Pain and Control

Question 1

What are the fives stages of response to terminal illness as demonstrated in the Kubler-Ross model?

Answer 1

1 denial 2 anger 3 bargaining 4 depression 5 acceptance

Question 2

The Kubler-Ross death and dying model can be applied to most grief or depression including illness and injury, but which type of injury is it not as applicable to?

Answer 2

Athletic injury

Question 3

What is the cognitive appraisal model?

Answer 3

Response to injury depends on individual’s understanding of the injury (no stages or order)

Question 4

Is depression following injury common among athletes?

Answer 4

No (refer to cognitive appraisal model)

Question 5

What is the most common use of therapeutic modalities?

Answer 5

Reduce pain levels

Question 6

What is transduction?

Answer 6

Process of changing energy of nociception into electrical action potential in the neuron

Question 7

Which proprioceptors detect change in muscle length and spindle tension?

Answer 7

Golgi tendon organs (GTOs)

Question 8

Which mechanoreceptors also detect change in joint position?

Answer 8

Pacinian corpuscles

Question 9

Which mechanoreceptors sense pressure and touch?

Answer 9

Meissner’s corpuscles

Question 10

Which mechanoreceptors sense skin stretch and pressure?

Answer 10

Merkle cells

Question 11

What two things determine the velocity of nerve transmission?

Answer 11

Diameter of the nerve and degree of myelination

Question 12

What are the unmyelinated pain fibers? Myelinated?

Answer 12

Unmyelinated = C fibers
Myelinated = A-delta

Question 13

Which first order afferent fibers are associated with only touch and vibration and NOT pain?

Answer 13

A-beta

Question 14

What is the relationship between nerve fiber diameter and speed?

Answer 14

Increased diameter = increased speed

Question 15

Which type of fibers are the fastest?

Answer 15

A-beta (greater diameter)

Question 16

Which are faster: C fibers or A-delta fibers?

Answer 16

A-delta (due to myelination and increased diameter)

Question 17

What is the location of C fibers?

Answer 17

Muscle, skin

Question 18

What is the location of A-beta and A-delta fibers?

Answer 18

Skin

Question 19

Which fibers have warm and cold receptors and are found in hair follicles?

Answer 19

A-delta

Question 20

What are the smallest peripheral nerve fibers associated with pain?

Answer 20

C fibers

Question 21

Where does the first order neuron of the pain pathway synapse?

Answer 21

Dorsal horn of spinal cord

Question 22

What are the most important parts of the thalamus for pain transmission?

Answer 22

VPL and VPM

Question 23

Where are the cell bodies of the third order neurons in the path pathway located?

Answer 23

Thalamus

Question 24

Where do ascending pain fibers from just the head and face synapse in the thalamus?

Answer 24

VPM

Question 25

Where do ascending pain fibers from the body synapse in the thalamus?

Answer 25

VPL

Question 26

Where does localization and discrimination of pain transmission occur in the cortex?

Answer 26

Postcentral gyrus

Question 27

What area of the brain is important for regulating emotional, autonomic, and endocrine responses to pain?

Answer 27

Limbic system

Question 28

Ice treatment is an example of what kind of pain modulation?

Answer 28

Peripheral pain modulation

Question 29

How does peripheral pain modulation work?

Answer 29

Desensitizes peripheral nociceptors and increases threshold making fewer pain impulses transmitted to the spinal cord

Question 30

What is the gate theory of pain?

Answer 30

Non-painful stimulus can block transmission of noxious stimulus

Question 31

What specific location in the spinal cord acts as a "switch operator" in the gate theory?

Answer 31

Substantia gelatinosa

Question 32

Which endogenous pain killer is present in the substantial gelatinosa?

Answer 32

Enkephalins

Question 33

Why does shaking your hand after hitting it with a hammer help reduce your pain?

Answer 33

Stimulation of A-beta fibers to cause inhibitory interneurons to be stimulated to block pain transmission

Question 34

Which modulation provides sensory feedback at a non painful level to stimulate A-beta fibers to reduce pain?

Answer 34

TENS

Question 35

What specific location is targeted during motor pain modulation?

Answer 35

Reticular formation and pituitary gland

Question 36

What are the types of central pain modulation?

Answer 36

Motor and noxious pain modulation

Question 37

What specific location is targeted during noxious pain modulation?

Answer 37

Periaqueductal gray (PAG) and raphe nucleus

Question 38

The descending endogenous opiate system (DEOS) is involved in which form pain modulation?

Answer 38

Motor (central) pain modulation

Question 39

Cryotherapy stimulates what fibers in an effort for noxious pain modulation?

Answer 39

C fibers

Question 40

What is another name for nerve block pain modulation?

Answer 40

Wedensky's inhibition

Question 41

What is Wedenski's inhibition?

Answer 41

When stimulation encroaches on the refractory period of the sensory nerve and causes inhibition by continual stimulation

Question 42

Which types of modalities are associated with nerve block pain modulation?

Answer 42

Russian stimulation, interferential current

Question 43

What is exercise induced hypoalgesia?

Answer 43

Decreased pain sensation during physical activity

Question 44

When was EIH first noticed?

Answer 44

During Civil War and WWI when solider felt less pain during battle than in safety of a hospital

Question 45

What is the scientific reason behind exercise induced hypoalgesia?

Answer 45

Increased endogenous opioids (endorphins) and catecholamines (epinephrine and norepinephrine)

Question 46

Why is EIH an important thing to consider with patients?

Answer 46

Patients who are athletes could be seriously injured by not feel the intensity of their pain during a game

Question 47

Is EIH more prevalent with aerobic or anaerobic exercise?

Answer 47

Aerobic

Question 48

What are the 3 components of neuromuscular control that should be addressed in a rehabilitation plan?

Answer 48

1 consciously controlled muscle contraction 2 reflex responses 3 complex movement patterns

Question 49

How can a knee injury lead to muscle issues?

Answer 49

Stretch receptors in joint capsule with joint effusion send signals to CNS leading to reflex inhibition of VMO