Pain Symposium

Front 1

Somatic pain vs. visceral pain? WHich is well localized and shard as opposed to poorly localized and referred? Example of each?

Back 1

somatic- well localized/sharp pain that results from tissue injusry- think of when a surgeon makes an incision
visceral- referred pain that corresponds to organ issues, such as distention, infection, compression, etc.- think of appendicitis

Front 2

What are the four steps of pain recognition//response?

Back 2

1. transduction
2. transmission up to brain
3. interpretation/cortical processing
4. modulation-descending control/neurohumeral mediators

Front 3

For pain transduction, what do C fibers carry? A-delta? (chronic vs acute?) which are myelinated/de? What laminae in dorsal horn does each synapse? which type upregulates serotonin, pgs, etc.

Back 3

C fibers- unmyelinated, responsible for upreg of pgs, etc.- seen in chronic pain- synapse on laminae 2
A-delta fibers- myelinated; respond to acute stimuli; synapse on laminae 1 & 5

Front 4

What is the gate theory of pain and how will this influence future pain management? What are A-beta fibers role in this? Which ascending pathway transmits pain/temp from tissues? Which transmits pain from visceral organs?

Back 4

the idea that incoming pain stimuli can be turned off (gated) by other stimuli
A-beta are the propioception/fine touch fibers and these can alter sensitivity of A-deltas and C-fibers
ALS/Spinothalamic transmit tissue pain
Dorsal columns transmit visceral pain

Front 5

What are some of the receptors of the pain fibers in the brain? (i.e think basis of current pain med regime?)
What two areas of the brain play a vital role in pain modulation? (and their neurotransmitters?)

Back 5

opiates, histamines, bradykinin, serotonin, prostaglandins
Locus ceruleus- NOREP (PONS)
Raphe Nucleus- Serotonin (medulla)

Front 6

What is the deal with the c-Fos gene? Where found? Goal of future therapy? But, does it explain chronic pain? New theory of pain w/ brain? (why do anti-seizure meds work for relief?)

Back 6

involved in the percerption of noxious stimuli; found in dorsal horn laminae (1,5 for A deltas and 2 for C fibers)
Goal of future therapy; to block C-fos expression
Chronic pain arises with no damage to nerve/c-fos production;...idea that nervr signals arise at the brain, but it is the brain that stimulates the pain...hence, anti-seizure meds can calm the brain down and reduce pain

Front 7

Men vs. women: who have lower pain thresholds (detection), lower tolerance for pains, and who report more clinical pain? Implications for treatment? Differences in MAC for inhaled anesthetics?

Back 7

Women have lower pain thresholds (detection), lower pain tolerance, and report more clinical pain than men.
Women need greater quanities than a similar sized man and possibly different meds due to our noxious stimulating differences; NO diff for MACs

Front 8

What is palliation? What symptoms are included? What does unrelieved pain frequently cause that is releived upon pain control?

Back 8

relief of symptoms that involve the patient's whole well-being
Include: nausea/vomitting, SOB, appetite disturbances, sleep problems, DELIRIUM and incontinence

Leads to psychiatric symptoms and the loss of a normal circadian rythm

Front 9

What is the rule of double affect as initiated by St. Thomas Aquinas? What is terminal agitation?

Back 9

intervening on the patient's behalf is risky because it could hasten the possibility of death
Terminal Agitation- source of psychological distress to patients (>50%) and caregivers in the last 24-48 hrs. before death

Front 10

1st stage of labor includes dilation of the cervix...where do we see pain from this? what is visceral pain? WHat is somatic pain? What about 2nd step when baby progesses down birth canal? WHere localized?

Back 10

Dilation- referred to umbilical region; non-localized; T10-L1, A-delta fibers that go to laminae V
Descension down birth canal- somatic pain that is highly localized and goes to S2-S4, via pudendal nerve

Front 11

What are the risk factors associated with an epidural? Is it harmful to the spinal cord? What psychological factors add to pain problems with labor? How overcome these issues?

Back 11

none really...since you are outside the dura and in the area where the spinal roots transverse
worry about anxiety and attention
overcome this with Lamaze childbirth classes where you practice anticipating the pain and techniques...highly motivated patients that tend to have great outcomes

Front 12

Since children can't express themselves, do they experience pain? How do we know they do? What are neonates in pain that goes untreated at risk for? What do we see in later pain responses that clue us in on early pain experiences?

Back 12

YES. They experience pain. We see it in their stress hormonal levels (cortisol).
Decreased respiratory volume/O2 saturation, increased CV stress
Babies who had no analgesia for circumsion are more agitated/have higher pain scores w/ subsequent immunizations, etc

Front 13

Do babies remember pain? How assess neonates/children in determining amount of pain and whther opiates are necessary?

Back 13

Yes...maybe not consciously, but their nervouse system does!

Look at behavior (like crying, expressions and sleeping patterns?, look at O2 sat and vital signs,
FOr children; look at if they are still playing

Front 14

What is the major consequence of giving neonates opiates and/or opiate/sedative combo therapy that you must monitor?

Back 14

respiratory depression, along with the minors ones including
sedation, nausea/vomiting, decreased bowel movement and incontinence