Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
68 Cards in this Set
- Front
- Back
|
what is pain?
is pain subjective or quanitative? |
a sensation and an emotion
subjective |
|
|
what is the most common reason for seeking medical attention?
|
pain
|
|
|
where is pain processed?
what does pain serve as? -from what three states? |
the cerebral hemisphere
a protective fxn -tissue injury -noxious stimuli -stress response |
|
|
what are the three stress responses possible?
|
1. in chronic pain
2. anxiety 3. increase in physiologic parameters |
|
|
what are the increased physiologic parameters due to pain?
|
1. pulse
2. blood pressure 3. respiration |
|
|
what is a pain threshold?
what is perceptual dominance? |
point at which a stimulus is perceived as pain
(minimal variations among individuals) percep dom=pain in one area diminishes pain in an other area |
|
|
what is pain tolereance?
|
intensity and time of pain one can endure
|
|
|
what increases tolerance?
|
a. temp
b. beliefs c. alcohol |
|
|
what decreases tolerance
|
a. repeated exposure
b. anxiety c. fatigue |
|
|
what are the 4 distinct process and physiological events of pain
|
1. pain transduction
2. pain transmission 3. painmodulation 4. pain perception |
|
|
is pain a simple or complex process?
|
simple
|
|
|
what are nociceptors?
where are they located? |
afferent nerves and free nerve endings that can be mechanical, thermal, electrical or chemical
located in skin, subcutaneous, joints, and muscles |
|
|
where are nociceptors found in the highest concentrations
|
in the skin
|
|
|
where are the cell bodies for the sensory nerves found?
|
dorsal root ganglion
|
|
|
what type of nerves are peripheral nerves?
name three characteristics of these nerves |
a-alpha nerves
1.small diameter 2.lightly myelinated 3.fast pain |
|
|
what are features of fast pain?
|
-well localized
-sharp, prickling -skin surface stimuli -.1 sec |
|
|
what are slow pain peripheral nerve fibers?
|
c fibers, also small in diameter and lightly myelinated
|
|
|
describe slow pain features.
|
-1 second
-less localized -throbbing, aching pain -skin or deep tissue -assoc tissue damage |
|
|
where do all sensory (afferent) fibers originate?
|
the dorsal horn
|
|
|
what happens when nociceptors are activated?
|
1. pain producing chemicals release in area of tissue damage
2.chemicals released 3. chemicals synthesized 4. substance P |
|
|
what happens if nociceptor activation is prolonged?
|
1. hyperalgesia
2. lowered pain threshold |
|
|
what chemicals are released from damaged tissue cells?
mast cells? Tcells and macrophages? |
K and histamine
bradykinin cytokines |
|
|
what chemicals are synthesized from activation of nociceptors?
|
a. prostaglandins
b.leukotrienes c. arachidonic acid metabolites |
|
|
where is substance P from?
what 4 things does it do? |
from the nociceptors
1. vasodilation 2. edema 3. bradykinin release 4. histamine and serotonin release |
|
|
what is the first order sensory neuron?
second? third? |
the dorsal root ganglion
in dorsal horn-crossing of midline thalamus |
|
|
what are the 6 afferent pathway fibers
|
1. a-alpha fibers
2. c nerve fibers 3. substantia gelatinosa 4. anterolateral spinothalamic tract 5. thalamus 6. cerebral cortex |
|
|
what are the three pathways in the substantia gelitanose fiber?
|
1. laminae I and II
2. pain modulation 3. gating mechanism |
|
|
what is the afferent pathway of pain and temp?
|
1 cross over midline at second order neuron
2. ascend contralateral phalamic tract 3. modulation of pain in gelatinosa |
|
|
what is afferent pathway of proprioception?
|
1.axon continues ascending ipsilateral
2. crosses over in medulla and ascends on contralateral size to thalamus 3. thalamus dispatches to cortex |
|
|
what is the sensory homunculus?
what is the fxn? |
where electrical activity synapses with cell body of cortex
tells us where a sensation is coming from |
|
|
what are the two influences of descending pathways
|
1. centers
2. efferent pathways |
|
|
what two centers are assoc with descending pathways
|
1.hypthalamus & limbic system
2. frontal cortex |
|
|
what is the hypothalamus and limbic system fxn?
frontal cortex? |
control and influence over painful stimuli
interpretation and response of pain |
|
|
what is the efferent descending pathway?
where do these fibers run (3)? |
the cerebral cortex to spinal cord
1. periaqueductal gray matter 2. nuclues raphe 3. dorsal horn (inhibitory complex) |
|
|
who came up with the specificity theory
|
descartes, 17th cent
|
|
|
according to the theory of specificity:
where does pain travel? describe the stimulus and response |
pain travels from specific pain receptors over specific tracts to specifric centers
direct and invariable |
|
|
who came up with the summation theory of pain?
|
goldscheider in 1898
|
|
|
according to the summation theory:
what evokes pain? describe the receptors how many conducting pathways are there? |
particular patterns of nerve impulses on dorsal horn evoke pain
non specific receptors two conduction pathways |
|
|
according to the gate control theory of pain what does pain vary with?
|
pain perception, even of identical stimuli
|
|
|
according to gate control theory:
where do all sensory fibers converge? where is the gating mechanism? |
converge on dorsal horn
in the substantia gelatinosa -gate close=no pain transmission |
|
|
according to gate control theory:
what type of fiber activity inhibits pain transmission? allows? what is this activity also influenced by? |
large fibers inhibit
small fibers allow pain impulse also influenced by higher centers thru descending pathways |
|
|
what is the most comprehensive and practical pain theory
|
gate control
|
|
|
where are opiate receptors located?
where are they concentrated? |
receptors on the synaptic membrane
concentrated in PAG area, dorsal horn and medial raphe |
|
|
how do narcotics (exogenous substances) work on these receptors?
|
bind to these sites
|
|
|
what are three types of endogenous opiod peptides?
|
1. enkephalins
2. beta-endorphin 3. dynorphin |
|
|
what type of opion peptide has the most extensive distribution?
|
enkephalins
|
|
|
what produces beta-endorphins
|
pituitatry gland and hypothalamus
|
|
|
what are two types of pain
|
1. acute
2. chronic |
|
|
how is pain resolved in acute pain?
describe the onset of acute pain. |
that which resolves after healing or successful treatment
onset is sudden and related to a specific event |
|
|
how long is the duration of acture pain?
how does this pain disappear? |
short duration, less than 6 motnhs
pain disappears after stimulus is removed |
|
|
what are predictable neurological responses in the autonomic nervous system
|
-tachycardia
-tachpnea -increased BP -catecholamines(norepi/epi) |
|
|
is chronic pain and extension of acute pain?
|
NO
|
|
|
define chronic pain
describe the onset |
pain that continues despite treatment or apparent healing and serves no biological prupose (arthitis)
gradual onset; continuous or intermittent |
|
|
is there autonomic hyperactivity assoc with chronic pain?
what are the usual causes of this type of pain? |
NO, its normal
usually organic causes |
|
|
what are other expressions of chronic pain?
|
-irritability
-no energy -loss of concentration |
|
|
what is the difference in response to analgesics with acute and chronic pain
|
acute responds well to analgesics while chronic does not
|
|
|
what are types of pain?
|
-superficial
-deep somatic -visceral -referred -phantom |
|
|
where does superficial pain arise?
where is sensation felt? what is felt in skin and vessels |
arises in skin and subq
localized sensation possible to dermatome tingling, sharp, burning cutting in skin and throbbing in vessels |
|
|
where does deep somatic pain arise from?
there are few receptiors so what does this mean? |
muscles, joints, tendons etc.
poorly localized |
|
|
where does viceral pain arise from?
what are some actions of the organ that would cause visceral pain |
arises from the body organs
pain arises from: -stretching -distention -ischemia -inflammation |
|
|
describe the true visceral pathway.
|
-autonomic fxn
-poorly localized |
|
|
describe the parietal pathway
|
-somatic nerves
-localized, felt directly over the area |
|
|
describe the ANS pathway
|
-dull or achy qualitities
|
|
|
what is the muscle reflex over an area a fxn of?
|
protection
|
|
|
what type of pain is often referred pain?
why> |
visceral
b/c innervations by same spinal cord segments |
|
|
what is the convergence projection theory
|
1. somatic and visceral afferent converge on same sensory cell
(2nd order cell) 2. brain incorrectly projects the visceral pain to the somatic dermatome |
|
|
what are examples of referred pain?
|
ex. MI, appendicitis
|
|
|
what is responsible for phantom pain?
what is phantom pain? |
hamonculus
can still feel pain in amputated limb |
