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pain pathway
patho
| Question | Answer |
|---|---|
| List three factors regarding pain | 1. complex 2. multidemensional 3. personal |
| Pain is influenced by what three factors | 1. genetic 2. psychosocial 3. cultural factors |
| What is the major reason people seek healthcare? | pain |
| Poena means what? | latin word that means punishment (pain derived from the word Poena |
| Pain was thought to be a ________ from the Gods. | punishment |
| Merskey definition of pain is | an unpleasant sensor and emotional experience associated with actual or potential tissue damage or described in terms of such damageq |
| Merskey's definition of pain is used by __________. | scientists |
| McCaffery definition of pain is | "Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does" |
| the state of severe distress associated with events that threaten the intactness of the person. | suffering |
| True or False Suffering can occur without pain | true |
| Research shows that nurses often __________ pain. | under-treat |
| It is estimated that only _____ percent of cancer patients receive adequate pain relief | 30% |
| What is often a problem among institutionalized elderly with regards to pain | chronic, inadequately treated pain is often a problem with institutionalized elderly |
| There are ________ consequences of untreated pain. | pysiological |
| True or False Rate of recovery is lengthened by uncontrolled pain. | TRUE |
| True or False Postoperative morbidity increases with uncontrolled pain | true |
| True or False Health care costs increase with uncontrolled pain | true |
| Unrelieved and inadequate management of pain costs an estimated _________ each year as a result of longer hospital stays, re-hospitalization, visits to outpatient clinics & emergency rooms | 100 billion |
| Lost workdays because of pain add up to over ________ per year | 50 million dollars |
| What is the leading cause of disability in Americans under 45 years of age | back pain |
| Unnecessary suffering leads to increased _____ which increases pain. | anxiety |
| uncontrolled pain can lead to _______ dysfunction | psychosocial |
| List some physiological things that can occur with uncontrolled pain. | 1. immunosuppression 2. sleep disturbances 3. increased heart rate & cardiac workload 4.increased muscular contraction & spasm 5. decreased GI motility & transit 6. Increased catabolism (hormone response) 7. Altered respiratory function |
| What specific respiratory functions are affected with uncontrolled pain | 1. decreased tidal volume 2. atelectasis 3. hypoxemia 4. sputum retention |
| American Pain Society encourages pain to be the _______ vital sign. | 5th |
| Joint commission's focus is to add pain as the | 5th vital sign |
| What are the components of nursing role regarding pain | 1. assessing pain & communicating info with health team 2. ensuring the initiation of adequate pain relief measures 3. evaluating effectiveness of these interventions |
| List some reasons for under treatment of pain | 1. Lack of knowledge & skills to assess & treat pain 2. Lack of access to practical treatment protocols 3. inaccurate info re: addiction, tolerance, respiratory depression & other side effects of opioids |
| List some more reasons for under treatment of pain | 4. fear that aggressive pain management may hasten death 5. fears of addiction & side effects 6. belief that pain is inevitable U& result of worsening disease 7. fatalism 8. desire to be "good" patient, does not complain (common in older adults) |
| What are the 5 dimensions (components) of pain and the pain process | 1. physiologic 2. sensory 3. affective 4. behavioral 5. cognitive |
| The sensory dimension of pain includes what? | PAIN P = pattern A=area I=intensity N=nature of pain |
| the affective dimension of pain and the pain process involves what | emotional response to the pain experience (anger, fear, depression, or anxiety) |
| what is the behavior dimension of pain | observable actions used to express or control pain |
| What are the cognitive aspects of the pain process | beliefs, memories, and meaning attributed to pain |
| List the 4 components of pain physiology | 1. transduction 2. transmission 3. perceptions 4. modulation |
| What is tranduction? | process by which noxious stimuli leads to electrical activity in the endings of the primary afferent fibers |
| Transduction takes one type of info and _____ it into something else | turns |
| Impulses sent from primary afferent nerves to the spinal cord, projection neurons then carry the message to the thalamus and from there the message is carried to the somatosensory cortex (parietal lobe) | Transmission |
| the somatosensory cortex is in what lobe | pariental |
| translation of neural responses into sensation (within somatosensory cortex) | perception |
| True or False there is no single, precise location where pain perception occurs. | TRUE |
| Perception involves several brain structures. What are they? | reticular activating system, somatosensory system, limbic system, cortex |
| What is the reticular activating system's role in pain perception? | responsible for the autonomic response of warning person to attend to pain stimulus |
| Somatosensory system is responsible for what with regards to pain perception? | responsible for localization and characterization of pain |
| What is the limbic system's role in pain perception? | responsible for emotional and behavior responses to pain |
| cortex is cruicial to constructing the ________ of pain. | meaning |
| Lack of behavioral response to pain does _____ indicate the person lacks pain perception. | not |
| control of pain transmission which involves activation of descending pathways that exert inhibitory effects on the transmission pain. | modulation |
| Descending modulator fibers release chemicals such as (name 4) that can inbibit pain transmission. | serotonin, norepinephrine, GABA, endogenous opioids |
| Process by which noxious stimuli leads to electrical activity in the endings of the primary afferent fibers | transduction |
| What is the first step of the pain process that occurs at the level of the peripheral nerves | transduction |
| Transduction involves a conversion of a mechanical (pressure), thermal(heat) or chemical stimulus into a _________ ________ _________ causing the peripheral sensory nerve fiber to become activated. | neuronal action potential |
| receptors that will carry information toward the spinal cord are called | (PAN) primary afferent nociceptor |
| When tissue is damaged, chemicals are released into the area around the PAN that activate the PAN to send signal to spinal cord. List them | bradykinin, serotonin, histamine, potassium, norepinephrine |
| Some chemicals released when tissue is damaged that sensitize the Peripheral afferent nociceptor (PAN) to send signal to spinal cord include: | leukotrienes, prostaglandins and substance P |
| free nerve endings in the periphery that transduce noxious stimuli into neuronal action potentials | nociceptors |
| means to translate one physical quantity to another (pressure or temperature into electrical signal) | transduce |
| Transduction is activated by what chemicals | potassium, H+, lactate, serotonin, bradykinins, histamine, substance P and prostaglandins (PE2) |
| How are prostaglandins formed? | when cells are damaged and an enzyme, phospholipase A, breaks down phospholipids in the cell membrane and converts them to arachidonic acid ....>cyclooxygenase....> prostaglandins |
| Where are the nociceptors located? | skin, muscle, connective tissue, the circulatory system and abdominal, pelvic and thoracic viscera |
| when the PAN is activated and fires an action potential, the PAN itself releases what chemical into the tissue | substance P |
| where is substance P stored? | in the distal terminals of the PAN (Primary afferent nociceptor) |
| What happens to the PAN when it releases substance P? | it sensitizes the PAN, dilates nearby blood vessels which leads to edema, and causes release of histamine from mast cells. |
| Are there nociceptors in the lungs? | NO that is why you can have a lung tumor and not no it. |
| Activation of the __________, specifically the sympathetic nervous system, contributes to PAN transduction through release of norepinephrine & synthesis of prostaglandins. | autonomic nervous system |
| Why can emotions like fear and anxiousness mediated by the sympathetic nervous system increase pain? | norepinephrine released by sympathetic nervous system activates a PAN on contact, if the PAN has been injured. |
| List all the chemical mediators in transduction | 1. potassium 2. prostaglandin (E2) 3. bradykinin 4. histamine 5. serotonin 6. leukotrienes 7. substance P |
| What is an action potential? | an influx of sodium, efflux of potassium, change in charge along the cellular membrane of the neuron |
| Depolarization starts at the ___________. | nociceptors |
| pain treatment at transduction step include? | 1. inhibition of prostaglandins (NSAIDS) 2. cell membrane stabilizers-anticonvulsants/ anesthetics 3. nerve blocks 4. local anesthetics |
| impulses sent from primary afferent nerves to spinal cord | transmission |
| Impulses sent from primary afferent nerves to the spinal cord, projection neurons then carry the message to the thalamus, and from there is carried to somatosensory cortex. | transmission |
| Can a nerve cell be long? | yes, e.g. is an afferent fiber in great toe travels from the toe through the fifth lumbar nerve root into the spinal cord; it is one cell |
| Once generated, an action potential will travel all the way to the spinal cord unless what? | it is blocked by a sodium channel inhibitor or disrupted by a lesion |
| Stimulated nociceptors transmit impulses to the central nervous by means of specialized ________ _________. | sensory fibers |
| stimulated nociceptors transmit impulses to central nervous system by means of what two types of fibers? | A-delta fibers and C fibers |
| Lidocaine does what to stop pain? | blocks Na+ channels |
| Nerve block is what type of medicine | some type of ______caine |
| List two types of peripheral nerve fibers | 1. fibers that transmit pain 2. fibers that transmit non-painful signals |
| What fibers transmit pain? | A-delta fibers and C fibers |
| What fibers transmit non-painful signals? | A-alpha fibers, A-beta fibers |
| Describe A-alpha fibers | 1. transmit vibration & pressure from muscle signals 2. large 3. myelinated 4. rapid conduction |
| Describe A-beta fibers | 1. transmit soft touch (sensory-skin) signals 2. large 3. myelinated 4. rapid conduction |
| Describe A-delta fibers | 1. transmit pain 2. small 3. myelinated 4. medium/rapid speed conduction |
| Describe C fibers | 1. transmit pain 2. smallest 3. not myelinated 4. slow conduction |
| Delta fibers transmit what type of pain? | sharp stinging and highly localized |
| The delta fibers are transmitted by what division of the anteriolateral spinal tract to the thalamus? | neospinothalamic division |
| A-delta fibers are _______, higher level functioning fibers that use the _________ division of anteriolateral spinal tract to the thalamus | newer; neospinothalamic |
| Chronic pain would be transmitted using what types of fibers | C fibers (non-localized, slow) |
| Describe C fibers | 1. unmyelinated 2. transmits pain slowly 3. poorly localized 4. dull or aching pain that lingers 5. travels to part of brain that evokes displeasure and anxiety |
| What division of the anteriolateral tract does the c fibers travel | paleospinothalamic division |
| Sensory (afferent) pain fibers enter the spinal cord by way of the ______ _______ roots | posterior nerve (dorsal nerve root)f |
| The cell bodies of pain neurons are located where? | dorsal root ganglion |
| As the sensory nerve enters the dorsal horn __________ _________ spread up and down the spinal cord for 2-3 segments by way of the ______ of _______. | collateral branches; tract of Lissauer |
| Why are the spinal collateral connections (branches) important? | they are important for reflex postural adjustments when a painful body part is suddenly withdrawn from the painful stimulus. |
| When you touch something very hot, what is responsible for making sure you don't just fall over when you jerk your hand away quickly? | collateral connections (branches) in the tract of Lissauer |
| The tract of Lissauer which contains the collateral branches in the spinal cord provide a neural explanation for what? | referred pain |
| the C fibers and A-delta fibers dendrites extend where? | up toward the brain or downward for two to four spinal segments |
| Explain why one c fiber or one A-delta fiber can communicate with as many as nine spinal segments. | because their dendrites extend up toward the brain and down for 2-4 spinal segments |
| section in dorsal horn whereby sensory afferent neurons synapse with interneurons | laminae 1 |
| Many of the neurons that orginate in lamina 1 do what? | cross the spinal cord and connect with the anteriolateral (spinothalamic) tract. |
| Which nerve fibers synapse with neurons in lamina 1 and cross over to spinothalamic tract? | c fibers and A-delta fibers |
| Where do the A-alpha, A-beta fibers cross to opposite side of CNS? | they are ipsalateral, meaning they stay on same side as afferent neuron entry until they reach the medulla and then they cross to opposite side |
| When the spinal cord is damage (lesion) on one side what happens to touch, pressure, proprioception and pain | the side that the damage is one will be affected whereby touch, pressure, proprioception is altered on that side and pain is numbed on the opposite side |
| What is the syndrome called whereby pain and temp is not felt on opposite side of injury and touch,vibration, propriception is not felt on injured side | Brown-Sequard syndrome (an incomplete cord syndrome) |
| Fibers that carry pain and temperature cross where? | in the spinothalamic tract |
| What is the key anatomic region of the cord that is involved in pain transmission? | Laminae II and Laminae III |
| the Laminae II and Lamina III which is involved in pain transmission is also called what? | substantia gelatinosa |
| Pain signals can eithe3r be enhanced or blocked at what synapses | synapses in the laminae II and Laminae III section of the dorsal horn (substania gelatinosa) |
| pain from a visceral organ that is perceived at the body surface is called | referred pain |
| explain why referred pain may exist and what section of the spinal cord is responsible? | both somatic and visceral fibers in lamina V converge |
| the concept of referred pain must be considered when interpreting the location of pain in a patient with injury involving __________. | visceral organs |
| What two types of substances are involved in synaptic transmission in the spinal cord? | neurotransmitters and neuropeptides |
| List the substances involved in the synaptic transmission in THE SPINAL CORD. | substance P, glutamate |
| Which neurotransmitter binds with NMDA (N-methyl-D-asparatate) receptors on the postsynaptic neuron and gives the neuron a kind of snyaptic memory in the pain pathway | glutamate |
| Excessive or repeated stimulation of C fibers sensitized the cord neurons so that even mild stimulation may be perceived as painful. What is this called? | wind-up (important mechanism in development of chronic pain syndromes) |
| Chronic activation of the NMDA receptors by glutamate can cause _______ . | neural remodeling |
| what is neural remodeling? | |
| in order to avoid neural remodeling and chronic activation of NMDA receptors by glatamate it is important to prevent ______. | pain (avoid sensitization, or enhanced excitability) |
| drugs that inhibit glutamate production may stop the wind up response which controls pain before synaptic memory develops. These drugs are called? | NMDA antagonists |
| what is the most commonly used NMDA antagonist? | ketamine |
| what are bad side effects of the NMDA antagonist, ketamine? | hallucinations, disturbing dreams, dissociative anesthesia |
| what is dissociative anesthesia and what drug may cause this? | patient feels dissociated from his or her environment (Ketamine) |
| Psychological reactions from ketamine are less likely to happen to what age groups | kids under 15 and adults over 65 |
| What tracts bring info from body to brain | ascending tracts |
| what tracts bring info from brain to body | descending tracts |
| corticospinal tract is descending or ascending? | descending (cortex in posterior frontal lobe to spine) |
| What is the major pathway for pain signal transmission up the spinal cord? | anterolateral tract AKA spinothalamic tract |
| Spinothalamic tract has two divisions. What are they | paleospinothalamic and neospinothalamic |
| Spinothalamic tracts cross where and carry what to the thalamus. | cross at spinal cord segment and carry pain signals up the contra-lateral (opposite) side of the cord |
| Which spinothalamic tract has: fewer synapses in the cord, signal reaches brain quickly, goes to thalamus 1st then to somatosensory cortex, A-delta fibers are transmitted here, reaches brain quickly to provide info on pain location | neospinothalamic tract |
| Which spinothalamic tract has more synapses, reaches brain slower, projects to widespread brain areas, stirs emotional responses, C fibers travel, pain is poorly localized, lasts longer and more distressing | paleospinothalamic |
| List two parallel pathways in the spinal cord | Dorsal column-medial lemniscal pathway and anterolateral Pathway |
| which spinal cord pathway carries impulses ipsilaterally (up same side as nerve) | dorsal column-medial lemniscal pathway |
| Which spinal pathway is rapid-conduction and which is slower-conducting? | rapid - Dorsal column-medial lemniscal pathway slower- anterolateral tract (spinalthalamic tract) |
| Which pathway carries information up the ipsilateral side and crosses over in medulla | dorsal column-medial lemniscal pathway |
| which pathway carries discriminative touch, two-point discrimination, proprioception, viration sensations of muscle and joint movements | dorsal column-medial lemniscal pathway |
| Sense shape and size of an object in the absence of visual information is called? | steriognoisis |
| tracing numbers on skin is a test called? | graphesesia |
| what is the major pathway for pain signal transmission up the spinal cord to the brain for perception? | spinothalamic tract |
| Neospinothalamic and paleospinothalamic tracts carry info up the __________ side of the cord | contra-lateral (opposite) |
| ipsalateral means | same side |
| contralateral means | opposite side |
| An area of skin innervated by sensory fibers from a single spinal nerve. | dermatome |
| Each spinal nerve contains the nociceptor fibers for a particular area of the body surface called a sensory _________. | dermatome |
| How is the brain able to localize a pain sensation to a particular part of the body? | because nociceptor pathways are kept in specific anatomic order in the cord and somatosensory cortex (parietal lobe) |
| Pain that follows a dermatomal distribution is due to spinal nerve compression or trauma and is called | radiculopathy |
| do peripheral neuropathies follow a dermatome pattern? | No they do not |
| List some examples of peripheral neuropathies | diabetic neuropathy, carpal tunnel syndrome |
| List some transmission level pain treatments | 1. TENS 2. Heat therapy 3. cold therapy 4. Epidural 5. Intrathecal (spinal) 6. opiods 7. intraspinal local anesthetic agents 8. alpha-adrenergic blocking agents 9 dorsal column stimulators |
| What does TENS stand for | Transcutaneous electrical nerve stimulation |
| Where should you not place the TENS? | over pregnant uterus, broken skin, anesthetic areas, carotid sinuses or laryngeal/pharyngeal muscles or on the eyes |
| What is TENS usually used for? | reduce pain in lower back, cervical syndrome, arthritis, sciatica, tic douloureux, post-herpetic neuralgia, peripheral nerve injuries, brachial plexus injuries, phantom pain, acute postoperative pain |
| When is TENS contraindicated | people with pace maker, myocardial ischemia or arrhythmias |
| Describe heat therapy | most or dry heat, superficial or deep, PT departments provide deep-heat; short-wave diathermy, microwave diathermy & ultrasound (intermittent applications of heath for short periods of time 5 minutes for acute or 20-30 minutes for chronic pain) |
| What is ice message? | therapy combining cold therapy and massage, ice applied evenly over area of pain with slow up-and-down strokes for 10-30 minutes |
| Physical therapists sometimes use what as part of cold therapy | ethyl chloride or vaso-coolant sprays |
| How do opioid work to block pain at transmission level? | bind with opioid receptor in the posterior horn of the spinal cord, thereby decreasing release of neurotransmitters such as substance P (also works at receptors in brain to alter preception of pain by brain) |
| What do intraspinal local anesthetic agents do? | they block nerve conduction at the posterior nerve root (example: bupivacaine) |
| Give an example of an alph-adrenergic blocking agent | clonidine (usually prescribed as antihypertensive agent but also found new uses, including treatment of some types of neuropathic pain) |
| what pain blocking method while during a laminectomy implants electrodes in the dorsal aspect of the spinal cord. Used to treat large ares such as lower extremities or back (closes the pain gate by modulating descending input from brain to spinal cord) | Dorsal column stimulators |
| Perception of pain occurs where? | sensory cortex |
| the point where the person actually perceives the pain | sensory cortex |
| if the pain is stopped prior to the activation of the sensory cortex what will happen | person never perceives pain and it is stopped |
| Pain perception can be influenced by the following? | anxiety, fear, fatigue, prior experience and expectation |
| True or False Pain perception is not localized to a specific area. | true |
| what parts of the brain all participate in the perception of pain | 1. somatosensory cortex (pariental lobe), frontal lobe, limbic structures |
| The level of painful stimulation required to be perceived: similar from person to person. | Pain threshold |
| the degree of pain that one is willing to bear before seeking relief | pain tolerance (varies among individuals) |
| What may influence a person's tolerance for pain? | age, culture, family upbringing, gender, noise, bright light, interrupted sleep |
| Highly variable nature of pain expression among individuals makes accurate pain assessment _________. | difficult |
| List some commonly used pain descriptors to describe the nature of pain. | throbbing, shooting, stabbing, sharp, dull, gnawing, burning, aching, tender, heavy, tight, tiring, exhausting, sickening, terrifying, torturing, nagging, annoying, intense, unbearable |
| List some clinical methods for altering the perception of pain. | Cognitive-behavioral therapies, anticipatory guidance, distraction, imagery and hypnosis, conditioning, relaxation |
| List some cognitive-behavior methods for blocking perception of pain | relaxation, thinking about scenic view, rhythmic breathing |
| descending systems inhibit pain impulse transmission and induce alagesia | modulation |
| list three important areas in the brain that regulate endogenous opioids | PAG, Rostral pons, and Raphe magnus |
| ______ has a high amount of endorphins | PAG |
| What do endorphins do? | they cause a powerful inhibition of pain transmission to opiate receptors found in the dorsal horn |
| Stimulation of PAG releases _______ and sends nerve impulses to the ________ _______. | endorphins; raphe magnus |
| what is the neurotransmitter from the PAG to the raphe magnus | serotonin (explains why tri-cyclic antidepressants are good for pain control) |
| Neurons that go from the Rostral pons to the ralphe magnus use what neurotransmitter | norepinephrine |
| stimulation of the neurons between the rostral pons to the ralphe magnus produces what kind of effect? | analgesic effect |
| Clonidine is a drug that mimics the effect of ________ in the brain | norepinephrine (clonidine shown to have pain-relieving properties) |
| Who were the authors of the gate control theory of pain | Melzack and Wall |
| What is the gate control theory of pain? | gate mechanism located in the substantia gelantinosa of the dorsal horn. stimulate large diameter fibers and they inhibit transmission via the small (pain/temp) fibers |
| Gate theory of pain claims that impulses received by large fibers like _______ could "close the gate" on nociceptor impulses so that pain signals would be blocked | a-beta (touch sensation) |
| Explain why rubbing, pressing or shaking the painful area may reduce intensity of pain? | gate theory of pain states that activating the large myelinated A-beta (touch receptors) fibers may close gate to smaller a-delta fibers |
| List three endogenous opioid | endorphins/enkephalins/dynorphins |
| What do the three endogenous opioids do? | block substance P |
| List three sources of endorphins | 1. brain 2. pituitary gland 3. adrenal gland |
| Explain brain and stress induced analgesia | during times of stress, pain or emotion; the brain creates its own alalgesia through the secretion of endogenous opioids |
| Explain pituitary connection to endorphins | contains high concentrations of beta-endorphins and it is likely that release of pituitary stress hormones (ACTH) also causes release of beta-endorphins |
| As a sympathetic response to stress the adrenal glands produce _________ | endogenous opioids |
| List the 4 types of opioid receptors | 1. mu 2. kappa 3. signa 4. delta |
| Where are mu receptors found | found in high concentrations in the brain and modulate pain perception |
| Kappa receptors are found where? | found in brain and concentrated in the spinal cord, where they contribute to pain modulation by CNS descending pathways |
| Depending on the affinity for certain receptors, different _____ may have differeing analgesic potency and side effect profiles. | drugs |
| As a rule, opioid analgesics do not interact with _____ receptors but endogenous opioid peptides act through all four types of opioid receptors | delta |
| Opioid analgesics act primarily by activating _____ receptors and produce weak activation of _____ receptors | mu; kappa |
| Activation of mu receptors produce what 6 responses? | analgesia, respiratory depression, sedation, euphoria, physical dependence, decreased GI motility |
| activation of kappa receptors produce what 3 responses? | analgesia, sedation, decreased GI mobility |
| In pain treatment, what is multimodal therapy? | 1. NSAIDS/acetaminophen for pain with exertion/activity 2. Systemic opioid for pain at rest 3. distraction, hypnosis, relaxation 4. biofeedback may improve blood flow and endorphin levels |
| What is the analgesic ladder that was proposed by the World Health Organization? | STEP ONE: mild pain (nonopioids - nsaids, acetaminophen, aspirin & adjuvant drugs) STEP TWO: mild to moderate pain (oxycodone, codeine (can also continue with adjuvant drugs) STEP THREE: moderate or severe pain (morphine, hydromorphone, methadone) |
| what are adjuvant drugs | antidepressants/anticonvulsants |
| what is a ceiling effect and what step in analgesic ladder does this occur? | increasing the dose beyond upper limit provides no greater analgesia (step one in ladder) |
| Which step in the step ladder contains drugs that do not produce tolerance or physical dependence | step one (many available without prescription) |
| In step three in analgesic ladder you should discontinue what and may continue with what? | discontinue step 2 drugs but may continue with adjuvant drugs |
| 1-3 on a pain scale is | mild pain |
| 4-6 on pain scale is | moderate pain |
| 7-10 on pain scale is | severe pain |
| List 6 different types of pain | 1. acute pain 2. chronic pain 3. neuropathic pain 4. referred pain 5. headaches 6. phantom pain |
| what percent of people still experience phantom pain even 7 years later | 60% some even 30 years later |
| What are the sympathetic nervous system symptoms of acute pain | 1. increased heart rate 2. > respiratory rate 3. increased BP 4. diaphoresis/pallor 5. anxiety 6.confusion 7. urine retention |
| Physiological stimulus in acute pain is | activation of nociceptors |
| Acute pain tells of _____ or _______ injury | actual; impending |
| Acute pain has a _____ onset | sudden |
| periods of waxing and waning (acute or chronic pain) | chronic |
| clinical manifestations of chronic pain include? | predominately behavioral manifestations like flat affect, decreased physical movement or activity, fatigue, withdrawal from others and social interaction |
| Which type of pain would you use multimodal therapy? | chronic |
| what type of pain is caused by damage to nerve cell or changes in spinal cord processing | neuropathic pain |
| what is allodynia and what type of pain has this symptom? | pain due to a stimulus which does not normally provoke pain and can be either static or mechanical (e.g. light wind or touch) neuropathic pain |
| Allodynia is typically described how | burning, shooting, stabbing or electrical in nature (can be sudden, intense, short living or lingering) |
| Neuropathic pain includes two types, what are they? | centrally or peripherally generated |
| List 4 examples of neuropathic pain | post-herpetic neuralgia, phantom limb pain, diabetic neuropathies and trigeminal neuralgia |
| What pain is sympathetically maintained | neuropathic pain |
| Is neuropathic pain controlled well by analgesicis alone? | no they usually include tricyclic antidepressants or other adjuvant analgesics |
| List some stress hormones that are secreted during episode of acute pain | cortisol from adrenal cortex, ADH from posterior pituitary, aldosterone from adrenal gland |
| During acute pain what happens to blood sugar | increased blood sugar because liver increases release of glucose |
| What are effects on Sympathetic nervous system with chronic or prolonged pain | VS return to normal, physiologic adaptation occurs |
| Does absence of SNS activation mean absence of pain? | no, body adapts to chronic pain |
| characterized by the need for an increased opiod dose to maintain the same degree of analgesia | tolerance (can develop as early as 2 weeks) |
| Tolerance develops to some opioid effects but not to others. Which does it not develop to | constipation (continues) |
| Tolerance can develop to what opioid effects? | analgesia, euphoria, respiratory depression, and sedation |
| expected physiologic response to ongoing exposure to pharmacologic agents that can produce a withdrawal syndrome (abstinence syndrome) when exposure is abruptly stopped | dependence |
| What are symptoms of an abstinence syndrome: | yawning, rhinorrhea, sweating, anorexia, irritability, tremor and gooseflesh (cold turkey) |
| At peak of withdrawal what are symptoms | sneezing, weakness, nausea, vomiting, diarrhea, abdominal cramps, bone and muscle pain, muscle spasm and kicking movements (hence kicking the habit) |
| Left untreated the morphine withdrawal syndrome runs its course in how many days | 7-10 days |
| Withdrawal from general CNS depressants like barbituates and alcohol can be _______ | lethal |
| a psychological condition characterized by a drive to obtain and take substances for other than the prescribed therapeutic value | addiction |
Created by:
kellyaem