Pain and its management

Question 1

Nociception is

Answer 1

the neural processes of encoding noxious stimuli.

Nociception is the physiologic process that underlines the conscious perception of pain.

Question 2

Nociception does not require

Answer 2

consciousness and can continue unabated during general anesthesia if techniques that interrupt or inhibit the transduction, transmission, and modulation of nociceptive stimuli are not included.

Question 3

Nociceptor is a

Answer 3

sensory receptor that generate action potential (nerve impulse) and sends signals that cause the perception of pain in response to potentially damaging stimulus.

Question 4

Nociceptive impulses are transmitted via what types of fibers?

Answer 4

A delta and
C fibers

Question 5

Describe A delta nociceptive fibers

Answer 5

(small myelinated fibers)
Fast, sharp pain

Question 6

Describe C nociceptive fibers

Answer 6

(smallest unmyelinated fibers)
Slow dull pain

Question 7

Excitatory transmitters that propagate the pain impulse are called what ?

Answer 7

prostaglandins

Question 8

Inhibitory transmitters that reduce painful stimuli are called? (4)

Answer 8

endorphins, epinephrine, norepinephrine, GABA

Question 9

Hyperalgesia is

Answer 9

increased sensitivity to pain, which may be
caused by damage to nociceptors or peripheral nerves or lack of inhibitory transmitters.

Question 10

Primary hyperalgesia describes pain sensitivity that occurs

Answer 10

directly in the damaged tissues.

Question 11

Secondary hyperalgesia describes pain sensitivity that occurs

Answer 11

in surrounding undamaged tissues.

Question 12

Allodynia means

Answer 12

pain due to a stimulus that does not usually
provoke pain.

E.g.
- Tactile allodynia - pain caused by touch
- Mechanical allodynia - caused by movement across the skin
- Thermal (temperature-related) allodynia - caused by heat or cold that is not extreme
enough to cause damage to your tissues
- Movement allodynia – pain triggered by normal movement of joints or muscles

Question 13

Describe Superficial somatic pain

Answer 13

¡ Skin, subcutaneous tissue
¡ Well localized, sharp, burning
¡ Burns, wounds, contusions

Question 14

Describe deep somatic pain

Answer 14

¡ Muscles, joints, bones, fascia
¡ Localized or diffuse
¡ Dull, spastic
¡ Arthritis, tendonitis etc.

Question 15

Visceral pain is pain that results from

Answer 15

the activation of nociceptors of the thoracic, pelvic, or abdominal organs (viscera)

Nociceptive fibers together with autonomic
nervous system.

Etiology:
¡ Distension (stretch)
¡ Ischemia
¡ Inflammation
¡ Not so sensitive to cutting or burning

Visceral pain is diffuse, difficult to localize.

Question 16

Neuropathic pain is pain that develops following

Answer 16

injury to peripheral nerves and central nervous system (spinal cord, brainstem, brain).

Accompanied by hyperalgesia and allodynia to both inflammatory and normally non-painful stimuli.

Spontaneous action potentials

e.g. Postamputation pain

Question 17

Consequences of pain of the Cardiovascular system:

Answer 17

¡ Tachycardia
¡ Hypertension
¡ Increased myocardial oxygen requirements
¡ Cardiac arrhythmias
¡ Coagulation

Question 18

Consequences of pain on the
Respiratory system

Answer 18

¡ Hyperventilation
¡ Atelectasis
¡ Pulmonary edema

Question 19

Consequences of pain on the
Central Nervous System

Answer 19

¡ Affected behavior
¡ Depression
¡ Aggression
¡ Dilated pupils
¡ Sleep disturbances

Question 20

Consequences of pain on the
Gastrointestinal system

Answer 20

¡ Delayed gastric emptying
¡ Ileus
¡ Nausea
¡ Vomiting
¡ Loss of appetite

Question 21

Consequences of pain on the
Urinary system

Answer 21

¡ Oliguria
¡ Urinary retention