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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