What are the 4 stages of pain processing?
Transduction
Transmission
Perception
Modulation
Describe the pain receptors. How are they activated?
A sensory neuron known as nociceptors that transduce noxious stimuli into action pot.
How do NSAIDs decrease pain?
By blocking cyclooxygenase that causes pain feeling.
Describe the primary sensory fiber? What types of pain does each type transmit?
�A?: large, myelinated fibers that transmits sharp, stinging and localized pain
�C: small, unmyelinated that transmit dull, aching and poorly localized pain.
Where is the substantia gelationosa? What is the function of this area?
Located in the posterior horn of the grey matter and its functions is to enhance or block pain.
What is the spinothalamic tract? What are the two divisions?
Aka: anterolateral tract, afferent fibers entering the spinal cord.
�Neospinothalamic tract carries A? fiber input, projects to thalamus and sensory cortex.
�Paleospinothalamic tract: carries c fiber input, projects diffusely to the reticular formation, m
What are the neurotransmitters of the spinal cord that are involved in pain neurotransmission?
�Opioids such as endorphins and morphine are mediator of presunaptic inhibition.
�Raphe magnus receives input from the periaqueductal gray (PAG), which high concentration of endogenous opiods, rostral pons that secrete norepinephrine.
Where is sensory information interpreted? How can we tell where the pain signal arise?
Sensory information interpreted in the brain and the pain signals arise from the surface of your skin.
What factors affect pain perception?
�Opiods work at specific receptors sites mostly concentrated in the brain.
�Opioids analgesics have similar mechanisms of action but very widely in potency.
Where in the nervous system can pain be altered?
In the brain
What is the gate theory of pain control? How does this work?
Pain signals can be block in the spinal cord and won't be able to process in the brain. Stimulation of large touch neurons could inhibit the transmission of nociceptor impulse.
Which opioid receptors provide analgesia? Which provide sedation?
Mu(?) and kappa(?) receptors provide analgesia and sedation.
What is pathologic pain? Define hyperalgesia and allodynia.
�Occurs after tissue injury, but long-term change occur in PNS and CNS.
�Hyperalgesia is when pain is enhance and allodynia is non-noxious stimuli may cause pain.
How is pain classified?
Duration (acute/chronic), source (cancer/neuropathic, ischemic), location, and referral pattern
What are the clinical manifestations of acute pain? What short-term therapy is indicated?
�Increased heart rate,
�Respiration
�Blood pressure
�Dilated pupils
�Perspiration
�Pallor
�Increased circulating blood glucose
�Decreased gastrointestinal motility
�Hypomotility of the bladder
How is headache classified?
migraine, tension, cluster, and sinus
�What is thought to cause migraine headache? Result from dysfunction of the brainstem areas involved with modulation of craniovascular afferent fibers
�What drugs can be used to treat migraine? Identifying and avoidin
How does chronic pain differ from acute pain? How does the treatment differ?
Acute pain is result from tissue injury and resolves when the injury is heals and chronic may be associated with a disease process. Chronic treatment by pain clinic with multimodal therapies and acute pain is short-term therapy with nonopioid and opioid m
With respect to the nervous system, what is proposed to explain fibromyalgia syndrome pain? What is pregabalin? (lyrica)
Etiology unknown, but many risk factors have been identified (trauma, sexual abuse, stress. Pregabalin used to target pain pathways
What are some causes of cancer-related pain?
�Associated with cancer disease process
�May result from infiltration of organs, compression of structures by an expanding tumor, or as a result of cancer treatments
What underlines neuropathic again? Describe this pain? How does the affected area manifest this type of pain?
�Results from tissue injury in which the nerves themselves become damaged or dysfunctional
�Constant aching sensations with intermittent sharp, shooting, burning, or shock-like pain
�May result from altered central processing of nociceptive input
What is thought to cause trigeminal neuralgia? What are the clinical manifestation of this pain?
Sudden, momentary, but excruciating pains along the second and third divisions of the trigeminal nerve.Clinical manifestations: sharp or shooting; like an electrical shock; may be pain free between episodes or complain of a dull ache in area
What is the cause of diabetic neuropathy? What are the clinical manifestations?
�Caused by damage to the large peripheral nerves by inflammation and demyelination
�Excess of smaller myelinated fibers causes loss of inhibitory input from the spinal cord with unopposed nociceptive afferent bombardment
�Clinical manifestations: burning
Describe post-herpetic neuralgia? What are the clinical manifestations of this pain?
�Reactivation of the latent virus (herpes) that has lain dormant along the nerve roots
�Herpes zoster is characterized by a burning pain that follows a dermatomal pathway and is accompanied by a blistering rash
�Persistent pain that lasts for more than 8
What causes ischemic pain? What is intermittent claudication?
�Results from sudden or profound loss of blood flow to the tissues
�Described as aching, burning, or tingling
�Management aimed at improving blood flow and reducing tissue hypoxia; removing clot if needed
�Chronic ischemic pain associated with atheroscler
Describe referred pain. Give an example. How is this pain explained?
�Perceived in an area other than the site of injury
-Examples include pain of myocardial infarction being felt in the jaw or left arm; shoulder pain after pelvic procedures; diaphragmatic irritation from peritonitis
�Pain generally referred to other struc
Describe the physiologic responses to pain.
�Sympathetic nervous system activation during acute pain can lead to:
-Increased heart rate, respirations, blood pressure
-Dilated pupils
-Perspiration
-Pallor
-Increased circulating blood glucose
-Decreased gastrointestinal motility
-Hypomotility of the
What are some considerations when the young and the elderly experience pain?
�Young and old often receive inadequate pain management
�Infants have pain perception
�Inadequate pain treatment in neonates and infants can result in persistent behavioral changes and physical changes in the CNS
�Pain perception does not decrease with ag
Describe pain treatment modalities.
�Pain management interventions can be directed at three points:
-Interrupting peripheral transmission of nociception
-Modulating pain transmission at the spinal cord level
-Altering the perception and integration of nociceptive impulses in the brain
How do we interrupt peripheral transmission of pain?
�Often the first step in controlling pain
�Splinting helps reduce tissue injury
�Application of heat or cold alters blood flow and reduces swelling
�NSAIDs decrease prostaglandins thereby interrupting peripheral transmission; many significant side effects
How do we modulate pain transmission at the spinal cord?
�Cutaneous stimulation activates large sensory fibers that can block the central progression of nociceptive transmission at the interneurons
-Transcutaneous electrical nerve stimulation (TENS)
-Massage
-Acupuncture
-Heat/Cold
-Therapeutic touch
-Epidural
How do we alter the perception and integration of pain?
�Opioids work at specific receptor sites located throughout the body but are highly concentrated in the brain
�Opioid analgesics have similar mechanisms of action but very widely in potency
-Side effects: nausea, vomiting, respiratory depression, constipa