Pain
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Questions and Answers

Which of the following chemical mediators directly contribute to the transduction of painful stimuli by activating nociceptors?

  • Prostaglandins and Kinins (correct)
  • GABA and Serotonin
  • Endorphins and Norepinephrine
  • Substance P and Glutamate

    • What is the primary role of nociceptive pain?

  • To protect the body by alerting it to potential or actual tissue damage. (correct)
  • To facilitate the transmission of non-essential sensory information to the brain.
  • To induce a state of euphoria that masks underlying tissue damage.
  • To initiate the release of endorphins, thereby promoting a sense of well-being.

    • Which of the following accurately describes the key differences between A$\delta$ and C sensory fibers in the transmission of pain signals?

  • A$\delta$ fibers are inhibitory neurotransmitters, while C fibers are excitatory neurotransmitters.
  • A$\delta$ fibers are myelinated and transmit sharp, stinging pain, while C fibers are unmyelinated and transmit dull, aching pain. (correct)
  • A$\delta$ fibers are unmyelinated and transmit dull, aching pain, while C fibers are myelinated and transmit sharp, stinging pain.
  • A$\delta$ fibers primarily transmit signals related to temperature, while C fibers transmit signals related to pressure.

    • Which of the following neurotransmitters, when released in the spinal cord, would most likely reduce the perception of pain?

    <p>Endorphins (B)</p> Signup and view all the answers

    A patient describes their pain as 'poorly localized' and 'aching'. Which type of sensory fiber is primarily responsible for transmitting this pain signal?

    <p>C fibers (A)</p> Signup and view all the answers

    Which of the following is the MOST accurate description of referred pain?

    <p>Pain perceived at a location different from the site of injury, involving shared dermatomes and nerve pathways. (C)</p> Signup and view all the answers

    Damage to the nerves, is the Etiology (E) for:

    <p>Neuropathic Pain (B)</p> Signup and view all the answers

    Which of the following is MOST characteristic of chronic pain's clinical manifestations (CM)?

    <p>Mood disturbances, fatigue, and sleep disturbances. (C)</p> Signup and view all the answers

    A patient reports deep, squeezing pain that is difficult to pinpoint. This BEST aligns with which type of nociceptive pain?

    <p>Visceral pain (C)</p> Signup and view all the answers

    Which of the following is the primary mechanism by which NSAIDs interrupt peripheral pain transmission?

    <p>Decreasing prostaglandin synthesis, thereby reducing inflammation and pain. (B)</p> Signup and view all the answers

    Of the opioid receptors listed, which one does NOT provide analgesia?

    <p>Sigma (σ) (C)</p> Signup and view all the answers

    Which of the following factors has the LEAST influence on an individual's perception of pain?

    <p>Ambient temperature (C)</p> Signup and view all the answers

    Which of the following adverse effects is MOST associated with mu (μ) opioid receptor activation?

    <p>Urinary Retention (D)</p> Signup and view all the answers

    Breakthrough pain is BEST described as:

    <p>Pain that arises suddenly and transiently, despite ongoing analgesic treatment. (C)</p> Signup and view all the answers

    Which intervention is LEAST likely to be used for interrupting peripheral pain transmission?

    <p>Antidepressants (A)</p> Signup and view all the answers

    Flashcards

    Nociceptor pathways

    Anatomic pathways in the spinal cord and somatosensory cortex for pain processing.

    Dermatome map

    A representation of the areas of skin innervated by specific spinal nerves.

    Perception of Pain

    Neural processing of pain influenced by awareness, emotion, and past experiences.

    Pain Threshold

    The minimum intensity at which pain is perceived.

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    Pain Tolerance

    The maximum level of pain an individual can handle before seeking relief.

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    Nociceptive Pain

    Pain resulting from injury to tissue, can be visceral or somatic.

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    Neuropathic Pain

    Pain caused by nerve damage or dysfunction, often chronic.

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    Acute Pain

    Pain that arises from tissue injury and resolves within six months.

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    Chronic Pain

    Persistent pain lasting longer than six months, affecting quality of life.

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    Referred Pain

    Pain perceived at a location other than the site of the injury, often related to organs.

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    Pain

    An unpleasant sensory and emotional experience tied to tissue damage.

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    Transduction

    Conversion of painful stimuli into action potentials by nociceptors.

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    Transmission

    The process where pain signals travel through spinal nerves to the brain.

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    Neurotransmitters in Pain

    Substance P and glutamate are excitatory; endorphins and GABA are inhibitory.

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    Study Notes

    Pain

    • Pain is defined as an "unpleasant sensory and emotional experience associated with actual or potential tissue damage," according to the International Association for the Study of Pain (IASP). It is also what the patient says it is, as determined by the Joint Commission.

    Reason for Pain

    • Pain serves to protect the body.
    • Pain alerts the body to dangerous situations.
    • Pain allows the body to remove itself from a harmful situation.

    Types of Pain

    • Nociceptive Pain:
      • Over-the-counter (OTC) analgesics:
        • Tylenol
        • NSAIDs
      • Prescription analgesics (opioids):
        • Morphine
    • Neuropathic Pain:
      • Anticonvulsants:
        • Neurontin
        • Lyrica

    Nociceptive Pain

    • Nociception: The process of pain receptors (nociceptors) detecting and signaling noxious stimuli.

    Nociceptive Pain Pathway

    • Transduction: Converting painful stimuli into action potentials.
    • Chemical Mediators:
      • Prostaglandins
      • NSAIDs
      • Lactate
      • Kinins
      • K+, H+
      • Histamine
      • Serotonin
    • Transmission: Spinal nerves transmit pain signals to higher centers.
      • Myelinated (Aδ) fibres: Fast, sharp, stinging pain
      • Unmyelinated (C) fibres: Slow, dull, aching, poorly localized pain
    • Perception: Brain interprets the signals as pain, considering factors such as awareness, mood, prior experience, expectations and culture.

    Spinal Neurotransmitters

    • Excitatory:
      • Substance P
      • Glutamate
      • Histamine
    • Inhibitory:
      • Endorphins
      • Norepinephrine
      • GABA
      • Serotonin

    How Does the Brain Localize Pain?

    • Nociceptor pathways follow anatomical order in the spinal cord and the somatosensory cortex.
    • Dermatome map

    Acute Pain

    • Etiology: Tissue injury
    • Duration: Less than 3 months
      • Clinical Manifestations (CM): Self-report and SNS stimulation (increased heart rate, respiration rate, blood pressure; pallor/diaphoresis; hyperglycemia; dilated pupils; nausea/vomiting; and urinary retention)
    • Treatment (TI): Short-term pain relief via opioid/nonopioid analgesics.

    Chronic Pain

    • Etiology: Underlying disease process; unclear cause; comorbidities e.g., sleep disturbances and depression
    • Duration: More than 6 months
      • Clinical Manifestations (CM): Non-SNS stimulation; mood disturbances, inability to function, chronic hyperglycemia, fatigue and sleep disturbances, and a weakened immune system.
    • Treatment (TI): Multimodal (e.g., opioid, antidepressants, anti-convulsants).

    Referred Pain

    • Etiology: Injury to a different site that is referred to a tissue in the same sensory dermatome.
      • Visceral nociceptor activity with primary somatic afferent nerves in the posterior horn of the spinal cord.
    • Clinical Manifestations (CM): Variable
    • Treatment (TI): Relief of underlying injury

    Neuropathic Pain

    • Etiology: Possible tissue injury to nerves; nerve damage or dysfunction; altered central processing of nociceptive input
    • Clinical Manifestations (CM): Shooting, burning, electric shock-like, tingling/pins and needles
    • Treatment (TI): Anticonvulsants, antidepressants

    Treatment Implications

    • Interrupting Peripheral Transmission:
      • Thermal treatment: reduces inflammation/swelling
      • Local anesthetics: block pain stimulus
      • Splinting: prevents further tissue injury/inflammation
      • NSAIDs: reduce prostaglandins, reduce inflammation and pain

    Altering the Perception and Integration of Pain

    • Medication: Opioids, Non-opioids, Anticonvulsants, Antidepressants
    • Non-medication:
      • Distraction
      • Imagery
      • Relaxation
      • Biofeedback
      • Hypnosis

    Opioids

    • Side effects:
      • Nausea/vomiting (N/V)
      • Respiratory depression (decreased respiratory rate)
      • Constipation

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