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Flashcards in Pain Modulation Deck (110):
1

What is pain

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

2

What are the dualities of pain

Physiological experience and psychological experience

3

What are the goals of pain treatment (3)

1. Resolve the underlying pathology causing pain
2. Modify the patient's perception of pain
3. Allow the patient to maximize their functional abilities

4

What are the categories of pain (4)

1. Nociceptive
2. Neuropathic
3. Psychogenic
4. Carcinogenic

5

What is the function of pain (3)

1. Warning for withdrawal
2. Alerts that something is wrong
3. Protective function

6

What are the 2 types of nociceptive pain

1. Somatic
2. Visceral

7

What is somatic pain

Activation of nociceptors found in most body tissue

8

What is visceral pain

Activation of nociceptors found in viscera

9

Is visceral pain referred or localized

Referred

10

Is all of the viscera sensitive to pain

Nope

11

What are the types of neuropathic pain (2)

1. Peripheral
2. Central

12

What is psychogenic pain

Pain that originates from nonorganic sources and is associated with emotional, cognitive, and behavioral responses

13

What are the 4 types of pain

1. Acute
2. Chronic
3. Referred
4. Radicular

14

What is carcinogenic pain

Pain caused by cancerous pathology that is severe

15

What is acute pain

Combination of unpleasant sensory, perceptual, and emotional experiences that occur in response to noxious stimulus

16

Characteristics of acute pain (3)

1. Time limited
2. Persists as long as noxious stimulus persists
3. Serve a protective function

17

What is treatment of acute pain from musculoskeletal injury aimed to (3)

1. Facilitate resolution of underlying problem
2. Reduce inflammation
3. Modify the transmission of pain from periphery to CNS

18

What is chronic pain

Continuous long term pain of more the 12 weeks after healing would have occurred

19

What causes chronic pain (2)

1. Changes in sympathetic NS, adrenal activity, reduced production of endogenous opioids, or sensitization of primary afferents
2. Increased sensitivity to noxious and non-noxious stimuli`

20

What is referred pain

Pain felt at a location distant from its source

21

What is radicular pain

Pain originating from an irritated nerve root that follows a dermatomal pattern

22

What are pain receptors called

Nociceptors

23

What are the 4 types of sensors

1. Mechano
2. Thermo
3. Noci
4. Proprio

24

What are the 2 categories of peripheral sensory receptors

Superficial and deep

25

What are the types of mechanoreceptors (4)

1. Meissner's corpuscles
2. Pacinian corpuscles
3. Merkle cells
4. Ruffini endings

26

What are the 2 types of thermoreceptors

Cold and hot

27

What are the 3 types of proprioceptors

1. GTO
2. Pacinian corpuscles
3. Ruffini endings

28

What do meissner's corpuscles sense

Pressure and touch

29

What do pacinian corpuscles, merkle cells, and ruffini endings sense

Skin stretch and pressure

30

What do GTO sense

Change in muscle length and spindle tension

31

What do deep pacinian corpuscles sense

Change in joint position and vibration

32

What do ruffini endings sense

Joint end range and heat

33

Is the life of a sensor long or short

Short

34

Why is the life of a sensor short

The brain decides if we need more or less receptors to modulate sensitization of stimuli

35

True or False:
Nociceptors respond to all manners of stimuli

True

36

When does a nociceptor send a signal

When it is stimulated enough

37

What is the pain threshold

The number of receptors needed to fire

38

What are the 3 fibers in the peripheral nerve afferent fibers

1. A beta fibers
2. A delta fibers
3. C fibers

39

What is the diameter, myelination and speed of A beta fibers

Diameter: 6-12 um
Myelinated
Speed: >30 m/sec

40

What is the diameter, myelination and speed of A delta fibers

Diameter: 1-6 um
Myelinated
Speed: 30 m/sec

41

What is the diameter, myelination and speed of C fibers

Diameter: 1mm
Nonmyelinated
Speed: 1-4 m/sec

42

What info do A beta fibers transmit (2)

Touch and vibration

43

What info do A delta fibers transmit (4)

Touch, temperature, pressure, and pain

44

What info do C fibers transmit (4)

Pain, touch, pressure, and temperature

45

Where do A beta fibers originate from

Hair follicles

46

Where do A delta fibers originate from

Warm/cold receptors, hair follicles, and free nerve endings

47

True or False:
A delta fibers are blocked by opiates

False

48

What percent of afferent danger transmitting fibers are C fibers

80%

49

What are group III afferent fibers

A delta fibers

50

What are group IV afferent fibers

C fibers

51

True or False:
C fibers are the largest amount of nociceptors we have

True

52

What type of fibers are activated by mechanical trauma

A delta and C fibers

53

What is the spinothalamic tract's main function

Primary nociceptive pathway that transmits type/location of pain

54

What is the main function of the spinoreticular tract

Motivational, emotional, unpleasant aspect of pain

55

What is the main function of the spinomesencephalic tract

Sensorimotor integration of pain

56

What is the main function of the spinohypothalamic tract

Autonomic responses associated with pain

57

What are the 6 sub-cortical centers

1. Reticular formation
2. Periaqueductal gray
3. Hypothalamus
4. Pituitary
5. Thalamus
6. Limbic system

58

What is the main function of the reticular formation

Mediates motor, autonomic, and sensory functions

59

What is the main function of the periaqueductal gray

Directs descending inhibition

60

What is the main function of the hypothalamus

Controls endocrine functions and vegetative state

61

What is the main function of the Pituitary

Master gland for endocrine system

62

What is the main function of the thalamus

Final gateway and relay center

63

What is the main function of the limbic system

Involved in emotional, motivational, and affective behavior

64

What is the somatosensory cortex

Area of the brain that identifies location of pain and central processing center

65

What is the association cortex

Responsible for affect that is associated with danger signals and results in pain tolerance

66

Sensation of pain depends upon stimulation of specific nerve endings that are specialized for that sensation

Specific theory of pain

67

Sensation of pain results from appropriate intensity or frequency of stimulation of receptors that also respond to other stimuli like touch, pressure, and temperature

Pattern theory of pain

68

True or False:
In the pattern theory of pain there is CNS influence on pain perception

True

69

Desensitize peripheral receptors activated during the inflammatory process (change how receptors in the periphery are perceived)

Peripheral pain modulation

70

What facilitate nociceptor sensitivity

Bradykinin, prostaglandin E2, and serotonin

71

Nerve impulses evoked by injury are influenced in the spinal cord by other nerve cells that act like gates

Gate control theory of pain

72

Example of gate control theory

Hit funny bone and rub the area enough and it will eventually cause the pain to go away as long as you keep rubbing the spot once you stop it will come back

73

Uses feedback loops to inhibit pain transmission at dorsal horn which results in the release of endogenous opioids

Supraspinal and descending pain modulation theory

74

Separate opiate binding sites in the CNS and two peptides produced physiologic effects similar to morphine

Endogenous opioid system

75

How did they know they were opioids

They were blocked by naloxone which is an opioid antagonist

76

What are opiopeptins

They control pain by binding with specific opiate receptors in the nervous system

77

How do opiopeptins cause presynaptic inhibition

Suppress influx of calcium

78

How do opiopeptins cause postsynaptic inhibition

Activate outflow of potassium current

79

Low frequency, high intensity stimulation of the peripheral nerves used to enhance the production of endogenous endorphins in the anterior pituitary

Motor pain modulation

80

What is the end result of motor pain modulation

Stimulation of descending pain control system in dorsal horn

81

Stimulation of C fibers activates PAG region and second system activates the pons

Noxious pain modulation

82

What is the end result of the noxious pain modulation

Stimulation of descending inhibition system in dorsal horn

83

How long is pain blocked when using the noxious pain modulation

30 minutes to an hour

84

Pain is a multidimensional experience that is produced by characteristic patterns of nerve impulses that are determined by heredity

Neuromatrix theory

85

What is the neuromatrix theory dumbed down

Smile more have less pain

86

Application of medium frequency electrical current that hyperpolarizes membrane further and blocks APs

Nerve block pain modulation

87

How long does it take for adaption to begin

A few seconds

88

What is hyperalgesia

That which hurt now hurts more

89

What is allodynia

That which did not hurt now hurts

90

What is the semantic differential scales

Word lists and categories that represent various aspects of pain experiences and pt selects most appropriate words for their pain

91

What are non systemic analgesics

NSAIDs, acetaminophen, opiates, opioids, and antidepressants

92

What are the effects of NSAIDs (5)

1. Analgesic
2. Anti-inflammatory
3. Anticoagulant
4. Antipyretic
5. Anticancer

93

How do NSAIDs inhibit pain

By inhibiting the conversion or arachidonic acid to cyclooxygenase and prostglandins

94

What are 5 NSAIDs

1. Aspirin
2. Ibuprofin
3. Naproxen
4. Piroxicam
5. Celecoxib

95

What is acetaminophen

Tylenol

96

What is the big problem with acetaminophen

Liver damage

97

What are the adverse effects of opiates (8)

1. Sedation
2. Mood changes
3. Confusion
4. Respiratory depression
5. Postural hypotension
6. Constipation
7. Nausea and vomiting
8. Tolerance and dependence

98

how are spinal analgesics given

Epidural

99

What can be injected into the epidural

Opiates, local anesthetics, catabolic corticosteroids

100

What does heat do to nerve conduction

Increases it

101

What does cold do to nerve conduction

Decreases it

102

What are physical agents that stimulate large diameter afferent fibers (3)

1. TENS
2. Superficial massage
3. Analgesic balms

103

What are physical agents that decrease pain fiber transmission (4)

1. Cryotherapy
2. Ultrasound
3. Iontophoresis
4. Phonophoresis

104

What are physical agents that stimulate small diameter afferent fibers and descending pain control mechanisms (2)

1. Deep massage
2. TENS

105

What are physical agents that stimulate the release of beta-endrophins through prolonged small diamter fiber stimulation (2)

1. TENS
2. E-stim

106

How long does it take for 5 minutes of cooling for decreased nerve conduction to be reversed

15 minutes

107

How long does it take for 20 minutes of cooling for decreased nerve conduction to be reversed

30 minutes

108

What are the advantages to physical agents (5)

1. Fewer and generally less severe side effects than medications
2. Patients do not develop physical dependency
3. Do not cause sedation that would impair ability to work or drive
4. Many are able to be applied independently
5. May help remediate the underlying cause of the pain

109

What is a noxious stimulus

An actual tissue damaging potential

110

What is a non noxious stimulus

A stimulus that has limited to no potential for injury