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47 Cards in this Set
- Front
- Back
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how do pain messages travel?
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Pain basically results from a series of exchanges among three major components of your nervous system:
1. peripheral nerves 2. spinal cord 3. brain |
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where are your peripheral nerves?
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-extend from spinal cord to your skin, muscles, and internal orgains
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describe peripheral nerves
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-vary in their size and rate at which they conduct messages to the brain
-receptors at the ends of these nerves vary as well |
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receptors
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some types of nerve fibers end with receptors that respond to touch, pressure, vibration, cold and warmth
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what are nociceptors?
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other types of nerve fibers end with nociceptors --which are receptors that detect actual or potential tissue damage
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how many nociceptors do you have?
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You have millions of nociceptors in your skin, bones, joints and muscles and in the protective membrane around your internal organs.
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where are the greatest concentration of nociceptors
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in areas prone to injury, such as your fingers and toes.
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what is the relay of pain messages?
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-When nociceptors detect a harmful stimulus they relay their pain messages in the form of electrical impulses along a peripheral nerve to your spinal cord and brain.
-Sensations of severe pain are transmitted almost instantaneously. |
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what do the nerve fibers do in the spinal cord?
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-The nerve fibers that transmit pain messages enter the spinal cord in an area called the dorsal horn.
-There, they release chemicals (neurotransmitters) that activate other nerve cells in the spinal cord, which process the information and then transmit it up to the brain. |
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what else do we have in the dorsal horn?
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dorsal horn is where we have the gait
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where does the message of pain travel after going up the spinal cord?
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thalamus -
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what does the thalamus do with messages of pain?
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sorting and switching station located deep inside your brain.
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thalamus
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The thalamus quickly forwards the message simultaneously to three specialized regions of the brain:
1. the physical sensation region (somatosensory cortex) 2. the emotional feeling region (limbic system) 3. the thinking region (frontal cortex). Your brain responds to pain by sending messages that moderate the pain in the spinal cord. |
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what are commonalities of pain?
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Common experience
Age Gender Economic status “Unfavorable experience |
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what are the definitions of pain?
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Personal experience
Acute pain Chronic pain Greater impact on quality of life |
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what is the definition of pain?
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An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”
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what year did the definition of pain occur?
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1979
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what is injury response?
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Alerts brain
Attempts homeostasis Cortisol is released Sustained release causes myopathy, weakness, fatigue, decalcification Suppress immune system |
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what are pain classifications?
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-disease state causing the pain
-mechanism of the pain itself -age of the sufferer -temporal profile or duration |
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what is acute recurrent pain
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-episode of pain
-pain-free periods between "flare-up" -less than 3 months -identified physical process |
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what is acute pain?
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May indicate tissue damage
Protective function Associated with tissue damage Of brief duration Relationship btw amount of tissue damage and pain experience |
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what is chronic pain?
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Less indicative of tissue damage
Occurs past point of tissue healing Lasts more than 3-6 months Identifiable cause Non-specific Due to nerve damage or nervous system reaction |
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what is neuropathic pain?
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-nerve pain" or neurophathy
-injury or irritation to nerves-sensory or motor nerves -pain persists unrelated to injury or condition -chronic pain category |
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what are neuropathic pain descriptors?
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-severe
-sharp -lancinating -stabbing -ongoing numbness, tingling weakness -CRPS (RSD) -post-herpetic neuralgia -radiculopathy |
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how is autoimmune disease related to pain?
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-pain syndromes
-RA, scleroderma -women suffer more |
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acute to chronic pain
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-on-going pain signals
-thoughts and emotions -pain affected by other factors than tissue input |
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what did Melzack and Wall do?
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-introduced Gate Control Theory
-Spurred research into pain and electrotherapy -theory continues to evolve |
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what is the revised theory of Melzack and Wall?
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-Neuromatrix theory
-focus should be on the brain for future pain research |
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what are the historical precedents: specificity theory
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-Descartes 1664
-Direct transmission systems -1:1 Relationship -Periphery to the pain center in brain -Nociceptors generate pain impulse -Carried by A-delta and C-fibers Travel to lateral spinothalamic tract then to thalamus |
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where did surgical intervention come from?
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decartes theory (specificity theory)
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what is the misconception of the specificity theory?
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-that "mental pain" is different than "physical pain"
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when did pharmaceuticals begin to be used?
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1800's
-"age of revolutions" |
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what occured in the 20th century?
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-advancements in medicine
-custom-designed drugs to block pain -aspirin, NSAIDS -narcotics-morphine and codeine |
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who was Dr. Henry Beecher?
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ER doc
-Relationship btw subjective psychological states and objective drug response -Difference btw soldiers wounded in combat vs. patients admitted to ER -No relationship btw wound severity and intensity of reported pain |
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what were beecher's finding?
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-Meaning attached to the injuries
-Soldier-thankful to be alive -Patient-loss of income, activities (thankful to be alive) |
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phantom limb pain
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-discounted specificity theory
-sensations occur in amputated wound -sensations of intactness or pain |
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what is gate control theory
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-developed by melzack and wall (1965)
-changed perception of pain -explains the experience of pain and psychological factors |
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gate theory in more detail
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-Peripheral nervous system
-Central nervous system (spinal cord & brain) -Pain peripheral nerves to spinal cord-proceed to brain -Dorsal horn-nerve gates |
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nerve activity
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-Activity in afferent large-diameter and small-diameter fibers influence spinal gates
-A-beta (lg) inhibit transmission -A-delta and C (small) facilitate transmission (open gate-more pain |
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what do sensory nerves do?
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-carry information
-specialized -a-delta ("fast" pain) c-fibers ('slow' or 'continuous' pain) |
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what are modifications?
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Pressure and touch-A-beta fibers (fast)
Override pain message of A-delta and C-fibers so pain message is decreased Less pain Accounts for therapeutic effect of massage, heat, cold, TENS, Acupuncture |
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how is the spinal cord involved in pain?
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-Pain message peripheral nerves to spinal cord
-Send the message, change the message, or stop the message -Influenced by: intensity of message -competition from incoming nerves -signals from brain affecting priority of message |
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what are brain fast pathways?
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-Areas of brain stem can inhibit signal
-Produce endorphins -Stress, excitement, vigorous exercise -Fast pain messages travel to thalamus and cortex -Cortex prompts action to decrease pain or injury |
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what are slow pathways?
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-Afferent pathways
-Chronic pain-slow pathway -Pathway to a different portion of brain, hypothalamus and limbic system -Hypothalamus releases stress hormones -Limbic system where emotions are processed (why chronic pain associated with stress, depression, and anxiety) -Brain also assigns meaning |
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what are efferent pathways?
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-Descend from brain to spinal cord
-Opens/closes gate -Anxiety, stress, may amplify afferent pain -Descending, efferent message can close the gate -Occurs in sports, hypnosis, battle, distractions |
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what are factors that open pain gates?
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-Sensory-injury, inactivity, drug use, body mechanics, pacing of activities
-Cognitive-focusing on pain, outside interests, worry, thinking bad things -Emotional-depression, anger, anxiety, frustration, hopelessness, helplessness |
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review :
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acute to chronic phase
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