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Pain Flashcards

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1
Q

What is pain?

A

Pain is a complex and highly subjective sensation affected by many variables

Pain is often motivated by traumatic injuries or progressive diseases.

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2
Q

Who defined pain in 1979 and how?

A

The International Association for the Study of Pain (IASP) defined pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage’

This definition emphasizes the negative and subjective nature of pain.

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3
Q

What are the key characteristics of pain according to the IASP definition?

A
  • Unpleasant sensation
  • Sensory experience
  • Emotional experience
  • Associated with tissue damage

These characteristics highlight pain’s complexity.

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4
Q

What is the sensory-discriminative aspect of pain?

A

The ability to locate a painful stimulus and describe its intensity and quality

It involves recognizing differences in aspects related to pain.

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5
Q

What is the affective-motivational aspect of pain?

A

The emotional response to pain that produces changes in mental state and behavior

This includes anxiety, distress, and motivation to avoid pain.

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6
Q

What types of stimuli can cause pain?

A
  • Actual tissue damage
  • Potential tissue damage

Pain can arise from stimuli that do not cause visible damage.

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7
Q

What is neuropathic pain?

A

Pain caused by injury or disease of the nervous system rather than peripheral tissue

It can last from months to a lifetime and is often more challenging to treat.

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8
Q

What is nociceptive pain?

A

Pain produced by nociceptive stimuli that cause or have the potential to cause peripheral tissue damage

It can be further divided into external and internal damage.

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9
Q

What is psychogenic pain?

A

Pain with no identifiable underlying pathology, often attributed to psychological disorders

It can be indistinguishable from pain with physical causes.

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10
Q

What is the difference between acute pain and chronic pain?

A
  • Acute pain lasts less than 3 months
  • Chronic pain lasts longer than 3 months

These terms refer only to the duration of pain, not its cause.

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11
Q

What is one method to manage acute pain without opioids?

A

Using regular dosing of paracetamol and NSAIDs such as ibuprofen

This method is effective for up to 70% of people with acute pain.

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12
Q

What is referred pain?

A

Pain that is felt in a part of the body other than the site of injury

This can occur in both neuropathic and nociceptive pain.

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13
Q

Fill in the blank: Pain can be considered a _______ multi-dimensional experience.

A

[negative]

Pain is typically associated with peripheral tissue damage but can exist without it.

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14
Q

What are the two subtypes of nociceptive pain?

A
  • External damage
  • Internal damage

External damage is common and usually mild, while internal damage is less common and typically more severe.

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15
Q

What can influence the experience of pain?

A
  • Behavior
  • Cognitive factors
  • Clinical intervention

Pain intensity can be modified by these elements.

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16
Q

What is referred pain?

A

Pain perceived as occurring in a region of the body topographically distinct from the region in which the actual source of pain is located.

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17
Q

What is hyperalgesia?

A

An increased response to a stimulus that is normally painful.

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18
Q

What is allodynia?

A

Pain due to a stimulus that does not normally provoke pain.

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19
Q

What is acute pain?

A

Pain that lasts less than 3 months.

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20
Q

What is chronic pain?

A

Pain that lasts longer than 3 months.

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21
Q

Describe the three-neuronal pain pathway.

A

First-order neuron carries information from periphery to spinal cord, second-order neuron relays information to the brain, third-order neuron transmits information to the cerebral cortex.

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22
Q

What are nociceptors?

A

The first-order neurons in the pain pathway responsible for the detection of painful stimuli.

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23
Q

What is the function of high threshold mechanoreceptors?

A

Activated by high intensity mechanical stimuli such as pin-prick, cutting, or pinching the skin.

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24
Q

What distinguishes polymodal nociceptors from high threshold mechanoreceptors?

A

Polymodal nociceptors respond to mechanical, thermal, and chemical stimuli of sufficient intensity to cause damage.

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25
What causes the burning pain sensation after a mechanical injury?
The activity of polymodal nociceptors.
26
Fill in the blank: The spinothalamic tract neurons are ______ neurons in the pain pathway.
second-order
27
Where do spinothalamic tract neurons terminate?
In the thalamus.
28
What is the role of the thalamus in pain perception?
It receives information from all senses (except smell) and passes this on to the cerebral cortex.
29
What is the conduction velocity of high threshold mechanoreceptors?
5–15 m/sec.
30
What is the conduction velocity of polymodal nociceptors?
0.5–2.5 m/sec.
31
What is the anatomical location of nociceptor cell bodies?
In the posterior root ganglia, just outside the spinal cord.
32
What triggers the activation of silent nociceptors?
Tissue inflammation.
33
What is the term for the substances released during tissue damage that produce pain?
Inflammatory soup.
34
What are the primary substances involved in the inflammatory response?
* Bradykinin * Histamine * Prostaglandin
35
What are dermatomes?
Regions of skin innervated by branches from one spinal nerve.
36
What is the primary role of nociceptors in deeper tissues?
To detect high-intensity mechanical stimuli and various pain-producing chemicals.
37
True or False: Nociceptors are activated by low-intensity (innocuous) stimuli.
False.
38
What type of pain do high threshold mechanoreceptors primarily detect?
Fast-sharp pain.
39
What type of pain do polymodal nociceptors primarily detect?
Slow-burning pain.
40
What is the thalamus?
A large, oval-shaped structure located deep underneath the cerebral hemispheres that receives information from all senses (except smell) and passes it to the cerebral cortex
41
What are the two structurally distinct regions where spinothalamic tract neurons terminate in the thalamus?
* Posterolateral part * Medial region
42
What is referred pain?
Pain that is perceived in a location different from the source of the pain due to convergence of nociceptor inputs onto the same spinothalamic tract neurons
43
What are thalamocortical neurons?
Third-order neurons of the pain pathway that collect information from the thalamus and relay it to the cerebral cortex
44
Which cortical regions are responsible for the perception of pain?
* Lateral pain pathway (parietal and insular lobes) * Medial pain pathway (frontal lobe)
45
What is the function of the lateral pain pathway?
Responsible for the sensory-discriminative aspect of pain, including position, intensity, and modality of tissue damage
46
What is the role of the anterior cingulate cortex in pain perception?
Involved in the affective-motivational aspect of pain; activated by peripheral tissue damage and responses can be alleviated by hypnosis
47
When was the use of medicinal cannabis approved in Australia and New Zealand?
* Australia: 2016 * New Zealand: 2017
48
What are cannabinoids?
Chemicals in marijuana that affect cannabinoid receptors in the nervous system, including THC and CBD
49
What are neuromodulators?
Substances released by neurons that alter the activities of other neurons in pain pathways
50
What are some examples of excitatory neuromodulators?
* Glutamate * Substance P * Somatostatin * Vasoactive intestinal polypeptide
51
What is the function of endorphins?
Inhibit transmission of pain impulses in the spinal cord and brain by binding to opioid receptors
52
What is pain tolerance?
The amount of time or intensity of pain an individual will endure before initiating overt pain responses
53
What factors can influence pain tolerance?
* Cultural perceptions * Expectations * Role behaviors * Gender * Physical and mental health
54
What is the pain threshold?
The lowest intensity at which a stimulus is perceived as pain
55
What can cause changes in autonomic nervous system activation during pain?
Pain experiences can lead to an increase in heart rate, blood pressure, ventilation, nausea, vomiting, and sweating
56
What is the primary method for evaluating a patient's pain?
Listening to and believing what the patient says about their level of pain
57
What is the World Health Organization analgesic ladder?
A guideline for determining pharmacological agents in pain management, starting from non-opioid analgesics to opioids
58
What is a midline myelotomy?
A surgical procedure that cuts the axons of spinothalamic tract neurons to produce bilateral analgesia
59
What is anterolateral cordotomy?
A surgical procedure that cuts the axons of the spinothalamic tract in the anterolateral funiculus
60
What is the objective of anterolateral cordotomy?
To cut the axons of the spinothalamic tract in the anterolateral funiculus ## Footnote This procedure is used to alleviate pain, particularly when it is unilateral.
61
How is anterolateral cordotomy performed today?
Percutaneously with an electrode inserted into the anterolateral funiculus, visualised using CT scanning ## Footnote The cut is made by heating the tip of the electrode.
62
What type of pain is anterolateral cordotomy particularly useful for?
Unilateral pain ## Footnote The lesion affects only one side of the body.
63
What is the estimated prevalence of chronic pain in Australians over 45?
Approximately one in five Australians ## Footnote The economic impact was about AU$73 billion in 2018.
64
What are the healthcare costs associated with chronic pain in Australia?
About AU$12 billion ## Footnote Costs mainly include inpatient, outpatient, and out-of-hospital medical expenses.
65
What causes complex regional pain syndrome (type II)?
Traumatic injury of peripheral nerves ## Footnote This leads to spontaneous action potentials in damaged and intact nociceptors.
66
What is the pathophysiology of painful diabetic neuropathy?
Hyperglycaemia leading to degeneration of unmyelinated sensory neurons ## Footnote Characterized by loss of sensation and burning pain in feet and hands.
67
What triggers postherpetic neuralgia?
Infection of peripheral nerves with varicella zoster virus ## Footnote This leads to sensory neuron loss and pain in the dermatome of the infected nerve.
68
What is the characteristic pain quality in lumbosacral radicular pain?
Lancinating (stabbing, piercing) pain ## Footnote Often felt in the thigh or lower leg due to spinal nerve compression.
69
What is phantom limb pain caused by?
Spontaneous activation of nociceptors in neuroma following nerve transection ## Footnote Results in ongoing cramping or aching pain referred to the amputated limb.
70
What is trigeminal neuralgia also known as?
Tic douloureux ## Footnote It involves severe, sharp pain referred to the facial region.
71
What is the typical cause of chemotherapy-induced peripheral neuropathy?
Chemotherapy-induced neurotoxicity of myelinated primary sensory neurons ## Footnote Results in loss of sensation and spontaneous burning pain.
72
What defines mononeuropathy and polyneuropathy?
Mononeuropathy involves a single nerve; polyneuropathy involves multiple nerves ## Footnote Both are forms of peripheral neuropathic pain.
73
What is the role of sympathetic nervous system in complex regional pain syndromes?
It may contribute to pain sensation ## Footnote Local anaesthetic blockade can alleviate pain in these cases.
74
What is central sensitisation?
Enhanced responsiveness of second-order neurons in the spinal cord ## Footnote Results from changes in excitability and disinhibition of these neurons.
75
What assessment tool is commonly used to evaluate pain in preverbal children?
Face Legs Activity Cry Consolability (FLACC) scale ## Footnote Scores pain-related behaviours from 0 to 10.
76
What are central pain syndromes?
Forms of pain caused by damage to the central nervous system ## Footnote They often feel like pain from peripheral tissues but lack identifiable peripheral damage.
77
What are some causes of central pain syndromes?
Vascular lesions, traumatic brain injury, neurosurgery, brain tumours, multiple sclerosis, spinal cord injury, epilepsy ## Footnote These factors can lead to damage in pain processing areas of the brain or spinal cord.

NURS427 (22 decks)

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