Pain

componenets of the pain experience

1. sensory discriminative
2. motivational/affective
3. cognitive/evaluate

where does the "hurt" or emotional component occur

the limbic system

the localization of where it hurts occurs where

parietal lobe

the cognition of pain occurs where

frontal cortex, temporal region

how long does acute PAIN last

0-6 weeks or 3 months

how long does chronic PAIN last

after 3 months

localized pain example

just hurt your ankle

referred pain example

you hurt your ankle but the entire foot hurts too

nociceptive pain

pain from non-neural tissue injury within the body
-pain from nociceptors
-joint, muscle, viscera, connective tissue

neuropathic pain

pain from damage to neural tissue
-neurons/axons
-damage to the nerve itself

if you compress your median nerve in carpal tunnel, what pain would that be (nociceptive/neuropathic)

BOTH

psychogenic

implies pain from psychological factors ONLY
-no physical cause of the pain

psychologic

implies psychological aspects of pain associated with nociceptive or neurogenic pain

all pain experience will have some ______ component to it

psychologic

anxiety and depression can enhance pain _____

perception

central pain

pain that is associated with lesions of the central nervous system

examples of central pain

multiple sclerosis
parkinsons disease
traumatic brain injury
spinal cord injury
stroke

pain is carried from the ________ to the _______ where it is recognized and given meaning

periphery; CNS

nociceptor

a sensory receptor which responds to tissue-damaging stimuli or potentially tissue-damaging stimuli

where are nociceptors found

skin, bone, muscle, joint capsules, ligament, fat pads, viscera, blood vessels, meninges, peripheral nerve sheaths

where are nociceptors NOT found

articular cartilage
synovial membranes
brain
spinal cord tissue

what does the nociceptor release

Substance P

what does Substance P cause

an action potential to be transmitted back to the spinal cord

delta fibers are (myelinated/unmyelinated)

myelinated

where is the first order neuron's cell body located

dorsal root ganglion

second order neurons

wide dynamic range or nociceptive specific afferent fibers

where do second order neurons carry the information

from the dorsal horn of the spinal cord to the thalamus

where does the third order neuron carry the information

from the thalamus to the cortex

what are the two types of 2nd order neurons

nociceptor specific
wide dynamic range

what would create a muscle contraction or spasm

second order neurons synapse with anterior horn cell neurons

deep tendon reflexes happen because of

the second order neurons

3 sources of pain

cutaneous structures
deep somatic structures
visceral structures (organs)

referred pain

pain experienced at a site other than the anatomic site of injured tissue

referred pain is an error in

perception by the brain

will referred pain give sensory loss?

no

radicular pain

a form of neuropathic referred pain

what is radicular pain

pain felt in a dermatome, or myotome due to direct involvement of a spinal nerve or nerve root

radiculitis

implies pain and paresthesia due to irritation of the nerve at the root level

radiculopathy

implies pain, paresthesia, and MOTOR loss due to a nerve compression at the root level

itis

irritation

radiculitis will have (sensory/motor) changes

sensory

radiculopathy will have (sensory/motor) loss

motor

cutaneous pain

pain source located in the skin or subcutaneous tissue

does cutaneous pain tend to be well localized?

yes

what is an example of a cutaneous pain

paper cut, you normally feel it right where it happened

deep somatic pain

pain source located in the bone, nerve, muscle, tendon, ligaments or arteries

is deep somatic pain well localized?

no

deep somatic pain is related to

sclerotomes or myotomes

visceral pain

pain source located in the internal organs

is visceral pain well localized

no

heart, bronchi and lung visceral pain will refer where

under sternum, base of neck, over shoulders, over pectorals and down one or both arms

esophagus visceral pain will refer where

pharynx, lower neck, arms, midline chest from upper to lower sternum

gastric visceral pain will refer where

lower thoracic to upper abdomen

gallbladder visceral pain will refer where

upper abdomen, lower scapular, and thoracolumbar

pancreas visceral pain will refer to

upper lumbar or upper abdomen

kidney visceral pain will refer where

upper lumbar, occasionally anterior abdomen, lateral to umbilicus

urinary bladder visceral pain will refer

lower abdomen or low lumbar

uterus visceral pain will refer where

lower abdomen or low lumbar

segmental pain referred in a pattern consistent with

dermatome, myotome or sclerotomes

extra-segmental pain

pain which does NOT follow a segmental pattern

extra-segmental pain is seen with involvement of what

dura mater
-dura is what is experiencing the pain

how would you describe muscle trigger points

active or latent

if someone is having bone pain, how would they describe it?

deep ache

if someone is experiencing acute pain, how would they describe it

sharp

is someone is having pain from a vascular source, how would they describe it

throbbing

what are associated symptoms of pain

dizziness, numbness, headache, nausea

how would someone describe muscular pain

dull
ache
cramp

how would someone describe nerve pain

sharp
shoot
burn

how would someone describe bone pain

deep
dull
nagging

how would someone describe vascular pain

throb
diffuse

who would use the face scale for pain

children or patients with language barriers

which pain scale requires a literacy level

McGill Pain Questionnaire