Pain Flashcards
(61 cards)
1
Q
How much more common is depression for those with persistent pain?
A
4x more common
2
Q
What % of people with chronic pain will have another significant medical problem (i.e.: a co-morbidity)?
A
87%
3
Q
What is pain?
A
an unpleasant sensory and emotional experience associated with actual or potential tissue damage
4
Q
Noxious
A
poisonous or harmful
5
Q
Hyperalgesia
A
heightened pain intensity as a response to noxious stimuli
6
Q
Analgesia
A
absence of pain or inability to feel pain
7
Q
Dysaesthesia
A
abnormal sensation felt when touched, caused by damage to peripheral nerves
8
Q
Paraesthesia
A
abnormal sensation with no apparent physical cause (e.g.: tingling, pricking, chilling, burning or numb sensation)
9
Q
Allodynia
A
innocuous (harmless) stimuli cause pain
10
Q
Hyperpathia
A
exaggerated responses to painful stimuli
11
Q
What is the physiology of pain?
A
- An irritation or injury is detected in the peripheral nervous system by special nerves (nociceptors).
- A nerve impulse is then generated, sending a pain impulse towards the CNS.
- The message is received by the brain where the extent and significance of the irritation or injury is interpreted, and pain is sensed.
12
Q
What are nociceptors?
A
free nerve endings present in every tissue in the body except for the brain, which are activated by noxious stimuli
13
Q
What are examples of noxious stimuli?
A
- Thermal: severe heat or cold
- Mechanical: trauma, disease, injury, hypoxia, ulceration, infection, peripheral nerve damage, inflammation, ischaemia
- Chemical: histamine, kinins, prostaglandins, which are released due to tissue damage and inflammation
14
Q
What are the 3-linked neurones that make up the ascending pathway of pain?
A
- First-order neurons
- Second-order neurons
- Third-order neurons
15
Q
What are first-order neurons?
A
travel from the nociceptors to the spine
16
Q
What are second-order neurons?
A
travel upwards through the spinal cord towards the thalamus in the brain
17
Q
What are third-order neurons?
A
run from the thalamus to the somatosensory area of the cerebral cortex
18
Q
How is line communication maintained?
A
by neurotransmitters (such as Substance P + Serotonin)
19
Q
What is the purpose of the descending pathway of pain?
A
to inhibit the sensation of pain
20
Q
How is pain sensation inhibited?
A
- Special neuropeptides with analgesic properties are released
- Which bind with opiate receptors, present throughout the CNS
- Block the action of neurotransmitter Substance P
21
Q
What are the 4 major categories of opiate receptor?
A
- mu (π)
- πππππ
- π ππππ
- delta.
22
Q
What are the (3) ascending tracts of the spinal cord transmission pathway?
A
- Spinothalamic
- Spinoreticular
- Dorsal column - medial lemniscal system
23
Q
What nerves are used to carry sensation from the head and oral cavity (trigeminal system)?
A
- Trigeminal nerve
- Facial nerve
- Glossopharyngeal nerve
- Vagus nerve
24
Q
What are the (3) classifications of pain duration?
A
- Transient
- Acute
- Chronic
25
What are the (3) classifications of pain type?
- Nociceptive
- Inflammatory
- Neuropathic
26
What is nociceptive pain?
detection of a noxious stimulus by nociceptors (C fibre)
- e.g.: mechanical, inflammatory, ischemic
27
What is inflammatory pain?
pain signalling & transmission behaviour in the presence of an inflammatory process
28
What is neuropathic pain?
a specific type of pain which results from damage to the signalling & transmission of neurons both within and outside of the CNS
29
What is peripheral sensitisation?
caused by multiple chemical mediators from nerve tissue damage and inflammatory response
30
What is central sensitisation?
change in the sensitivity of the spinal cord synapses in the dorsal horn and upstream through the nervous system to the cortex
31
What are the (4) different sources of nociception?
- Cutaneous (superficial somatic)
- Deep somatic (bone, tendon + joint)
- Visceral (internal organs)
- Referred pain
32
Describe transient pain characteristics?
- Short duration
- No significant consequence
- Don't seek medical attention
e.g: stubbed toe or cut finger
33
Describe acute pain characteristics?
- Severe sudden onset, but is intense and can be intolerable
- Could be associated to medical condition or injury
- Brain response is to achieve homeostasis by initiating autonomic response
34
Describe chronic (persistent) pain characteristics?
- Continues even though healing is complete
- No autonomic response
- Considered a 'syndrome' or medical condition in its own right
35
Where does the liver contribute to pain distribution?
- Right lower thoracic pain
- Right shoulder pain
- Right epigastric pain
- Joint pain/back pain
36
What are some identifiable features of visceral pain?
- Pain diffuses and is poorly defined
- Non mechanical pattern
- Associated autonomic responses (e.g.: palpitations, nausea, etc)
37
Where does the gall bladder contribute to pain distribution?
- Epigastric pain
- Right shoulder pain
- Right lower thoracic pain
38
Where does the pancreas contribute to pain distribution?
- Epigastric pain
- Left or right shoulder pain
- Mid-thoracic pain
39
Where does the stomach contribute to pain distribution?
- Mid-thoracic pain
- Epigastric pain
40
Where does the kidney contribute to pain distribution?
- Loin pain
- Lateral buttock & thigh pain
- Groin pain
- Lower quadrant abdominal pain
41
Where does the bowel contribute to pain distribution?
- Central & lower abdominal pain
- Lower-quadrant abdominal pain (left>right)
42
Where does the ovaries contribute to pain distribution?
Abdominal pain left or right mid-abdomen
43
Where does the uterus contribute to pain distribution?
- Central lower back pain
- Posterior thigh pain
- Abdominal pain
44
Where does the bladder contribute to pain distribution?
- Central suprapubic pain
- Central pain over sacrum
- Pain around gluteal crease (left or right, or both)
- Perineal pain
45
Where does the prostate contribute to pain distribution?
- Genital pain
- Lower back pain perineal pain
46
Where does the abdominal aorta contribute to pain distribution?
- Lower back pain
- Groin pain
47
What is nociception?
The process of encoding noxious stimuli
48
What is allodynia?
Pain due to a stimulus that doesn't normally provoke pain
49
What is hyperalgesia?
Increased pain from a stimulus that normally provokes pain
50
What is central sensitisation?
Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input
51
What is neuropathic pain?
Pain caused by a lesion or disease of the somatosensory nervous system
52
What is nociplastic pain?
Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain
53
What is chronic/persistent pain?
Pain that persists or recurs for longer than 3 months
54
Why do we not feel pain all the time?
- When the messages reach the spinal cord there is another gateway neurone.
- This second gateway neurone also needs stimulating to pass on the βdangerβ response to the brain.
- However, the brain can block these messages from ascending.
- The brain decides whether to let messages through and once through what they mean and how best to deal with the information.
55
What is a normal pain response?
- Unpleasant sensation associated with actual or potential harm
- Caused by stimulation to mechanical, chemical and thermal receptors.
- Receptors are stimulated and ion channels open.
- Positive ions enter the neurone if a threshold reached - action potentials created.
- The action potential travels along the nerve to the spinal cord.
56
What changes in persistent pain?
- βDangerβ system becomes more sensitive + better at passing on messages.
- Thresholds that trigger responses are lowered causing hypersensitivity and allodynia.
- Non-nociceptive neurones sprout new neurones near synapses + start taking βdangerβ messages to the brain.
- Spinal cord amplifies the information going up to the brain + can make it up
- Unsurprisingly the brain thinks the danger level has increased (so increases pain sensation)
- Thoughts start to influence pain (the endocrine + immune systems get involved)
57
What is the role of a physio in pain management?
- Assessment
- Treatment and needed
- Red flag assessment
- Pain education / demystifying pain
- Goal setting
- Encourage self management
- Onwards referral to pain specialist
58
Describe a pain assessment.
- Subjective ratings scales: VAS, NRS, faces pain scales
- Objective measures: McGill pain questionnaire, Pain beliefs and attitudes inventory, EQ-5D
- Visual observations: pain behaviours, communication changes
- Physiological responses: HR, BP, sweating, colour
59
What factors affect pain?
- Anatomy / pathology
- Mood
- Sleep
- Stress
- Environment
- Lifestyle eg work
- Upbringing / childhood
- Past experiences
- Friends / family reactions
60
What may we offer our patients advice on?
- Pain management
- Pain education
- Pacing
- Postural advice
- Workstation advice
- Manual handling
- General activity and exercise
- Pathology education
61
Describe the ascending system of pain?
- Nociceptors are stimulated due to extremes of hot, cold, mechanical or chemical (inflammatory) stimuli
- Sensory nerves carry the information to the dorsal horn of the spinal cord
- This synapses with the βsecond order neuronβ which relays the signal to the Thalamus via the spinothalamic tract
