Pain Flashcards by Nikolas Leventis

Define

Pain

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

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Describe the characteristics of pain

pain is subjective and variable;
there are inherent limitations to measuring pain

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Classification of Pain

Acute Pain

Nociceptive pain
Caused by trauma, inflammation, disease
Can be recurrent

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Classification of Pain

Chronic Pain

Persistent/recurrent pain that lasts for >3 months
Persists past healing phase after an injury

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Nociceptive pain pathway terminology

transduction, transmission, perception, modulation

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Nociceptive Pain Pathway

Transduction

nociceptors to Spinal Cord

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Nociceptive Pain Pathway

Transmission

Spinal Cord to Thalamus

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Nociceptive Pain Pathway

Perception

Thalamus to Post Central Gyrus

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Nociceptive Pain Pathway

Modulation

Cerebral Cortex through Thalamus down efferent pathway to Substansia Gelatinosa

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Nociceptive Pain Pathway

What neuropeptides are released upon nociceptor activation

subtance P
arachidonic acid (prostaglandins and leukotrienes that are associated with inflammatory process)

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Nociceptive Pain Pathway:Transduction

Nociceptors convert

Nociceptors convert the intial stimulus into electrical activity in the form of action potentials

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Nociceptive Pain Pathway: Transduction

Action potential propagation:

The APs propagate from nociceptors along afferent nerves toward the spinal cord

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Nociceptive Pain Pathway: Transduction

Role of released neuropeptides

May initiate or participate in transduction because they sensitize nociceptors

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Second Order Neurons will do one of three things:

Synapse with motor neurons causing a reflex
Synapse with autonomic fibers that could cause vasodilation, pilorection, sweating, etc
Travel to higher brain centers through ascending tracts to complete pain perception

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Ascending pathway

C fiber activation

unmyelinated, slow
chronic pain
burning, dull ache

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Ascending pathway

A-delta fiber activation

myelinated
fast
acute pain

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Immune based intermediearies

Substance P function

vasodilator
produces edema
vascular plexus
cell-mediated immune based changes
releases histamine from mast cells

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Primary afferent nociceptor not only signals the presence of tissue damage but plays a direct role in:

local mechanisms of defense and repair

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Gate Control Theory

Severity of pain is determined by:

Severity of pain sensation is determined by balance of excitatory and inhibitory inputs to T cells in the spinal cord

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Gate control theory

Inhibitory inputs from A-beta fibers (non-nociceptor) help to “close gate” and reduce pain

Dr.Nolan shaking his hand after smashing it with a hammer

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Counterirritant mechanism

circuits in the dorsal horn that may produce inhibition of nociceptive pain
collaterals of mechanoreceptive afferents stimulate internuerons that release enkephalins

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Counterirritant mechanism

Enkaphalin binding

inhibits transmission of nociceptive messages by primary afferents and interneurons in the nociceptive pathway

endorphin

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Descending Efferent Pathway

can close gate at SG by inhibiting T cells through release of endorphins and inhibit release of painful neurotransmitters

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Placebo

inert treatment that is beneficial because person believes it will be beneficial

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Nocebo

inert treatment that increases symptoms because the person believes it will increase symptoms

Nociceptive

Activation of nociceptors by noxious stimulation, whether it be mechanical, thermal, chemical

Neuropathic

Caused by a lesion or disease of the peripheral or central nervous system

Neuroplastic

Central Sensitization increases sensitivity of neurons in the CNS to normal or subthreshold input

terms to avoid when describing pain

* psychogenic * affective * non-organic pain * medically unexplained * headcase

# Neuropathic pain Source

from the NS itself pain may originate from peripheral nervous system or from the central nervous system

# Neuropathic pain Causes

Nerve degeneration (MS, stroke, brain hemorrhage, O2 starvation) Nerve pressure (trapped nerve) Nerve inflammation (torn or herniated disc) Nerve infection (shingles or other viral infection)

# Neuropathic pain Receptors activated

the nervous sytem does not have specific receptors for pain (non nociceptive)

# Neuropathic pain Characteristics

signals are interpreted by the brain as pain, and can be associated with signs of nerve malfunction such as hypersensitivity, tingling, numbness, and weakness

# Neuropathic pain People often describe neuropathic pain as:

shooting, burning, itchy and hypersensitive; not usually a vague deep ache

# Neuropathic pain Example of referred pain to an area where that nerve would normally supply

Sciatica from a herniated disc irritating L5 spinal nerve produces pain down the leg to the outside shin and big toe

# Neuropathic pain Acute examples of Neuropathic pain

"funny" bone leg "asleep" burning pain

# Neuropathic pain Chronic examples of Neuropathic pain

Post-herpetic neuralgia Diabetic neuropathy Cancer pain Surgical nerve injury Back pain

# Neuropathic pain Recurring examples of Neuropathic pain

trigeminal neuralgia migraine headache back pain

Central Sensitization

CNS is stuck in a heightened sense of reactivity

# Central Sensitization Allodynia

pain caused by usually non noxious stimuli

# Central Sensitization Hyperalgesia

normally painful stimuli is perceived as more painful

# Central Sensitization Implications of Response to Nerve Injury

Pain can continue after healing May see nonphysiologic or spreading pain Different treatments work differently on different people

# Visceral Pain Source

internal organs of the 3 main body cavities

# Visceral Pain Main cavities

Thorax (heart and lungs) Abdomen (liver, kidneys, spleen, bowels) Pelvis (bladder, womb, ovaries)

# Visceral Pain Receptors activated

specific receptors (nocireceptors) for stretch, inflammation, O2 starvation/ischemia

# Visceral Pain Characteristics

often poorly localized vague deep ache cramping or colicky in nature

# Visceral Pain Referred pain in lower back

pelvic pain

# Visceral Pain Referred pain in the mid back

abdominal pain

# Visceral Pain Reffered pain in the upper back

thoracic pain

# Sympathetic Pain Source

possible over-activity sympathetic nervous sytem, and C/PNS mechanics

# Sympathetic Pain Causes

occurs more commonly after fractures and soft tissue injuries of the arms and legs

# Sympathetic Pain Injuries may lead to

CRPS

Patient Examination: Observation

Note facial expression Observe gait as pt enters room Look for evidence of inflammation & SNS dysfunction

Assessment of Pain Intensity

Verbal Analog Scale (VAS) Patient chooses number from 0-10 that equals their pain experience compare numbers for pain when it is at its worst and at its best Visual Analog Scale Measures pain status of pt on provided line

Location of Pain

Localized Vague, non specific Referred Cutaneous Dermatomes

# Musculoskeletal Pain Descriptions and Related Structure: Muscle

* cramping * dull * aching

# Musculoskeletal Pain Descriptions and Related Structure: Ligament/joint capsule

* dull * aching

# Musculoskeletal Pain Descriptions and Related Structure: Nerve

* sharp * shooting

# Musculoskeletal Pain Descriptions and Related Structure: Bone

* deep * nagging * dull

# Musculoskeletal Pain Descriptions and Related Structure: Fracture

* sharp * severe * intolerable

# Musculoskeletal Pain Descriptions and Related Structure: Vasculature

* throbbing * diffuse

Interviewing pt with persistant pain:

Determine if: * there is a structural lesion * whether there are somatic & psychosocial factors * impact of pain on pt's life * remember pain is a biopsychosocial phenomena

Treatment of Pain

Medications PT: Biophysical agents/energies Exercise Manual therapy Correction of faulty posture and movement

How do PTs address the psychosocial aspects of pain?

Listen carefully- the pt will often reveal the psychologic/social aspect of their pain

Pain neuroscience education

change pt's thinking de-educate and re-educate decrease fear and anxiety abnormal findings don't necessarily mean there is an issue

# Pain neuroscience education Pathoanatomic terms to avoid:

* deterioration * herniation * bone on bone * wear and tear

What is the make and model of the train at the end of the lecture

NZR JA class steam locomotive 1271

"Explain Pain"

goal is to shift the pt's conceptualization of pain away from believing pain is necessarily an indicator of tissue damage/disease, and to understand that pain indicates the brain's perception that it needs to protect the body

Pain Flashcards

(68 cards)