Flashcards in Pain Management Deck (83)
What are the two main categories of chronic pain?
neuropathic and nociceptive
What is neuropathic pain?
pain arising from abnormal neural activity secondary to disease, injury, or dysfunction of the nervous system (described as burning or tingling)
What are the types of nociceptive pain?
musculoskeletal, inflammatory, mechanical/compressive
What is hyerpalgesia?
increased response to a stimulus that is normally painful
What is hypoalgesia?
diminished response to a normally painful stimulus
What is analgesia?
absence of pain in response to a stimulus that is normally painful
What is hyperesthesia?
increased sensitivity to stimulation, especially the skin (excluding the special senses - senses that have specialized organs devoted to them: vision [the eye] hearing and balance [the ear, which includes the auditory system and vestibular system] smell [the nose] taste [the tongue])
What is hypesthesia?
diminished sensitivity to stimulation, excluding the special senses
What is dysesthesia?
act of touching a part of the body causes some unpleasant sensation, such as pain, burning, or tingling - may be spontaneous or evoked
What is paresthesia?
an abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves - may be spontaneous or evoked
What is allodynia?
pain resulting from a stimulus (such as a light touch) that does not normally elicit pain
What is nerve convergence?
convergence of sensory nerves from the viscera and superficial areas onto the same neurons in the spinal cord
What is the spinothalamic pathway?
major route by which pain and temperature information ascend to the cerebral cortex
What are nociceptors?
highly specialized sub-set of primary sensory neurons preferentially sensitive to a noxious stimulus or to a stimulus that would become noxious if prolonged - categorized by the kind of stimulation they respond to and the nature of their response
What are myelinated nociceptors?
relatively fast-conducting A-delta fibers that are responsible for the first (immediate) sharp pain associated with a noxious stimulus
What is the pathway of the pain response from an external stimulus?
nociceptors on the skin pass signals through the sympathetic ganglion of the ANS - the signal then passes through the dorsal root ganglion of the spinal cord and then along to the brain, which perceives the pain in the somatosensory cerebral cortex
What is transduction?
conversion of a noxious stimulus into electrical activity in the peripheral terminals of nociceptor sensory fibers
What is transmission?
passage of action potentials from the peripheral terminal along axons to the central terminal of nociceptors in the CNS
What is conduction?
the synaptic transfer of input from one neuron to another
What is modulation?
alteration (i.e., augmentation or suppression) of sensory input
What is perception?
the decoding/interpretation of afferent input in the brain that gives rise to the indiviudal's specific sensory expeirence (i.e., realization that something is painful)
What is the International Association for the Study of Pain's Pain Taxonomy?
Axis I: anatomic regions; Axis II: organ systems; Axis III: temporal characteristics/patterns of occurrence; Axis IV: intensity/time since onset of pain; Axis V: etiology
What are the six major categories of treatment options for chronic pain?
(1) pharmacologic, (2) physical medicine, (3) behavioral medicine, (4) neuromodulation, (5) interventional (neural blockade, spinal cord stimulation), (6) surgical
What is included in Step 1 for management of chronic (mild) pain?
aspirin, acetaminophen (analgesic, *not* anti-inflammatory), NSAIDs, COX-2 inhibitors, adjuvants
What is included in Step 2 for management of chronic (moderate) pain?
acetaminophen or aspirin, codeine, hydrocodone, oxycodone, dihydrocodeine, tramadol, adjuvants
What is included in Step 3 for management of chronic (severe) pain?
morphine, hydromorphone, methadone, levorphanol, fentanyl, oxycodone, nonopioid analgesics, adjuvants
What is adaptive pain?
contributes to survival by protecting the organism from injury and/or promoting healing after injury
What is maladaptive pain?
represents pathologic functioning of the nervous system
What are the two components of the nervous system?
CNS and peripheral nervous system