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Questions and Answers
Nociceptive pain is characterized by being acute, localized, and well described.
False
Neuropathic pain serves a protective function against harmful stimuli.
False
Visceral pain arises from organs while somatic pain arises from tissues like skin and muscle.
True
Neuropathic pain can only be acute and resolves quickly.
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Central sensitization leads to a decrease in central inhibition.
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Hyperalgesia refers to a decreased response to noxious stimuli.
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Nociceptive pain generally responds well to conventional analgesics.
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Neuropathic pain is always associated with numbness.
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Allo-dynia refers to a painful response to a normally innocuous stimulus.
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Chronic pain is always accompanied by high levels of pathology that explain the pain.
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Referred pain is the spread of pain to uninjured tissue.
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Acute pain is referred to as maladaptive pain.
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Chronic pain can lead to disruption of sleep and normal living.
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Persistent pain is classified as pain that occurs only after a transient stimulus.
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Functional pain arises from abnormal processing of stimuli by the CNS.
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Chronic pain is never caused by non-life-threatening conditions.
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Chronic malignant pain is always associated with non-progressive diseases.
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Chronic non-malignant pain lasts for more than 6 months beyond the healing period.
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The only way to diagnose pain is through laboratory tests.
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Pain can have both physical and psychological symptoms, such as anxiety and depression.
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Routine screening for pain is not recommended by many organizations.
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Acute pain can cause physiological signs such as tachycardia and hypertension.
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Chronic pain has no impact on social relationships and can lead to isolation.
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Pain assessment and reassessment are important for effective pain management.
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Pain is classified solely based on its duration.
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The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience.
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Chronic pain affects more than 76 million people in the US according to the American Pain Foundation.
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Nociceptors are primarily responsible for transmitting signals through unmyelinated C-fibers and small A delta fibers.
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Inflammatory pain occurs when tissue damage does not activate the nociceptive defense system.
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There are five types of pain categorized under pathophysiology.
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Prostaglandins, substance P, and bradykinin are examples of mediators released during tissue damage.
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Low back pain lasting at least one day was reported by one-fourth of U.S. adults in the last three months.
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The mnemonic PQRST stands for Palliative, Quality, Region, Severity, and Temporal.
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Analgesics history does not include information about adverse effects.
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Single-dimensional pain scales only provide a numerical value for pain intensity.
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Patient expectations and goals do not affect pain assessment.
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Observations of patient behavior are part of the clinical examination in pain assessment.
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Multidimensional pain assessment tools focus solely on pain intensity.
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One aspect evaluated in pain history is the quality of the pain experienced.
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Renal or hepatic dysfunction can influence therapy choices in pain management.
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Study Notes
Definition of Pain
- Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
- It is subjective and affects all aspects of a person's life.
Epidemiology of Pain
- Over 76 million people in the US suffer from chronic pain.
- 25 million experience acute pain from injury or surgery.
- Approximately one-fourth of US adults report low back pain lasting at least 1 day in the past 3 months.
Pathophysiology of Pain
- The nociceptive system is a key physiologic function that prevents further tissue damage.
- When tissue damage occurs, inflammatory pain ensues.
- Signals from nociceptors travel along two fiber types: slowly conducting unmyelinated C-fibers and small, myelinated A-delta fibers.
- Tissue damage releases various tissue byproducts and mediators of inflammation (e.g., prostaglandins, substance P, bradykinin, histamine, serotonin, cytokines).
- These mediators sensitize nociceptors, increasing their excitability and discharge frequency.
Classification of Pain
- Multiple systems exist for classifying pain.
- Pain can be classified based on:
- Underlying pathophysiology
- Duration
Pain Classification: Pathophysiology
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Nociceptive pain: Transient pain in response to a noxious stimulus at nociceptors.
- Caused by ongoing activation of A-δ and C-nociceptors.
- Serves to protect against painful stimuli.
- Acute, localized, well-described, and relieved with conventional analgesics.
- Visceral pain arises from organs, somatic pain from tissues like skin, muscle, and bone.
-
Neuropathic pain: Spontaneous pain or hypersensitivity associated with damage to the nervous system.
- Reflects nervous system injury or impairment.
- Serves no purpose.
- Common causes include trauma, inflammation, metabolic diseases, infections, tumors, toxins, and neurological diseases.
- Pain can be continuous or episodic, perceived in various ways (e.g., burning, tingling, shooting).
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Inflammatory pain: Body's response to tissue damage by activating pain pathways.
- Protects the injured tissue.
- Examples include appendicitis and rheumatoid arthritis.
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Functional (dysfunctional) pain: Pain due to abnormal CNS processing of normal stimuli.
- Pain in the absence of tissue damage.
- Influenced by factors like stress, anxiety, depression, or illness.
- Examples include IBS and fibromyalgia.
Central Sensitization
- A balance generally exists between excitatory and inhibitory neurotransmission.
- Central sensitization occurs when this balance is disrupted, leading to exaggerated responses.
- Repeated or prolonged input from C-nociceptors or damaged nerves causes increased neuron excitability.
- Central sensitization is associated with a reduction in central inhibition.
- Clinically, this manifests as:
- Hyperalgesia: increased response to a noxious stimulus.
- Allodynia: painful response to a normally innocuous stimulus.
- Persistent pain: prolonged pain after a transient stimulus.
- Referred pain: spread of pain to uninjured tissue.
Pain Classification: Duration
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Acute pain: Adaptive, referred to as a symptom.
- Easily identified cause and location.
- Usually resolves with healing of the underlying injury.
- Should be treated aggressively.
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Chronic pain: Maladaptive, a pathologic function of the nervous system.
- Pain that extends beyond the period of healing.
- Levels of identified pathology often are low.
- Disrupts sleep and normal living.
- Degrades health and functional capability.
- Can be nociceptive, inflammatory, neuropathic, or functional.
- Either continuous or recurrent.
- Adversely affects quality of life.
- Has four main effects: physical function, psychological changes, social consequences, and societal consequences.
Classification of Chronic Pain
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Chronic malignant pain: Associated with progressive disease.
- Examples include cancer, AIDS, progressive neurological diseases, and end-stage organ failure.
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Chronic non-malignant pain: Lasts longer than 6 months beyond the healing period.
- Examples include low back pain, osteoarthritis, and previous bone fractures.
Cancer Pain
- Associated with potentially life-threatening conditions.
- Includes pain caused by the disease itself and/or painful procedures or treatments.
- Has multiple etiologies.
Clinical Presentation and Diagnosis of Pain
- Symptoms:
- Described based on onset, duration, location, quality, severity, and intensity.
- Others may include anxiety, depression, fatigue, anger, fear, and insomnia.
- Signs:
- Acute pain may cause hypertension, tachycardia, diaphoresis, mydriasis, and pallor.
- Diagnosis:
- The patient can describe the intensity and quality of their pain.
- No laboratory tests can diagnose pain.
Pain Assessment
- Pain is considered the 5th vital sign.
- Effective pain management begins with thorough and accurate pain assessment.
- Reassessment should be done as needed.
- Lack of regular assessment and reassessment contributes to under-treatment of pain.
Methods of Pain Assessment
- General history: Including psychological status, drug and alcohol use.
- Pain history: Onset, duration, location, quality, intensity, relieving and exacerbating factors, impact on functional, behavior, and psychological states.
- Analgesics history: Dose, route, duration, effectiveness, adverse effects.
- Clinical examination: Observations of patient behavior, physical examination, functional assessment.
- Others: Other conditions (e.g., renal or hepatic dysfunction), patient's expectations and goals.
Pain Assessment Tools or Scales
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Rating scales: Simple way to classify pain intensity.
-
Single-dimensional pain scales:
- Numerical Rating Scale (NRS)
- Visual analog scale (VAS)
- Categorical scale: Verbal Description Scale (VDS), Faces Pain Scale (FPS)
-
Multidimensional pain assessment tools: Obtain information about pain and impact on quality of life.
- Brief Pain Inventory (BPI)
- McGill Pain Questionnaire (MPQ)
-
Single-dimensional pain scales:
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Description
Test your knowledge on the definition, epidemiology, and pathophysiology of pain. This quiz covers the sensory and emotional components of pain, as well as the physiological mechanisms involved in tissue damage and nociception. Perfect for students in health sciences or anyone interested in understanding pain better.
