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47 Cards in this Set

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Withdrawal reflex
1. a noxious stimulus activates a nociceptor
2.Interneurons excite or inhibit motor neuron and activate t-cell
3.efferent nerve to muscle
Sensory Discriminative
Localizes the source are and the type of pain
Cognitive-Evaluative
Interprets sensations base on past experiences, expected outcomes, etc.
Affective-Motivational
affects internal and outward response to the stimulus, is influenced by the limbic system
Pain threshold
level of noxious stimulus required to alert the individual to a potential threat to tissue
Pain tolerance
a measure of how much pain a person can or will withstand
Subjective way of assessing Pain
P-provacation (how did it occur?)
Q-quality (characteristics of pain)
R-referral/radiation
S-severity
T-timing
Objective ways of assessing pain
1.Visual analog scale
2.numeric rating sclae
3.McGill pain questionnaire
4.Submaximal effort touriquet test
Acute Pain
trauma is stimulus
activation of nociceptors
released by damaged cells
presence linked to healing process
Chronic Pain
extends beyond normal course of injury/illness
>6 months, few objective findings, med abuse, dif. sleep, depression, manipulative behaviors, somatic preoccupation
Type of chronic pain (1)- Nociceptive chronic pain
disease persists
Type of chronic pain (2)-Neuropathic chronic pain
abnormalities in neurons with in pain system
Referred pain
originates from visceral organs but is perceived as orginating from surface of body
Pain in the neck, jaw, or left shoulder
Myocardial Infarction
Pain in the left shoulder
spleen injury
Pain in the lower abdomen and right groin
appendicitis
Pain in the left shoulder, low back and mid and left abdomen
pancreatic injury or pancreatitis
pain in the right shoulder and midscapular region
Cholecystitis (gallbladder)
pain in low back and left shoulder pain
renal (kidney) disorder
Pain in left shoulder
stomach and upper small intestine duodenum disorder
Radicular pain
Distally radiating pain cased by spinal nerve root involvement
Basic somatosensory transduction
1st order neuron
connects sensory receptor in PNS to CNS
Cell bodies located in dorsal root ganglion
primary afferent nerve fiber
Basic somatosensory transduction
2nd order neuron
Crosses midline of nervous system and projects info to higher levels of CNS
Cell bodies in dorsal horn of spinal cord or trigeminal nuclei in brain stem
Basic somatosensory transduction
3rd order neuron
Projects to even higher levels of CNS-cerebral cortex
Cell bodies primarily in thalamus
Mechanoreceptors
encapsulated receptors that detect pressure
Merkel's disks-surround end of A-beta fibers, low threshold (slow to adapt)
Hair follicle receptors-low threshold
Meissner's corpuscles-low threshold rapidly adapt
Pacinian-larger deeper higher threshold rapidly adapt
Thermoreceptors
free nerve endings (no capsule)
slow adapting, but discharge in phasic bursts when temp changes quickly
Nociceptors
unencapsulated free nerve endings
mechanical, thermal- A-delta fibers
polymodal-(pressure,temp,chemical)-
C-fibers
A-Beta
touch and vibration
originate from mechanoreceptors
large,myleniated;low threshold, easily stimulated, fast conducting
A-Delta
from noxious mechanical stimulus: touch, pressure, pain, temp.(pinch, pricking, crushing)
myleniated, slower and smaller than A-beta
C Fibers
Higher threshold
Smallest, slowest, unmyleniated
require a stimulus greater than others to elicit a response
Ascending Pathway for Pain
Dorsal Column/ Medial Leminscus system (DC/ML)
Fine touch and proprioception (A-beta fibers)
(DC/ML)
1st order neuron
enters at medial side of dorsal root to enter dorsal column and ascends to medulla
1st synapse occurs in medulla
nucleus gracilis-lower body
nucleus cuneaths-upper body
(DC/ML)
2nd order neuron
crosses opposite side and ascent to thalamus via medial leminscus
2nd synapse occurs in VPL of thalamus
(DC/ML)
3rd order neuron
exits VPL,passes through internal capsule to postcentral gyrus of cerbral cortex
Anterior Lateral System (ALS)
pain and temperature pathways (A-delta, C fibers)
Anterior Lateral System (ALS)
1st order neuron
Enters Lateral side of the dorsal root either:
1. Synapse Immediately
2. Travels to various spinal levels, then synapses (presynaptic fiber bundle, dorsolateral fasciculus)
Then enters dorsal horn (lamina)
C fibers- lamina 1&2, A-Delta- lamina 5
Anterior Lateral System (ALS)
2nd order neuron
crosses spinal cord and forms anterior lateral fasciculus (ALF), which has 2 pathways
Anterior Lateral System (ALS)
2nd order neuron
2 pathways
1. Spinothalamic- straight to thalamus (lateral pain system) synapses in VPL of thalamus
2. Reticulothalamic-ascends to various brain stem nuclei before reaching thalamus
synapse in midline and intralaminar nuclei and thalamus
Anterior Lateral System (ALS)
3rd order neuron
2 pathways
1. VPL in thalamus to postcentral gyrus (spinothalamic)
epicritic pain-localized pain
2. Midline and intralaminar nuclei to cingulated gyrus (reticulothalamic) part of limbic system
Protopathic pain-poorly localized and unpleasant pain
Hyperesthesia
pain produced by normally non-painful stimuli
Hyperalgesia
mildly painful stimulus generates considerable amount of pain
Modalities used for peripheral pain modulation
-Subsensory level TENS (microcurent)
increased chemotactic effect of immune cells
affect peripheral mediators of pain
-Non-thermal ultrasound
lessens sensitivity of pain receptors
Gate-Control Theory
Non-painful stimulus can override painful
C fibers synapse directly on 2nd order afferent neuron and dorsal horn interneuron-DEACTIVATES- keeps gate open
A-Beta fibers ACTIVATES- closes gate
Noxious Pain Modulation
PAG receives fibers from? Cingulated cortex
Stimulates raphe nucleus which released serotin and enkephalins- acts on interneuron inhibiting the 2nd order neuron or the t-cells,
Pons-release of norepinephrine which activate inhibitory interneurons
Motor Pain Modulation
Goal=enhance production of endorphins
Acting on pituitary which is controlled by hypothalamus-releases beta-lipoprotein breaks downs to beta-lipoendorphins acts on raphe nucleus can
Pituitary releases ACTH acts on adrenal gland releases cortisol and cortisol plays role in inflammation
Nerve block pain modulation
Goal=create action potential failure
Nerve can’t continually fire because of refractory period
Subsequent stimulation (during refractory period) causes hyperpolarization
Creates inhibitor
Neuropathic pain- (3 types)
1.sympathetically maintained pain syndrome, (RSD)
2. myofascial pain syndrome
3. neuropathy-nerve severing