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Flashcards in Pain Deck (8)
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Factors affecting pain perception/input

-Mood: depressed, anxiety, catastrophizing
-Chemical/structural: atrophy (happens w/ chronic pain) and opiod/DA dysfunction
-Injury: peripheral and central sensitization
-Context: beliefs, culture, placebo, expectations
-Cognition: attention, distraction, hypervigilance
-Pain inhibitory center: periaqueductal gray sends messages to the thalamus that leads to profound analgesic affects


Generation of pain

-Due to inflammatory events that lead to the formation of prostaglandins (COX2 pathway- inhibited by NSAIDs)
-Prostaglandins sensitize skin pain receptors and makes them more prone to firing
-Also regulates hypothalamic temperature control center


Types of pain

-Can be chronic or acute, and nociceptive (inflammatory) or neuropathic
-Nociceptive: protective response of body to trauma or inflammation, pain is relieved when inflammation is gone, responds to NSAIDs
-Neuopathic: no protective purpose or biologic value, persists beyond healing, does not respond to NSAIDs


Factors that chronic pain influences

-Non-opioid mediators
-Endogenous opioids (placebo works on same receptors)
-Respiratory center


Neuropathic pain

-Caused by a lesion or disease of the nervous system
-Central (stroke, MS, trauma, compression of SC, ect) or peripheral (diabetic, herpetic, etoh neuropathies, complex regional pain syndrome)
-Most common neuropathic pains are lower back pain and diabetic neuropathy


Neuropathic pain Dx

-Dx: spontaneous pain that's worse at night
-Exam: no sensory loss, may have allodynia (pain from cotton swab), hyperalgesia (exaggerated response to pain), or hyperpathia (summation of pain after repetitive stimulus)
-Sympathetically-driven pain: ANS is in overdrive
-Assess joints, fascia, tendons, psychology
-Lab tests: nerve conduction studies, skin biopsy, neuroimaging (fMRI and PET)


Rx for nociceptive pain

-NSAIDs then opiates then sedatives/anesthetics
-Rx the injury


Rx of neuropathic pain

-Rx the biological, social and psychological problems (biopsychosocial)
-Can use pharmacologic Rx (mostly anti epileptics, TCAs, and steroids) along w/ psychological and physical Rx
-TCAs block Na channels, do not use opiates as they can increase neuropathic pain
-Can also to stimulation on parts of the brain or SC
-Goals of Rx: improve pt understanding, level of function, promote self-management, and modify their perceived level of pain

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