Pain and Inflammation

Question 1

Acute Pain

Answer 1

• Frequently results from a disease, injury, or inflammation
• Sudden onset
• Short duration (<6months)
• Resolves with Healing

Question 2

Chronic Pain

Answer 2

• Considered a disease
• Persistent
• Continues after healing
• Resistant to majority fo medical treatments
• Can be influenced by environment and psychological factors

Question 3

Nociceptive Pain

Answer 3

• Physiologic
• “Normal” pain transmission
• Tissue injury
• Pharmacologic management: Nonopioids, opioids, local anesthetics

Question 4

Neuropathic

Answer 4

• Pathologic
• Abnormal processing
• Pharmacologic management: Adjuvant analgesics

Question 5

Somatic Pain

Answer 5

• Skin, bone, muscle, soft tissue
• Well localized
• Sharp, burning, gnawing, throbbing, cramping
• Intermittent or constant
• Acute or chronic

Question 6

Inflammatory Pain (Inflammatory Joint Diseases)

Answer 6

• Inflammatory joint diseases
• Acute or chronic
• Signs & symptoms: swelling, tenderness, deformities, limitation of motion
• Treat with anti-inflammatory meds

Question 7

Visceral Pain

Answer 7

• Diffuse, not well localized
• Nociceptor stimulation in abdominal or thoracic organs and tissues
• Dull, aching, cramping
• Referred

Question 8

Neuropathic Pain

Answer 8

• Injuries to peripheral pain receptors, nerves or CNS
• Pain can arise from a stimulus that usually would not cause pain
• Shooting, burning, stabbing
• Difficult to treat

Question 9

Nociceptive Pain Processes

Answer 9

1. Transduction
   - Nociceptors
   - Inflammatory response
2. Transmission
   - A-Delta and C Fibers
3. Perception
   - Higher brain structure activation
4. Modulation
   - Neurochemicals

Question 10

Transduction

Answer 10

• If above needed threshold, the neuron will depolarize and trigger action potential
• Release of excitatory neurotransmitters and compounds

Question 11

Transmission

Answer 11

Action potential
A-delta
- Glutamate
C fibers
- Substance P
Dorsal root ganglia
Spinal cord
Brain

Question 12

A-delta fibers

Answer 12

Faster transmission
Lightly myelinated
Rapid reflex withdrawal

Question 13

C fibers

Answer 13

Slow conduction
Unmyelinated
Poorly localized pain
Aching, burning

Question 14

Glutamate

Answer 14

Binds to N-methyl-D-aspartate (NMDA) receptor
Promotes pain transmission
Secreted in spinal cord at A-delta nerve fiber endings

Question 15

Substance P

Answer 15

Secreted at C nerve fiber endings
Opioids block at dorsal horn

Question 16

Serotonin and Norepinephrine

Answer 16

Suppress nociceptive transmission

Question 17

Perception

Answer 17

Higher brain structures are activated
Brain perceives pain

Question 18

Modulation

Answer 18

Descending neuronal pathways
Inhibit pain transmission
- Endorphins
- Serotonin
- Norepinephrine

Question 19

Endogenous Analgesia System

Answer 19

Opioids can activate
Neuropeptides

Question 20

Neuropeptides

Answer 20

Endorphins
Enkephalins
Dynorphins

Question 21

Endorphins

Answer 21

Inhibit pain signal transmission
Induce euphoria

Question 22

Enkephalins

Answer 22

Inhibit Substance P release
Modulate pain perception

Question 23

Dynorphins

Answer 23

Produce analgesia

Question 24

Opioid Receptors

Answer 24

Mu Receptors
Kappa Recepotrs
Delta Receptors

Question 25

Mu Receptors

Answer 25

Analgesia Respiratory Depression Euphoria Miosis Reduced GI motility

Question 26

Kappa Receptors

Answer 26

Analgesia Sedation Respiratory Depression Dysphoria Miosis

Question 27

Delta Receptors

Answer 27

Analgesia

Question 28

Neuropathic Pain Transmission

Answer 28

Damage or dysfunction of the PNS or CNS Abnormal processing of stimulus Absence of tissue damage and inflammation No useful purpose Hyper excitable nerve endings

Question 29

Inflammation

Answer 29

Nonspecific localized reaction Protective function

Question 30

Acute Inflammation

Answer 30

Less than 2 weeks Protective function Resolves after cause is removed

Question 31

Chronic Inflammation

Answer 31

Months to years Not protective Long-lasting or permanent tissue damage

Question 32

Five Cardinal Signs of Inflammation

Answer 32

Redness Warmth Swelling Pain Loss of function

Question 33

Inflammatory Response Vascular Changes

Answer 33

Immediate vasoconstriction, then vasodilation Increased vascular permeability

Question 34

Inflammatory Response Cellular Changes

Answer 34

Increased Leukocyte Chemical Mediators

Question 35

Inflammatory Mediators

Answer 35

Bradykinin Histamine Prostaglandins

Question 36

Bradykinin

Answer 36

- Vasodilation - Increased vascular permeanbility - Attract neautrophils - Associated with pain response

Question 37

Histamine

Answer 37

- Mast Cells - Vasodilation - Increased capillary permeability

Question 38

Prostaglandins

Answer 38

- Chemical mediators - Participate in inflammatory response - Cyclooxygenase (COX) enzymes -> metabolize arachidonic acid -> produce prostaglandins - Sensitize pain receptors

Question 39

COX-1 causes...

Answer 39

- Decrease gastric acid secretion - Increased mucus production - Maintenance of renal perfusion - Maintenance of renal function - Vasodilation - Bronchodilation - Regulates plateleet aggregation

Question 40

COX-2 causes...

Answer 40

- Vasodilation - Increased capillary permeability - Edema - Pain - Leukocytosis | *Inflammtion*

Question 41

Inhibiting COX-1 can cause...

Answer 41

* Gastric erosion * Gastric ulceration * Bleeding tendencies * Renal impairment * Protects against MI and stroke

Question 42

Inhibiting COX-2 can cause...

Answer 42

* Renal impairment * Promotion of MI and stroke by suppressing vasodilation

Question 43

Systemic Effects of Inflammation

Answer 43

Fever, leukocytosis, malaise, anorexia, sepsis