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Anat 1082 Multiple Choice Revision > Pain > Flashcards

Pain Flashcards

1
Q

5 examples of relevance for pain……GO

A
  • Approx 10 million brits suffer pain- affecting their quality of life - causing them to have more days of work (British pain society, 2014)
  • 8 Million people have chronic pain of at least moderate intensity.
  • 6-8% of the population have severe pain that prevents some or most of their daily activities.
  • It is a warning system telling us that something isn’t right
  • The prevalence of pain doubles after the age of 65 but chronic pain can be experienced by anyone.
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2
Q

What is chronic pain?

A
  • This is a persistent pain which continues after healing or is the result of ongoing damage.
  • Chronic pain Is recognised as a long term condition in its own right.
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3
Q

What is acute pain?

A
  • This relates to pain occurring during tissue damage and repair for example during sudden illness, surgery, trauma and burns 🥵.
  • The pain typically improves with tissue healing.
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4
Q

What are the 5 types of pain?

A

1- Cutaneous pain - originates from the skin
2- Somatic pain - generated from deeper connective tissue - muscle, tendons and joints
3- Visceral pain - from internal organs
4- Referred pain - `perceived in an area away from the site of origin.
5- Neuropathic pain - resulting from the damage to i nerves or nerve endings.

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5
Q

What are the 3 classic physiological causes of pain?

A

1- Nociception- Pain caused by actual or potential injury
2- Inflammatory pain - Caused by the inflammatory process
3- Neuropathic pain - Caused by damage to nerves.

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6
Q

What are the 5 stages of nociceptive pain?

A 
1- Transduction 
2- Conduction 
3- Transmission 
4- Modulation 
5- Perception
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7
Q

What is the nervous system comprised off?

A 
Central= Brain and spinal cord
Peripheral = Sensory ( afferent nerves)
Motor = Efferent nerves
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8
Q

What do dendrites do in a neurone?

A

They percieve information from the body.

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9
Q

What does the cell body (stoma) do in a neurone?

A

Organises information.

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10
Q

What doors the axon do in the neurone?

A

It transmits information to other parts of the nervous system.

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11
Q

What is the space between 2 nerves meeting called?

A

Synapse

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12
Q

Pain is detected by specialised nerve endings what are these called?

A
  • Nociceptors

- These are highly specialised primary sensory neurones mainly located in the skin, joints and walls of organs.

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13
Q

How do nociceptors work?

A
  • They contain specialised protein receptors within their membrane.
  • Once stimulated by noxious stimuli
  • The protein receptors re- shape to create ion channels causing ions to flow through.
  • This stimulates an action potential
  • these nerve endings convert noxious stimuli into an electrical current (action potential)
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14
Q

What do mechanoreceptors do?

A

They respond to pinch and prick pain sensation

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15
Q

What do silent nociceptors do?

A

They respond to inflammation.

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16
Q

What does Polymodal mechanoheat do?

A

These are nociceptors that respond to heat and cold

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17
Q

Stage 1 of pain

What is TRANSDUCTION?

A
  • A process where noxious stimuli are translated into electrical activity.
  • It occurs at the sensory endings of nerves
  • It refers to how the noxious (pain) stimuli causes the release of chemical mediators from damaged cells to cause an action potential
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18
Q

What are Free Nerve Endings (FNE)?

A
  • These are afferent nerve endings meaning it brings info from the bodies periphery towards the brain.
  • In the case of pain FNE are called nociceptors
  • They function as cutaneous receptors and are essentially used to detect pain
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19
Q

What mediators are released following tissue injury?

A
  • Prostaglandin
  • Bradykinin
  • Serotonin
  • Potassium
  • Histamine
  • Substance P (The most famous pain mediator)
20
Q

What do the pain mediators do?

A
  • They produce reactions at the sites such as, vasoconstriction, vasodilation, increased permeability and inflammation.
  • The consequence of mediator activity is the conversion of cell trauma into an electrical impulses. This istransduction
  • Pain sensation requires sufficient chemical mediator action to stimulate nociceptors above a physiological point known as the ‘pain threshold’
  • The bigger the stimulus the bigger the pain sensation.
21
Q

What do the pain mediators prostaglandin and bradykinin do?

A

They reduce the threshold of pain receptors subsequently increasing the sensation of pain.

22
Q

What does the pain mediator histamine do?

A
  • They bind to receptors sites present on nociceptors directly stimulating receptors to begin the cause of pain.
23
Q

How does lactic acid effect pain mediators?

A
  • Lactic acid production lowers the pain threshold and both hydrogen and potassium ions released by damaged cells sensitise pain receptors making them more sensitive to low intensity stimuli.
  • This means anyone producing Lactic acid can be in pain.
24
Q

How is a pain impulse generated?

A
  • There is an exchange of sodium and potassium ions (depolarisation and depolarisation) occurs at the cell membranes
  • This results in an action potential and generation of a pain impulse (transduction)
25
Q

Stage 2 of pain

What is CONDUCTION?

A
  • This refers to to the collection of impulses throughout the sensory nervous system.
  • Primary afferent neurone project the electrical pain impulse to the dorsal horn of the spinal cord ( this is where the peripheral nervous system and the central nervous system meet)
  • Ascending relay neurones project this impulse from the spinal chord to the brain stem and thalamus via the thalamo- cortical projections
  • Conduction is simply the electrical impulse moving through the nervous system
26
Q

What is the process of conduction?

A
  • Pain impulse is sent along the first order neurones to the dorsal horn located in the spinal cord.
  • Here you have 2nd order neurones. The impulse the synapses between the two
  • The 2nd order neurones relay the impulses via the sympathetic tract up to the brain which will synapse with the 3rd order neurones in the thalamus.
  • From here it will process the info and various areas will perceive the pain
27
Q

What are sensory afferent nerves?

A
  • These nerves are relatively thick in size and allow the pain to be transferred very fast (5-30 m per second)
  • These nerves make the body withdraw immediately from the painful and harmful stimulus.
  • Produces sharp pain
28
Q

What are C- fibres (also afferent nerves) and what do they do?

A
  • They transmit impulses more slowly
  • Produces a throbbing, burning pain, starts immediately following the the fast pain.
  • They have very thin
  • Pain impulses via C- fibres are transmitted slowly at a spread of less then 2m per second.
  • The bodies response to this is immobilisation (guarding, spasm, or rigidity) so that healing can take place.
29
Q

What is fast pain?

A
  • Fast pain is associated with ‘A fibres’

- The sensation is experienced as sharp.

30
Q

What is slow pain?

A
  • This is a more dull burning sensation
  • Occurs after a short if amount of time and can last days or weeks/
  • Chronic pain is inappropriately processed by the body it can last several ,months.
  • Slow pain is associated with C fibres
31
Q

Where do C- fibres and delta fibres terminate?

A
  • Terminate at the Dorsal horn of the spinal cord.
  • Here there is a synaptic cleft between the terminal ends of these fibres (1st order neurones) and the nociceptive dorsal horn neurones (ADHN) (2nd order neurones).
  • At this point the conduction ENDS and transmission begins
32
Q

Stage 3 of pain

What is TRANSMISSION?

A
  • In order for the pain to be transmitted across the synaptic cleft to the Nociceptive Dorsal Horn Neurones (NDHN) excitatory neurotransmitters are released which bind to specific receptors in the NDHN.
  • After transmission from the spinal cord to the brain 🧠 stem via the spinothalmic and spinearabrachial pathway once again as an electrical impulse along the 2nd order neurones
  • Spinothalmic = up the vertebrae
  • Spinearabrachial = up the arm
33
Q

What are the neurotransmitters involved in stage 3 of pain TRANSMISSION?

A
  • Adenosine triphosphate (ATP)
  • Glutamate
  • Bradykinin
  • Nitrous oxide
  • Substance P (this is the most famous neurotransmitter)
34
Q

Briefly explain what happens in the stages of pain up to stage 3.

A
  • The electrical pain impulse is sent along the first order neurones to the dorsal horn at the spinal chord
  • At this point is where the second order neurones are located and the impulse travels along the synapse between the 2
  • The second order neurones then relay this impulse via the spinothalmic (vertebrae)tract up to the brain 🧠
  • Here the impulse with travel along the synapse between the 2nd order neurones and 3rd order neurone in the thalamus.
  • From here it will then process the information and various areas will perceive the pain
35
Q

Stage 4 pain

What is MODULATION?

A
  • Transmission of a painful stimuli is modified by a number of influences and this is known as MODULATION
  • It is best considered and explained through the Gate control theory.
  • E.G if you bump your head and put ice on it your head will stop hurting and will start to feel cold.
36
Q

Explain the gate control theory in terms of MODULATION

A
  • According to the Gate control theory, stimulation of the fibres that transmit non-painful stimuli can block the pain impulses at the gate of the dorsal horn.
    For example
  • I’d A- beta fibres (touch receptors) are stimulated they dominate and close the gate.
  • This ability to block pain impulses is the reason a person is prone to immediately grab and rub a stubbed toe.
  • Desending fibres of the central nervous system have the ability to excite inhibitory neurones which then release endorphins, dynorphins which inhibit substance-P release.
    -By locally coding the nerve supplying the injured tissue slows the rate of transmission of nerve impulses reducing the number of pain signals transmitted to the brain.
37
Q

Explain the Phenomena of referred pain.

A
  • The proximity of the skin and heart neurones is very close.
  • Meaning the brain sometimes cant differentiate and process them separately.
  • This is known as the Phenomena of referred pain
  • For example if someone has a heart attack they can feel pain in the chest and all over the skin.
38
Q

Stage 5 pain

What is PERCEPTION?

A
  • This is the unique psychology of the individual and the conscious experience of pain.
  • Pain signals are sent from the thalamus to the higher brain 🧠 centres including the anterior cingulate cortex and the somatosensory cortex where pain perception occurs.
39
Q

What is the Limbic system?

A
  • This is the area of the brain thought to influence the emotional response to pain.
  • It deals with the feelings of pain, pleasure affection and anger
  • The limbic system also evaluates the seriousness of pain and helps individuals remember why the pain occurred.
40
Q

What is the stomatosensory cortex?

A
  • This is the area of the brain that allows individuals to locate pain and describe it
41
Q

What is the anterior cingulate cortex?

A
  • A number of imaging studies show this region is activated during the perception of pain.
  • It plays an important part in Chronic pain
42
Q

What are the physiological consequences of pain?

A
  • Due to the elevation in hormones and the sympathetic nervous response individuals in pain will experience:
  • Increase in heart rate
  • Increase in BP
  • Both cardiac output and O2 consumption will also increase
  • Pain instigates the bodies stress response increasing circulating catecholamine’s which subsequently causes vasoconstriction and impaired tissue perfusion.
  • Can promote anxiety and sleeplessness
  • Can lead to hyperglycaemia, lipolysis, and the breakdown of muscle mass.
  • Pain can suppress natural killer cell activity critical for immune system function.
43
Q

Please explain the relation to pain and vomiting.

A
  • Low BP can make you vomit
  • Chemoreceptors trigger zone at the base of the 4th ventricle has receptors including substance P and serotonin.
  • Lots of receptors are involved in common pathways leading to vomiting. The final common pathway Substance P is involved
  • If you release/ produce substance P you are at risk of vomiting because substance- P acts of the 4th ventricle of the brain.
  • Vomiting can interfere with normal sodium potassium pump for normal electrical activity in the heart and brain.
  • Excess vomit can cause cardiac arrest due to the failure of the heart.
  • It can also cause seizures
44
Q

How can pain be adequately managed?

A
  • Pain cannot be adequately managed if its impact is not assessed regularly using valid and reliable tools. (British Paine society, 2018)
  • In acute settings pain should be considered as the 5th vital sign and should be measured alongside temp, pulse, BP, and resps.
45
Q

How can pain be monitored?

A
  • Verbal- none, mild, moderate
  • Numerical - 1-10
  • Visual :) :(
  • Behavioural- expressions, body language.
46
Q

What is the PQRST pain assessment (Hudack, 1998)?

A 
P= Precipitating Factors
Q= Qualitative data
R= Radiation 
S= Symptoms 
T= Time

Anat 1082 Multiple Choice Revision (20 decks)

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