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81 Cards in this Set

  • Front
  • Back
Sensory/discriminative system
Processes information about pain and causes withdrawal from stimulus.

Mediated through afferent nerve fibers, spinal cord, brain stem & higher pain centers.
Motivational/affective system
determines conditioned or learned approach and avoidance behavoirs.

Mediated through the interaction of the reticular formation, limbic system and brain stem.
Cognitive/evaluative system
Cultural influences may block, modulate or enhance the perception of pain.
Somatogenic pain
Physical cause
Psychogenic pain
No known physical cause, however not imaginary and just as distressing
A protective mechanism that alerts the individual to a condition that is immediately harmful.
Acute pain
How is acute pain relieved?
After chemical mediators that stimulate the nociceptors are removed.
What are some characteristics of chronic pain?
-continuous or intermittent
-may develop insidiously or suddenly
-lasting at least 6 months
-cause may not be known
-does not respond to usual therapy
-painful areas not easily differentiated
-complete relief is usually not possible
What are some characteristics of acute pain?
-painful areas differentiated
-Self-limited or readily corrected
A point at which a stimulus is perceived as pain.
Pain Threshold
A phenomenon in which intense pain in one area may increase the pain threshold in another area
Perceptual dominance
The duration of time or the intensity of pain an individual will indure before outwardly responding to it.
Pain tolerance
What factors decrease pain tolerance?
-repeated exposure
-sleep deprivation
What factors increase pain tolerence?
-alcohol consumption
-distracting activities
-strong belief's or faith
What physiological signs would you assess in a infant who is in pain?
-increased HR, BP, RR, decreased O2 sat, sweating, pallor or flushing.
What other infant expressions would signal an experience of pain?
Crying, lowered brows, vertical bulge and furrows in forehead, tighten closed eyes, chin quiver
True or False.... Children usually have higher pain thresholds than adults.
FALSE, they usually have lower thresholds. Children are also as adults are, highly individual in responses to pain.
What changes in pain threshold and pain tolerance would you expect in the elderly?
-Increased pain threshold: caused by neuropathies and changes in skin,
-Decrease in pain tolerance
What are nociceptors and what is the function?
-They are pain receptors, part of the afferent pathway.

-carry signals to the spinal cord which transmits signal to brain.
What portions in the CNS are responsible for interpetation of pain?
-Limbic System
-reticular tracts
What is the role of the limbic and reticular formation in interpretaion of pain?
Alerting, arousal and motivational behaviors.
What is the role of the medulla and hypothalamus in interpretation of pain?
Activation of "fight or flight", the release of corticosteroids and cardiovascular responses.
Nociceptors respond to...
chemical, mechanical and thermal stimuli
How do Unimodal nociceptor respond and where are they found?
-respond to one type of sensory modality (Mechanosensitive)
-found in skin, mucous membranes and some walls lining cavities
How do Polymodal nociceptors respond and where are they found?
-respond to more than one sensory modality (mechanosensitive, thermosensitive and chemosensitive)
-found in deep tissues and skin.
"Majority of nociceptors"
Are nociceptors evenly distributed in the body?
No, Maldistribution affects the relative sensitivity to pain at different areas in the body.
Polymodal nociceptor responsible to transmitting diffuse burning or aching sensations
Why is transmission though C-fibers relatively slow?
Because they are small and unmyelinated
Carries well-localized, sharp pain sensations.
Larger myelinated A& fibers.
Important in initiating rapid reactions to stimuli.
A& fibers
What and where does the Neospinothalamic Tract carry?
Acute pain impulse to the brain
What and where does the Paleospainothalmic tract carry?
dull and burning pain impulse to the brain.
What is the efferent pathway responsible for?
inhibition of afferent pain signals.
What is the periaqueductal?
Gray matter suffounding the cerebral aqueduct
Explain the efferent pathway.
-Efferent neurons located in the PAG form synapses with structures in the medulla the inhibit pain.
-from the medulla the impulse is transmitted through the spinal cord to the dorsal hour to impair or block transmission of nociceptive impulses.
Where do secondary neurons transmit information?
-From the substantia getainosa and laminae to the ventral and lateral horn
-Crossing, in the same or adjacent spinal segments to the other side of the cord.
Specificity theory of pain
Include 4 major cutaneous sensations:
touch, warmth, cold, and pain
-direct relationship between the stumulus and perception of pain.
-fails to accout for adaptation
Intensity theory of pain
Pain results from excessive stimulation of sensory receptors or a pathologic condition that promotes summation of impulses by nonnoxious stimuli.
-does not account for intense stimulation at some sites that is not painful
Pattern theory of pain
-perception of pain results from stimulus intensity.
-nonspecific receptors transmit patterns of nerve impulses from the skin to the spinal cord.
-does not account for adaptation.
Gate control theory of pain
Cells in the substantia gelatinosa function as a gate, regulating transmission of impulses to the CNS
Where are neuromodulators found?
In pathways that mediate information about painful stimuli
-Periphery, ascending & descending spinal tract, the cortex & GI tract
What do the release of prostaglandins do to nociceptors?
Cause depolariziation of adgacent nociceptors.
What contributes to pain inhibition in the medulla and pons.
Norepinephrine and 5-hydroxytryptamine
What contributes to inhibition of pain in both the afferent and efferent fibers of the spinal cord?
Substance P and other neurotransmitters.
They inhibit transmission of pain impulses in the spinal cord to the brain.
Endorphins (endogenous morphines)
-Beta-Lipotropin (beta, alpha and gamma)
Located in hypothalamus and responsible for general sensations and well-being.
Found in neurons of the spinal cord, it is a weaker analgesic that the others, but more potent and longer lasting than morphine.
A powerful endorphin, originates in the neual lobe of the pituitary.
Dynorphin. 50 times more powerful than beta-Lipotropin
Where do all endorphins act?
They act by attaching to opiate receptors on the plasma membrane of the afferent neuron, inhibiting the release of excitatory neurotransmitters.
What factors increase levels of circulating endorphin and other neurotransmitters?
Stress, exessive physical exertion, acupuncture, & intercourse.
What does an increase of endorphins do to the pain threshold?
Raises the pain threshold.
List 3 classifications of Acute pain
Somatic, Visceral and Referred pain
List some charateristics of somatic pain
-Superficial (from skin or closed surface)
-sharp and well localized OR
-dull, aching and poorly localized
-Accompanied with Nausea and Vomiting
Define Visceral pain
Pain in internal organs, the abdomen, or the skeleton
List some characteristics of viceral pain
-poorly localized (due to lesser # of mechanoreceptors)
-associated with N & V, hypotension, restlessness and in some cases shock
-often radiates
Define Referred pain
-pain is present in an area removed or distant from it's point of origin.
-Area of referred pain is supplied be the same spinal segment as the actual pain
List some physiologic Responses to pain
-Increased HR, RR, BP
-Pallor or flushing
-Dilated pupils
-Elevated blood sugar
-decreased gastric secretion and motility
-Decreased blood flow to viscera & skin
-Occasional nausea
Which type of pain is more difficult to control? Chronic or Acute
What 4 changes in the nerve terminals, afferent fibers and CNS may contribe to chronic pain?
-changes in sensitivity of neurons (lower threshold)
-spontaneous impulses from regenerating peripheral nerves
-reoragnization of nociceptive neuron after peripheral nerve injury
-Loss of pain inhibition in the spinal cord.
Increase in the exitability of medullary and spinal neurons arising from persistent stimulation from injured peripheral nerves.
-Central Sensitiation
-Cause spinal cord neuron to be more sesitive to all of its inputs.
Pain caused be a lesion or dysfunction in the CNS (brain or spinal cord)
Central pain
What are some cause of central pain?
-tramatic injury
Name 2 characteristic of central pain.
Irritating and constant (causes considerable suffering)
Result of trama or disease of the peripheral nerves.
Neuropathic pain
What is the pathophysiologic process of neuropathic pain?
Injured nerves become hyperexcitable and generate ectorpic discharges with spontaneous firing of some neurons with low thresholds for mechanical, chemical or thermal stimuli
What are some physiologic responses to chronic pain?
-If intermittent, then the same respones as acute
-If persisant, physiologic adaptation, normal vital signs even though pain is not relieved.
The most chronic pain condition is?
Low back pain
A painful condition from an infection or disease that damages a peripheral nerve
A 2 types of neuralgias that caused severe burning pain that is triggered by normally nonnoxious stimuli
Causalgia and Reflex sympathetic dystrophies
How does causalgia present?
-severe, diffuse and persisent pain occurs in the extremity supplied by the injured nerve
Reflex sympathetic dystrophies are associated with?
Vasospasm and vasomotor changes. If muscle wasting occurs amputation my be needed.
A condition where pain is cause by stimuli that normally does not cause pain
-increased sensitivity and decreased pain threshold
What causes myofascial pain syndromes?
myositis, fivrositis, myofibrositis, myalgia and muscle strain.
What is myofascial pain the result of?
Muscle spasm, tenderness, & stiffness
What is hemiagnosia?
-Inability to identify source of pain on one side (affected side)
-painful stimuli produes discomfort, anxiety and distress but no attempt to withdraw from.
-associated with stroke pt.
Pain that a person feels in an amputated limb after the stump is completely healed.
Phantom limb pain
Small hypersensitive regions in muscle or connective tissue that when stimulated cause pain in specific area
Trigger points
3 major catagories of pain syndromes that result in chronic pain in cancer patients.
-pain from advancing disease
-pain associated with treatment
-pain from coexisting unrelated disease
Deafferentation pain is...
a loss of sensory input from a portion of the body.
Describe deafferentation pain
-constant, dull, viselike ache with paroxysms of burning or electric shock-like sensations.
-poorly controlled by peripheral & epidural analgesia
Is chronic postoperative pain is possible surgical interventions for cancer?
Yes. Small percentage with
radical mastectomy
radical neck dissection
surgical amputation