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81 Cards in this Set
- Front
- Back
Sensory/discriminative system
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Processes information about pain and causes withdrawal from stimulus.
Mediated through afferent nerve fibers, spinal cord, brain stem & higher pain centers. |
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Motivational/affective system
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determines conditioned or learned approach and avoidance behavoirs.
Mediated through the interaction of the reticular formation, limbic system and brain stem. |
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Cognitive/evaluative system
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Cultural influences may block, modulate or enhance the perception of pain.
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Somatogenic pain
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Physical cause
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Psychogenic pain
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No known physical cause, however not imaginary and just as distressing
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A protective mechanism that alerts the individual to a condition that is immediately harmful.
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Acute pain
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How is acute pain relieved?
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After chemical mediators that stimulate the nociceptors are removed.
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What are some characteristics of chronic pain?
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-Persistent
-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 |
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What are some characteristics of acute pain?
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-sudden
-painful areas differentiated -Self-limited or readily corrected |
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A point at which a stimulus is perceived as pain.
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Pain Threshold
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A phenomenon in which intense pain in one area may increase the pain threshold in another area
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Perceptual dominance
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The duration of time or the intensity of pain an individual will indure before outwardly responding to it.
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Pain tolerance
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What factors decrease pain tolerance?
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-repeated exposure
-fatigue -anger -boredom -apprehension -sleep deprivation |
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What factors increase pain tolerence?
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-alcohol consumption
-medication -hypnosis -warmth -distracting activities -strong belief's or faith |
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What physiological signs would you assess in a infant who is in pain?
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-increased HR, BP, RR, decreased O2 sat, sweating, pallor or flushing.
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What other infant expressions would signal an experience of pain?
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Crying, lowered brows, vertical bulge and furrows in forehead, tighten closed eyes, chin quiver
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True or False.... Children usually have higher pain thresholds than adults.
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FALSE, they usually have lower thresholds. Children are also as adults are, highly individual in responses to pain.
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What changes in pain threshold and pain tolerance would you expect in the elderly?
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-Increased pain threshold: caused by neuropathies and changes in skin,
-Decrease in pain tolerance |
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What are nociceptors and what is the function?
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-They are pain receptors, part of the afferent pathway.
-carry signals to the spinal cord which transmits signal to brain. |
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What portions in the CNS are responsible for interpetation of pain?
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-Limbic System
-reticular tracts -thalamus -hypothalamus -medulla -cortex |
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What is the role of the limbic and reticular formation in interpretaion of pain?
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Alerting, arousal and motivational behaviors.
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What is the role of the medulla and hypothalamus in interpretation of pain?
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Activation of "fight or flight", the release of corticosteroids and cardiovascular responses.
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Nociceptors respond to...
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chemical, mechanical and thermal stimuli
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How do Unimodal nociceptor respond and where are they found?
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-respond to one type of sensory modality (Mechanosensitive)
-found in skin, mucous membranes and some walls lining cavities |
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How do Polymodal nociceptors respond and where are they found?
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-respond to more than one sensory modality (mechanosensitive, thermosensitive and chemosensitive)
-found in deep tissues and skin. "Majority of nociceptors" |
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Are nociceptors evenly distributed in the body?
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No, Maldistribution affects the relative sensitivity to pain at different areas in the body.
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Polymodal nociceptor responsible to transmitting diffuse burning or aching sensations
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C-fibers
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Why is transmission though C-fibers relatively slow?
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Because they are small and unmyelinated
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Carries well-localized, sharp pain sensations.
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Larger myelinated A& fibers.
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Important in initiating rapid reactions to stimuli.
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A& fibers
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What and where does the Neospinothalamic Tract carry?
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Acute pain impulse to the brain
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What and where does the Paleospainothalmic tract carry?
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dull and burning pain impulse to the brain.
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What is the efferent pathway responsible for?
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inhibition of afferent pain signals.
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What is the periaqueductal?
(PAG) |
Gray matter suffounding the cerebral aqueduct
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Explain the efferent pathway.
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-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. |
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Where do secondary neurons transmit information?
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-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. |
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Specificity theory of pain
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Include 4 major cutaneous sensations:
touch, warmth, cold, and pain -direct relationship between the stumulus and perception of pain. -fails to accout for adaptation |
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Intensity theory of pain
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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 |
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Pattern theory of pain
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-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. |
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Gate control theory of pain
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Cells in the substantia gelatinosa function as a gate, regulating transmission of impulses to the CNS
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Where are neuromodulators found?
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In pathways that mediate information about painful stimuli
-Periphery, ascending & descending spinal tract, the cortex & GI tract |
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What do the release of prostaglandins do to nociceptors?
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Cause depolariziation of adgacent nociceptors.
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What contributes to pain inhibition in the medulla and pons.
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Norepinephrine and 5-hydroxytryptamine
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What contributes to inhibition of pain in both the afferent and efferent fibers of the spinal cord?
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Substance P and other neurotransmitters.
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They inhibit transmission of pain impulses in the spinal cord to the brain.
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Endorphins (endogenous morphines)
-Beta-Lipotropin (beta, alpha and gamma) -Enkephalin -Dynorphin |
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Located in hypothalamus and responsible for general sensations and well-being.
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Beta-Lipotropin
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Found in neurons of the spinal cord, it is a weaker analgesic that the others, but more potent and longer lasting than morphine.
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Enkephalin
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A powerful endorphin, originates in the neual lobe of the pituitary.
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Dynorphin. 50 times more powerful than beta-Lipotropin
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Where do all endorphins act?
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They act by attaching to opiate receptors on the plasma membrane of the afferent neuron, inhibiting the release of excitatory neurotransmitters.
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What factors increase levels of circulating endorphin and other neurotransmitters?
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Stress, exessive physical exertion, acupuncture, & intercourse.
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What does an increase of endorphins do to the pain threshold?
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Raises the pain threshold.
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List 3 classifications of Acute pain
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Somatic, Visceral and Referred pain
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List some charateristics of somatic pain
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-Superficial (from skin or closed surface)
-sharp and well localized OR -dull, aching and poorly localized -Accompanied with Nausea and Vomiting |
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Define Visceral pain
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Pain in internal organs, the abdomen, or the skeleton
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List some characteristics of viceral pain
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-poorly localized (due to lesser # of mechanoreceptors)
-associated with N & V, hypotension, restlessness and in some cases shock -often radiates |
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Define Referred pain
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-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 |
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List some physiologic Responses to pain
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-Increased HR, RR, BP
-Pallor or flushing -Diaphoresis -Dilated pupils -Elevated blood sugar -decreased gastric secretion and motility -Decreased blood flow to viscera & skin -Occasional nausea |
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Which type of pain is more difficult to control? Chronic or Acute
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Chronic
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What 4 changes in the nerve terminals, afferent fibers and CNS may contribe to chronic pain?
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-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. |
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Increase in the exitability of medullary and spinal neurons arising from persistent stimulation from injured peripheral nerves.
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-Central Sensitiation
-Cause spinal cord neuron to be more sesitive to all of its inputs. |
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Pain caused be a lesion or dysfunction in the CNS (brain or spinal cord)
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Central pain
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What are some cause of central pain?
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-infarction
-hemorrhage -abscess -degeneration -tumors -tramatic injury |
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Name 2 characteristic of central pain.
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Irritating and constant (causes considerable suffering)
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Result of trama or disease of the peripheral nerves.
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Neuropathic pain
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What is the pathophysiologic process of neuropathic pain?
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Injured nerves become hyperexcitable and generate ectorpic discharges with spontaneous firing of some neurons with low thresholds for mechanical, chemical or thermal stimuli
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What are some physiologic responses to chronic pain?
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-If intermittent, then the same respones as acute
-If persisant, physiologic adaptation, normal vital signs even though pain is not relieved. |
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The most chronic pain condition is?
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Low back pain
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A painful condition from an infection or disease that damages a peripheral nerve
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Neuralgias
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A 2 types of neuralgias that caused severe burning pain that is triggered by normally nonnoxious stimuli
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Causalgia and Reflex sympathetic dystrophies
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How does causalgia present?
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-severe, diffuse and persisent pain occurs in the extremity supplied by the injured nerve
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Reflex sympathetic dystrophies are associated with?
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Vasospasm and vasomotor changes. If muscle wasting occurs amputation my be needed.
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A condition where pain is cause by stimuli that normally does not cause pain
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Hyperesthesias
-increased sensitivity and decreased pain threshold |
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What causes myofascial pain syndromes?
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myositis, fivrositis, myofibrositis, myalgia and muscle strain.
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What is myofascial pain the result of?
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Muscle spasm, tenderness, & stiffness
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What is hemiagnosia?
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-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. |
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Pain that a person feels in an amputated limb after the stump is completely healed.
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Phantom limb pain
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Small hypersensitive regions in muscle or connective tissue that when stimulated cause pain in specific area
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Trigger points
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3 major catagories of pain syndromes that result in chronic pain in cancer patients.
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-pain from advancing disease
-pain associated with treatment -pain from coexisting unrelated disease |
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Deafferentation pain is...
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a loss of sensory input from a portion of the body.
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Describe deafferentation pain
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-constant, dull, viselike ache with paroxysms of burning or electric shock-like sensations.
-poorly controlled by peripheral & epidural analgesia |
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Is chronic postoperative pain is possible surgical interventions for cancer?
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Yes. Small percentage with
Thoracotomy radical mastectomy radical neck dissection surgical amputation |