1
Q
What is pain?
A
- multidimensional
- pain is subjective; unpleasant and emotional
2
Q
pain
A
unpleasant sensory and emotional experience associated with tissue damage or in regard to damage
3
Q
somatosensory system
A
awareness and info of the body’s deep and SUPERFICIAL PART
4
Q
function of somatosensory
A
relays info regarding touch, temperature, pain, and body position
-via neurons
5
Q
what makes up sensory unit?
A
- cell body of dorsal root ganglia neuron
- its peripheral branch
- central axon
6
Q
dorsal root ganglion neuron
A
neurons that carry impulses from TRUNK of body and limbs to BRAIN
7
Q
3 types of fiber
A
A, B, C
8
Q
first order (level of neurons) *****
A
detect sensation
-PERIPHERY to CNS (spinal cord)
9
Q
second order (level of neurons) *****
A
in SPINAL CORD
- transmit messages to BRAIN (thalamus)
10
Q
how does second order communicate?
A
communicates with various reflexes networks and sensory pathway and spinal cords and travels directly to BRAIN
11
Q
third order (level of neurons) *****
A
in the brain
-neurons relay msg from BRAIN to CEREBRAL CORTEX (where info gets processed and results in feeling of pain)
12
Q
sensory impulse
A
sensory impulse travels up SPINAL NERVES –> SPINAL CORD
- periphery to spinal cord
13
Q
second order neurons route
A
- coming from CNS –> thalamus –> cerebellum
- from spinal nerve root to medulla
- crosses over to THALAMUS on other side of brain
- SPINAL CORD TO THALAMUS
14
Q
what identifies sensation in the third order neurons?
A
- primary somatosensory cortex
- associatoin cortext relates sensation to memories, other sensations
15
Q
what does the thalamus do in the 3rd?
A
in thalamus relay impulses to primary sensory cortex, where info is processed –> resulting feeling of pain
16
Q
discriminative pathway
A
used for rapid transmission of sensory info such as discriminative touch
17
Q
what is the discriminative pathway used and composed of?
A
used/composed of and for RAPIDLY CONDUCTED MYELINATED FIBERS transmission
- touch and vibration
18
Q
anterolateral pathway
A
- ascending pathway, conveys pain and temp, sense of crude touch (poorly identified sense that doesnt provide enough info)
- provides transmission of sensory info such as pain, thermal sensation, crude touch and pressure that does not require discrete localization of signal source
19
Q
what is the anterolateral pathway impulse?
A
- paleospinothalmic tract
- neospinothalmic tract
20
Q
palespinothalamic tract ***
A
-affects arousal, mood, attention
21
Q
what does palespinothalamic activates ?
A
activates reticular –> activating system (control sleep/wake cycle)
22
Q
speed of paleospinothalamic
A
SLOWER
- transmitted thru MOSTLY TYPE C FIBERS
- dull, aching, sensation
23
Q
what type of pain is associated with paleospinothalamic tract?
A
- associated chronic pain and visceral pain (TYPE C FIBERS)
- unmyelinated
24
Q
neospinothalamic tract
A
- allows localization, IDENTIFICATION OF PAIN
- mainly TYPE A –> faster conducting fibers
25
type A fibers
acute pain
| - allows us to LOCALIZE AND IDENTIFY PAIN
26
Speed of neospinothalamic tract
RAPID transmission to thalamus
27
What level of neuron carries sensory impulses to the brain?
a. ) first order
b. ) second order
c. ) third order
d. ) association
b.) second order
28
The paleospinothalamic tract allows you to identify the location of your pain. T or F
FALSE. Its the neospinothalamic
29
acute pain
result from injury, surgery, or invasive medical procedures
- could be sign or symptoms of infection
- injuries, surgeries, or invasive surgeries
30
chronic pain
can be symptomatic and associated with other health problems
| -Ex: someone with cancer, back pain
31
specificity theory
special pain receptors detects pain (nociceptors)
32
what are specificity theory evoked by?
evoked by activities specific receptors that transmit info by special nerve ending who are in pain center
- “Specific pain receptors transmit pain signals to the brain that produces our perception of pain”
33
pattern theory
sensory receptors create pain signals when stimuli are too strong
- sends signal to brain only when stimuli come together to produce specific pattern
34
gate control theory (function)
pain is carried by distinct fibers in spinal cord
35
gate control theory
-neurogating mechanism at segmented spinal cord level accounts for interaction btw pain and sensory modality
36
how is pain from gate control theory resulted?
pain result from opening of spinogate from spinal cord in response to excess of nociceptors (stuffs hat helps us detect pain) must pass before reaching to brain
- if gate closed, this stops firing of transmission and doesnt send pain signal to brain
37
neuromatrix theory
the brain identifies pain
- brain contains widely distributed neural networks with multiple sensory and limbics, and thalamocortical
- used mostly for people with limbic and chronic pain
38
2 loops btw thalamus and cortext...
creates sensation even when pain not there
39
what do people get treatment for?
chronic and acute
40
what does the brain contain?
widely distributed neural networks with multiple sensory and limbics
41
A-delta fibers
| carries pain impulse
- large, myelinated fibers
- impulses travel quickly ; "fast pain"
- release glutamate at the synapse with spinal neurons (paper cut)
42
c fibers (carries pain impulse)
- small, non-myelinated
- impulse slower; "slow pain"
- transmit pain signal to nervous system
- associated with chronic pain
43
what does c fibers release?
release glutamate and substance P (a polypeptide that is widely distributed in your brain, spinal cord, and peripheral area)
44
nociceptive pain
- "pain sense"
| - initiated by nociceptors that are activated by harm to peripheral tissue
45
neuropathic pain
direct injury or dysfuncional of the sensory axons of peripheral or central nerves
46
pain threshold ***
- when stimulus becomes pain
| - associated with painful stimuli point is perceived as pain
47
pain tolerance ****
- how much pain is someone willing to endure before doing something (total pain)
- max intensity or duration that a person is willing to endure before seeking treatment
48
cutaneous pain
skin and subq tissue
| -sharp, burn, really quick or slow
49
deep somatic pain
- originating from body surface that are deep
- muscle, joint, tendons, sprain ankle
- can have radiation pain --> can move to other area
50
visceral pain
- origin in visceral area
| - most common pain produced by DISEASE
51
What is the difference btw visceral and somatic pain?
its the damage tha causes pain
- Ex: surgeon can cut bowel into 2 and pt is awake and may not cause significant pain
- Ex: Whereas someone having strong contraction or lack of blood flow (ischemia) can induce pain
52
referred pain
-the site that is different from point of origin
-where pain originated
Ex: someone with MI can have pain in the shoulder or arm
-result bc of nerves are from same area
53
what is acute pain associated with?
-increase level of high anxieties
54
how should acute pain be managed?
aggressively
| -give preemptive and multimodal therapy
55
how should chronic pain be managed?
- by multidisciplinary team
- highly variable
- nociceptors are persistently stimulated
56
hyperpathia
continued stimulation causes pain
| -exaggerated and sensitive (sensitive to heat, cold, and touch)
57
paresthesias
spontaneous, unpleasant sensations
- tingling, burning, pin and needles feeling
- no cause
58
dysesthesia
distortions of somesthetic sensation
| -inability of touch, diabetic pt cant feel their feet
59
most common area of dyesthesia
skin, scalp, mouth
60
hypalgesia
reduced pain sensation
| aka hypoalgesia
61
analgesia
ABSENCE of pain
| -Ex: when give analgestic, goal is to eliminate pain
62
allyodnia
pain after non-noxious stimulus
- non painful
- stabbing, burning, shooting pain
- ex: neuropathy or someone that has fibromalgia
63
Your patient has been given morphine following minor surgery. What effect will the morphine have?
a. ) paresthesia
b. ) dysesthesia
c. ) analgesia
d. ) all of the above
c. ) analgesia
| - morphine is an opiod that causes the suppression
64
causes of pain
- pressure on the nerve (someone that has a tumor or mass)
- physical injury to neuron
- chemical injury to neuron
- ischemia (no O2)
- inflammation
65
trigeminal neuralgia (tic doulourex)
- neuropathic syndrome
- characterized by brief repetitive attacks or throbbing pain
- usually caused by stimulation of some area or cutaneous regions that supplies nerves (can be cause by diabetes)
66
what is postherpetic neuralgia caused by?
-caused by HERPES ZOSTERS (think of shingles
67
postherpetic neuralgia
- neuropathic pain syndrome
- characterized by constant pain (throbbing, aching)
- interfere with ADLs (including sleeping --> chronic fatigue)
68
how is postherpetic treated?
with antivirals
| - use 5% litakin gel on actual area where they have shingles
69
phantom limb pain
- neurologic pain followed by amuptation
- tingling, shooting, may disappear spontaneously or chronic
- nerve endings regenerate become trap in scar tissues
70
where may phantom limb pain arise?
brain
- complete nerve block to stop pain
- tens unit, hypnosis, relaxation to distract it
71
when does pain begin for children?
neonatal period
72
when can you get accurate report for pain from kids?
3 yrs at age
73
what scale of pain to use for kids?
wong scale
74
flacc
Face, legs, activity, crying, considerable
75
pain older adults
- pain increases in older adult
- unrelieved pain can lead to immobility or falls
- decrease flow of blood or organs
76
issues with older adult regarding pain
- impaired appetite, sleep disturbance, and cognitive dysfunction
- if pt lucid, pain is easier to assess
- drug metabolism different in older adults and should be taken into account when prescribing pharmacologic
77
assessment -pain management
- pain is subjective and cant be measured obj
- WANT TO ELIMINATE CAUSE RATHER THAN TREAT SYMPTOMS
- take careful history
- include coldspa
- use numeric pain scale to measure intensity of pain
78
intervention (non-pharmacological) - pain management
- cognitive behavioral interventions
- phsyical agents
- electroanalgesia
- acupuncture
79
intervention (pharmacological) - pain management
- combination of narcotic and nonnarcotic analgesias as well as adjuvant (other drugs) medications
- if used only when in pain, addictions are rare
- long term use may cause a need for increase dosage
80
interventions with analgestics
- analgestics help eliminate pain without causing unconsciousness, but do not cure underlying cause
- helps make pain tolerable
81
non narcotic analgestics
- aspirin and other NSAIDS
| - antipyretic and anti-inflammation
82
what does aspirin and other NSAIDS inhibits?
inhibition of COX-enzymes
- these enzymes mediate BIOSYNTHESIS PROSTAGLANDIN (inflammatory response -aspirin and nsaids)
- act peripherally and block transmission of pain impulse
83
acetaminophen
equal to aspirin and other NSAIDS but not anti-inflammatory response
84
opiod analgestic
- group of medication with morphine like action (natural or synthetic)
- morphine and codeine
- acute and chronic
- helps to give ROUTINELY BEFORE pain is severe (always check respiratory status before giving)
Pathophysiology
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