Theraputic Modalities Test 2 Pain

Front 1

Withdrawal reflex

Back 1

1. a noxious stimulus activates a nociceptor
2.Interneurons excite or inhibit motor neuron and activate t-cell
3.efferent nerve to muscle

Front 2

Sensory Discriminative

Back 2

Localizes the source are and the type of pain

Front 3

Cognitive-Evaluative

Back 3

Interprets sensations base on past experiences, expected outcomes, etc.

Front 4

Affective-Motivational

Back 4

affects internal and outward response to the stimulus, is influenced by the limbic system

Front 5

Pain threshold

Back 5

level of noxious stimulus required to alert the individual to a potential threat to tissue

Front 6

Pain tolerance

Back 6

a measure of how much pain a person can or will withstand

Front 7

Subjective way of assessing Pain

Back 7

P-provacation (how did it occur?)
Q-quality (characteristics of pain)
R-referral/radiation
S-severity
T-timing

Front 8

Objective ways of assessing pain

Back 8

1.Visual analog scale
2.numeric rating sclae
3.McGill pain questionnaire
4.Submaximal effort touriquet test

Front 9

Acute Pain

Back 9

trauma is stimulus
activation of nociceptors
released by damaged cells
presence linked to healing process

Front 10

Chronic Pain

Back 10

extends beyond normal course of injury/illness
>6 months, few objective findings, med abuse, dif. sleep, depression, manipulative behaviors, somatic preoccupation

Front 11

Type of chronic pain (1)- Nociceptive chronic pain

Back 11

disease persists

Front 12

Type of chronic pain (2)-Neuropathic chronic pain

Back 12

abnormalities in neurons with in pain system

Front 13

Referred pain

Back 13

originates from visceral organs but is perceived as orginating from surface of body

Front 14

Pain in the neck, jaw, or left shoulder

Back 14

Myocardial Infarction

Front 15

Pain in the left shoulder

Back 15

spleen injury

Front 16

Pain in the lower abdomen and right groin

Back 16

appendicitis

Front 17

Pain in the left shoulder, low back and mid and left abdomen

Back 17

pancreatic injury or pancreatitis

Front 18

pain in the right shoulder and midscapular region

Back 18

Cholecystitis (gallbladder)

Front 19

pain in low back and left shoulder pain

Back 19

renal (kidney) disorder

Front 20

Pain in left shoulder

Back 20

stomach and upper small intestine duodenum disorder

Front 21

Radicular pain

Back 21

Distally radiating pain cased by spinal nerve root involvement

Front 22

Basic somatosensory transduction
1st order neuron

Back 22

connects sensory receptor in PNS to CNS
Cell bodies located in dorsal root ganglion
primary afferent nerve fiber

Front 23

Basic somatosensory transduction
2nd order neuron

Back 23

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

Front 24

Basic somatosensory transduction
3rd order neuron

Back 24

Projects to even higher levels of CNS-cerebral cortex
Cell bodies primarily in thalamus

Front 25

Mechanoreceptors

Back 25

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

Front 26

Thermoreceptors

Back 26

free nerve endings (no capsule)
slow adapting, but discharge in phasic bursts when temp changes quickly

Front 27

Nociceptors

Back 27

unencapsulated free nerve endings
mechanical, thermal- A-delta fibers
polymodal-(pressure,temp,chemical)-
C-fibers

Front 28

A-Beta

Back 28

touch and vibration
originate from mechanoreceptors
large,myleniated;low threshold, easily stimulated, fast conducting

Front 29

A-Delta

Back 29

from noxious mechanical stimulus: touch, pressure, pain, temp.(pinch, pricking, crushing)
myleniated, slower and smaller than A-beta

Front 30

C Fibers

Back 30

Higher threshold
Smallest, slowest, unmyleniated
require a stimulus greater than others to elicit a response

Front 31

Ascending Pathway for Pain
Dorsal Column/ Medial Leminscus system (DC/ML)

Back 31

Fine touch and proprioception (A-beta fibers)

Front 32

(DC/ML)
1st order neuron

Back 32

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

Front 33

(DC/ML)
2nd order neuron

Back 33

crosses opposite side and ascent to thalamus via medial leminscus
2nd synapse occurs in VPL of thalamus

Front 34

(DC/ML)
3rd order neuron

Back 34

exits VPL,passes through internal capsule to postcentral gyrus of cerbral cortex

Front 35

Anterior Lateral System (ALS)

Back 35

pain and temperature pathways (A-delta, C fibers)

Front 36

Anterior Lateral System (ALS)
1st order neuron

Back 36

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

Front 37

Anterior Lateral System (ALS)
2nd order neuron

Back 37

crosses spinal cord and forms anterior lateral fasciculus (ALF), which has 2 pathways

Front 38

Anterior Lateral System (ALS)
2nd order neuron
2 pathways

Back 38

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

Front 39

Anterior Lateral System (ALS)
3rd order neuron
2 pathways

Back 39

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

Front 40

Hyperesthesia

Back 40

pain produced by normally non-painful stimuli

Front 41

Hyperalgesia

Back 41

mildly painful stimulus generates considerable amount of pain

Front 42

Modalities used for peripheral pain modulation

Back 42

-Subsensory level TENS (microcurent)
increased chemotactic effect of immune cells
affect peripheral mediators of pain
-Non-thermal ultrasound
lessens sensitivity of pain receptors

Front 43

Gate-Control Theory

Back 43

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

Front 44

Noxious Pain Modulation

Back 44

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

Front 45

Motor Pain Modulation

Back 45

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

Front 46

Nerve block pain modulation

Back 46

Goal=create action potential failure
Nerve can’t continually fire because of refractory period
Subsequent stimulation (during refractory period) causes hyperpolarization
Creates inhibitor

Front 47

Neuropathic pain- (3 types)

Back 47

1.sympathetically maintained pain syndrome, (RSD)
2. myofascial pain syndrome
3. neuropathy-nerve severing