Pain

Question 1

Fast pain defined

Answer 1

Short, well localized, sharp, stabbing sensation- duration matched to stimulation

Question 2

Fast pain from what kind of fibers

Answer 2

Myelinated A-delta fibers

Question 3

Slow pain defined

Answer 3

Throbbing, burning, aching, diffuse, poorly localize & less related to stimulus

Question 4

Slow pain from what kind of fibers

Answer 4

unmyelinated C-fibers

Question 5

Eudynia

Answer 5

Symptomatic/normal pain

Question 6

Maldynia

Answer 6

Pathophysiological disease of the nervous system

Question 7

Dysesthesia

Answer 7

Unpleasant abnormal sensation

Question 8

Neurogenic pain

Answer 8

Pain initiated or caused by primary lesion, dysfunction, or transitory perturbation in peripheral or central nervous system

Question 9

Neuropathic pain

Answer 9

pain initiated or caused by primary lesion or dysfunction of nervous system

Question 10

Gate control theory

Answer 10

Specialized nerve endings (nociceptors) whose response is modulated in dorsal horn of spinal cord

Question 11

How fast pain travels

Answer 11

A-delta to Rexed’s lamina I and V, 2nd order neurons cross over to contralateral STT and ascend to brain

Question 12

How slow pain travels

Answer 12

C-fibers to Rexed’s lamina II and III (also called substantia gelitanosa)

Question 13

GABA effects on pain

Answer 13

Inhibitor - hyperpolarizes via increase in chloride in cerebral cortex, basal ganglia, cerebellum and spinal cord

Question 14

Acetylcholine effects on pain

Answer 14

Inhibitor - increases potassium conductance in peripheral paraSNS

Question 15

Dopamine effects on pain

Answer 15

Inhibitory by acting on adenylate cyclase

Question 16

Norepi effects on pain

Answer 16

Inhibitor in RAS and hypothalamus

Question 17

Epi effects on pain

Answer 17

inhibitory in RAS

Question 18

Glycine effects on pain

Answer 18

Increases chloride in spinal cord

Question 19

Endorphins effects on pain

Answer 19

excitatory for descending pathway which inhibits pain transmission

Question 20

Serotonin effects on pain

Answer 20

Inhibitory in brain

Question 21

Histamine effects on pain

Answer 21

Inhibitory in hypothalamus and RAS

Question 22

Glutamate effects on pain

Answer 22

Excitotoxic neuronal injury - acts in hippocampus, outer layer of cerebral cortex and susbstantia gelitanosa

Question 23

Pain transmission

Answer 23

Impulse -> dorsal horn -> glutamate or substance P release and then acted on by inhibitory or excitatory neurotrasmitters

Question 24

Do pain receptors adapt

Answer 24

No

Question 25

Flaccid paralysis and absent stretch reflex indicate a ____ motor neuron lesion

Answer 25

lower

Question 26

Spastic paralysis with accentuated stretch reflex in absence of skeletal muscle paralysis indicates ___ motor neuron lesion

Answer 26

upper

Question 27

primary afferent neurons are __polar with a cell body in the ____ where the ___ of sensory neurons are located

Answer 27

uni, dorsal root ganglion, cell bodies

Question 28

Incision stimulates ____, but not ____ nociceptors

Answer 28

cutaneous, visceral

Question 29

Visceral nociceptors are activated by ____

Answer 29

distension

Question 30

Muscle and joint nociceptors are activated by ____

Answer 30

stretching or pressure

Question 31

Silent nociceptors are activated after ____

Answer 31

tissue injury

Question 32

Chronic pain defined

Answer 32

Peristent beyond normal time frame, starts around 6 weeks to 3 months and lasts 1-6 months or longer

Question 33

Deep pain defined

Answer 33

diffuse and difficult to locate, referred to other structures

Question 34

Sympathetic vs parasympathetic innervation of pain

Answer 34

Para: mouth, esophagus, laryngeal nerve, upper thoracic, rectum, urethra, testicles, genitofemoral, cervix and upper vagina SNS: stomach, intestines, lungs, renal, peritoneum, etc

Question 35

Independent indicators for postoperative pain

Answer 35

Preoperative pain, younger age, type of surgery, preop anxiety, size of incision, female

Question 36

Max tylenol dose for preterm/infants/children

Answer 36

preterm 60 mg/kg, infants 75 mg/kg, children 100 mg/kg (max 4 g/day)

Question 37

Capsaicin cream

Answer 37

Burns with administration but depletes substance P

Question 38

Pain meds to avoid in elderly

Answer 38

Meperidine, non-cox NSAIDS (GI), indomethacin (GI, renal, liver), ketorolac (can use reduced dose), pentazocine (HTN/tachy), skeletal muscle relaxants

Question 39

Neuropathic pain defined

Answer 39

Damage or disease to somatosensory system (thermo/photo/mechano/chemo receptors), have dysesthesia (abnormal sensations) and pain with non-painful stimulus (allodynia)

Question 40

Approach to chronic pain management

Answer 40

Bio-psycho-social... include patient as active participant and pain expert.. outcome oriented pain with emphasis on function not pain

Question 41

Untreated or poorly treated acute pain will likely lead to ____

Answer 41

chronic pain syndromes