fibers
• Conduct impulses 100x faster than C-fibers
• Easily stimulated

A

A-BETA fibers

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20
Q

– unmyelinated fibers transmit dull, aching pain
• >60% of all sensory afferents
• Require more stimulation
• Polymodal pain
• Regulate affective and motivational elements of pain by projecting onto thalamic, hypothalamic, and cortical areas

A

C-fibers

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21
Q
  • Primary & secondary somatosensory cortices
  • Anterior cingulated cortex (ACC)
  • Thalamus
  • Cerebellum
A

Brain areas involved in pain:

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22
Q

– The affective dimension of pain
– Feelings of unpleasantness and negative emotions
– Psychological and neural mechanismsinvolved
– Processed in the cerebral cortex are involved in
cognitive judgments about pain

A

Secondary Affect

23
Q

Electrical stimulation of a rat’s brain produced a

high level of analgesia

A

– The rat did not feel the pain of surgery
• Conclusion: The brain can control the amount of
pain experienced

24
Q

-substances like heroin or morphine,
but they are produced by the body
• These substances constitute an internal painregulation system

25
– Produce peptides that project to the limbic system, | brain stem, & elsewhere
Beta-endorphins
26
– Peptides that have widespread neuronal, endocrine, & CNS distributions
Proenkephalin
27
– Found in the gut, the posterior pituitary, & the brain
Prodynorphins
28
• Highly complex system (receptor sensitivity) • Important in natural pain suppression • Must be triggered – Released by stress (Stress-Induced Analgesia) • Suppress immune functioning • Also implicated in cardiovascular control • used for treating chronic pain
endogenous opioid peptides
29
• Typically results from a specific injury – Wound or broken limb • Disappears when damaged tissue is repaired • goes on for six months or less • During there is an urgent search for relief
acute pain
30
``` – Typically begins with an acute episode – Pain does not decrease with treatment – Pain does not decrease as time passes • Three types : – benign pain – recurrent pain – progressive pain ```
chronic pain
31
``` – Persists more than 6 months – Varies in severity – Any number of muscle groups – Relatively intractable to treatment – Ex: Chronic low back pain & myofacial pain ```
Chronic benign pain
32
– Intermittent episodes of acute pain – Chronic because the condition lasts more than 6 months – Ex: Migraine headaches & TMJMD
chronic recurrent pain
33
``` – Increases in severity over time – Persists longer than 6 months – Typically associated with malignancies or with degenerative disorders – Ex: Rheumatoid arthritis & cancer ```
Chronic progressive pain
34
Chronic pain may result from a predisposition to respond to a bodily insult with a specified bodily response
Prechronic pain – most crucial stage – Time between acute and chronic pain – Do you get better? – Do you develop chronic pain?
35
* To soldiers, pain means, “I’m alive” | * To civilians it interrupts activities
Beecher’s study of WWII injuries
36
``` – Classical conditioning • Dentist office, hospital – Operant conditioning • Rewards for pain behaviors may promote development of chronic pain – Attention, sympathy, relief from normal responsibilities, disability compensation – Secondary gains – Personality – Psychopathology ```
individual diff of experience of pain
37
– Specific pain fibers and pain pathways exist, making the experience of pain virtually equal to the amount of tissue damage or injury – Pain is a physical experience largely uninfluenced by psychological factors – In reality, specificity is limited – Pain is a complex, multidimensional phenomenon
Specificity Theory
38
– Structures in the spinal cord act as a gate for the sensory input that the brain interprets as pain • Increase pain (open gate) • Decrease pain (close gate) – Gate located in substantia gelatinosa in the dorsal horn • A-delta, A-beta, and C fibers regulate the “gate” – Central control trigger consists of nerve impulses that descend from the brain and regulate the “gate” • Periaqueductal gray matter supports this theory • Affected by beliefs & prior experience
Gate Control Theory
39
– Extension of Gate Control Theory – Stronger influence of the brain in pain perception – The neuromatrix is a network of brain neurons that processes sensory information but can act even in the absence of sensory input (e.g., phantom limb)
Neuromatrix theory
40
* Rating scales * Large informal vocabulary * Questionnaires
Measuring Pain - Verbal Reports
41
• Multidimensional Pain Inventory – Pain characteristics, interference with lives and functioning, mood
Measuring Pain: Self-report
42
• Dysfunctional – Higher pain, interference & distress, lower activity • Interpersonally distressed – Support persons not providing necessary support • Adaptors – Lower pain, interference & distress and higher functioning • Repressors – Report high pain & low activity but report low distress
Group patients into 4 categories for multidemensional pain inventory
43
• Beck Depression Inventory (BDI) – Chronic pain patients present with a different profile than do depressed patients without pain • Symptom Checklist 90-Revised (SCL-90-R) – Can differentiate between pain patients and people pretending to have pain
Measuring Pain: Standardized Tests
44
``` ___ ____are behaviors that arise as manifestations of chronic pain – Distorted gait or posture – Facial/audible expressions of distress – Avoidance of activities ```
pain behaviors
45
– Measures muscle tension | – Little relationship with self-report pain
Electromyography (EMG)
46
Hyperventilation, blood flow in the temporal artery, heart rate, hand surface temperature, surface temperature, finger pulse volume, skin resistance level
Autonomic indices
47
• Acute Pain – Advantages: signals injury and promotes healing – Disadvantages: it hurts! – Advantages outweigh disadvantages
• Chronic Pain – No Advantages – Syndromes of pain based on symptoms
48
– Recurrent attacks of pain that vary in intensity, frequency, & duration • Symptoms: loss of appetite, nausea, vomiting, & exaggerated sensitivity to light and sound • 30-50yrs of age
migraine headaches
49
– Muscular in origin, accompanied by sustained contractions of the muscles of the neck, shoulders, scalp, and face – Includes mechanisms in CNS • Symptoms: gradual onset; sensations of tightness; constriction or pressure; highly variable intensity, frequency, and duration; dull, steady ache on both sides of head – 40% of US population affected
Tension headaches
50
– Severe headache that occurs in daily or nearly daily clusters – Symptoms similar to migraines but much briefer, rarely last longer than 2 hours – Localized on one side of the head; the eye on the other side often becomes bloodshot and waters – Men > women at 10:1
Cluster Headache
51
• Very common; 80% of people in US • Most people recover • Those who do not recover develop chronic pain problems • Substantial cost: > $90 billion a year • Causes: – Most frequent: injury or stress resulting in musculoskeletal, ligament, and neurological in the lower back – Infections, degenerative diseases, cancer, stress & psychosocial factors
Low Back Pain
52
• Experience of chronic pain in the absence of a body part • Amputation removes the nerves that produce the impulses leading to the experience of pain but not the sensations • Not limited to limbs, also found with breasts and teeth • Severity and frequency varies • Decreases over time • Cause is debated but evidence supports the Neuromatrix Theory
Phantom Limb Pain
53
– Rheumatoid arthritis • Autoimmune disease characterized by swelling & inflammation of joints, cartilage, bone, & tendons • Can occur at any age & more frequent in women – Osteoarthritis • Progressive inflammation of joints; dull ache • Most common form; especially among elderly
athiritis pain