Pain Management and Physiology Quiz

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Questions and Answers

What type of pain is characterized by damage to muscles, tendons, ligaments, and soft tissue?

Nociceptive pain (correct)

Somatic pain

Neuropathic pain

Neurogenic pain

Which of the following conditions can open the 'gate' in the Gate Control Theory?

Tension (correct)

Medication

Positive emotions

Relaxation techniques

What is the main role of opioids in pain control?

Stimulating neurotransmitter release

Increasing blood flow to tissues

Enhancing the sensation of pain

Blocking the release of neurotransmitters (correct)

Which fibers are responsible for transmitting sharp, pricking pain?

A delta fibers Signup and view all the answers

Which of the following conditions is likely to close the pain gate?

Involvement in life activities Signup and view all the answers

Which neurotransmitter is specifically mentioned as being blocked by opioids to manage pain?

Substance P Signup and view all the answers

Which phase of pain transmission is characterized by slow, burning pain?

C fibers Signup and view all the answers

How does vasodilation contribute to sympathetically maintained pain?

It increases sensitivity of pain fibers. Signup and view all the answers

What type of pain is characterized by damage or malfunctioning nerves?

Neuropathic Pain Signup and view all the answers

Which test is used to assess for Carpal Tunnel Syndrome by holding the wrist in acute flexion?

Phalen's Test Signup and view all the answers

Which condition is known to cause pain, numbness, and weakness specifically of the median nerve?

Carpal Tunnel Syndrome Signup and view all the answers

What percentage of individuals typically experience Phantom Limb Pain after an amputation?

60 to 80% Signup and view all the answers

Central post-stroke pain is classified as which type of pain?

Neuropathic Pain Signup and view all the answers

Which of the following is NOT a characteristic of neuropathic pain?

Pain originating from organs Signup and view all the answers

Which of the following conditions is considered a type of Central Neuropathic Pain?

Post Stroke Pain Signup and view all the answers

What does Tinel's Test assess in relation to median nerve function?

Numbness response to percussion Signup and view all the answers

How do Filipino individuals typically perceive pain?

Pain is regarded as 'God's will.' Signup and view all the answers

In which cultural background is voicing pain considered acceptable?

Italians Signup and view all the answers

Which of the following factors is NOT mentioned as influencing pain perception?

Physical fitness level Signup and view all the answers

What is the primary purpose of measuring pain according to the content?

For documentation and baseline assessment. Signup and view all the answers

What characterizes the pain response of Native Americans based on the given information?

They may tolerate pain until physically disabled. Signup and view all the answers

What physiological factor affects older adults' response to pain?

A greater ratio of body fat to muscle mass. Signup and view all the answers

Which pain assessment component directly involves understanding the patient's past experiences with pain?

Pain history Signup and view all the answers

What concept refers to the observed effect of a treatment due to the patient's expectation?

Placebo effect Signup and view all the answers

What is the primary function of an implantable infusion device or pump?

To deliver an active drug to a target organ Signup and view all the answers

How long can the medication in an intrathecal pump last?

1 to 6 months Signup and view all the answers

What is the major concern associated with exceeding the maximum dosage of acetaminophen?

Liver toxicity Signup and view all the answers

What is a common use for NSAIDs?

Reduction of prostaglandin synthesis Signup and view all the answers

What is the recommended maximum dosage of acetaminophen for adults in a single day?

4 grams Signup and view all the answers

Which of the following is a characteristic of DepoDur?

It lasts up to 48 hours after a single injection Signup and view all the answers

What is one of the nursing considerations when administering acetaminophen?

Limit usage to a maximum of 5 days for children Signup and view all the answers

What is the role of morphine pump implantation?

To deliver morphine for chronic pain management Signup and view all the answers

What is the primary purpose of a neurectomy?

To alleviate localized pain Signup and view all the answers

Which procedure involves the surgical removal of the presacral plexus?

Laparoscopic Presacral Neurectomy Signup and view all the answers

What is a common symptom that may lead to a rhizotomy?

Electric shock-like facial pain Signup and view all the answers

What is a major consequence of performing a rhizotomy?

Permanent loss of sensation Signup and view all the answers

In what condition would a cordotomy typically be performed?

Pain in the legs and trunk Signup and view all the answers

Which surgical procedure is performed after a laminectomy?

Rhizotomy Signup and view all the answers

What characterizes trigeminal neuralgia?

Extreme facial pain and spasms Signup and view all the answers

Which of the following describes the outcome of a laparoscopic presacral neurectomy?

Reduction in menstrual pain Signup and view all the answers

Study Notes

Visceral Pain

Pain stemming from activation of pain receptors in organs or hollow viscera.

Neuropathic Pain

Caused by damage or malfunctioning nerves.
Peripheral Neuropathic pain: pain stemming from damaged peripheral nerves.
- Phantom Limb pain (PLP): pain felt in a limb that has been amputated.
  - Occurs in 60-80% of individuals who have experienced limb amputations.
  - Can also occur after breast amputation, tooth extraction, and eye removal.
Inflated: inflammatory disorder of the nerves.
- Examples include repetitive stress injuries and physical injuries.
Carpal Tunnel Syndrome:
- Occurs when the median nerve is compressed in the carpal tunnel.
- Common in professions like secretaries and computer programmers.
- Symptoms include pain, numbness, paresthesia, and weakness of the median nerve.
- Assessment: Phalen's Test and Tinel's Test.
  - Phalen's Test: holding the wrist in flexion for 60 seconds to assess for numbness and burning in the fingers.
  - Tinel's Test: percussing lightly over the median nerve to assess for pain, numbness, and tingling.
Central Neuropathic pain: occurs when nerves in the CNS are malfunctioning.
- Examples include spinal cord injury pain, post-stroke pain, and multiple sclerosis pain.
Sympathetically maintained pain: inflammatory reaction involving neurotransmitters.
- Results in sensitization of other pain fibers, vasodilation, and edema.

Gate Control Theory

Theory that explains how pain signals are transmitted to the brain.
Pain signals are transmitted via A fibers (fast pain) and C fibers (slow pain).
Pain signals travel through the spinal cord to the brain.
Conditions that open the gate:
- Physical: extent of injury, inappropriate activity.
- Emotional: anxiety, worry, tension, depression, boredom.
- Mental: focusing on the pain.
Conditions that close the gate:
- Physical: medication, counter-stimulation, massage.
- Emotional: positive emotions, relaxation, rest, intense concentration.
- Mental: involvement and interest in life activities.

Phases of Pain transmission

Phase 1: Injury occurs (mechanical, thermal, chemical).
Phase 2: Activation of pain receptors.
Phase 3: Transmission of pain signals along nerve fibers.
- A fibers (fast pain): transmit sharp, pricking, electrical pain.
- C fibers (slow pain): transmit burning, aching, throbbing pain.

Pain Control

Opioids: pain relievers that block the release of neurotransmitters, particularly Substance P.
- Stops pain at the spinal level.

Cultural Influences on Pain Perception

Filipino: believe pain is "God's will" and may refuse pain medication.
Native Americans: may tolerate high levels of pain and may not request pain medication.
Arab Americans: pain is considered private and is reserved for immediate family, not health professionals.
Italians: voicing pain is considered acceptable.

Factors Influencing Pain

Gender: women have higher pain intensity and fear compared to men.
Placebo Effect: response to medication or treatment due to the expectation that it will work.
Environment and Support People: hospital environment can compound pain, and lonely individuals may experience increased pain.
Age: older adults may require smaller doses of analgesics due to slower metabolism, greater ratio of body fat to muscle mass.

Pain Assessment

Two major components:
- Pain History
- Direct observation of behaviours, physical signs of tissue damage, and secondary physiologic responses.
Goal: gain an objective understanding of the subjective pain experience.
Importance of pain assessment:
- Documentation
- Establishing baseline to assess therapeutic interventions.
- Facilitating communication between staff regarding patient care.

Pain Intensity Scales

Used to measure the intensity of pain.
- Examples include:
  - Numerical Rating Scale (NRS)
  - Verbal Rating Scale (VRS)
  - Visual Analogue Scale (VAS)
  - Faces Pain Scale (FPS)

Implantable Infusion device/Pump

Surgically implanted device that delivers medication to a target organ or body compartment for long-term pain management.
Pump is powered by a battery and is connected to a tube or catheter placed in the specific body area.
Refilled every 1-2 months.

Intrathecal Pump Implant

Also known as Spinal Pain Pump.
Implant delivers medication directly to the spinal fluid via a catheter.
Medication lasts 1-6 months, depending on concentration and amount infused.

DepoDur

One-time injection of morphine sulfate given during or shortly after surgery.
Maintains a therapeutically effective level of morphine in the bloodstream for 48 hours.

Spinal Anesthesia

Local anesthetic is injected into the subarachnoid space, typically through a fine needle.

Pharmacologic Interventions for Pain Control

Anesthetic Agents
Analgesics
- Nonopioid Analgesics:
  - Salicylates (e.g., Aspirin): analgesia, antipyretic, anti-inflammatory, antiplatelet.
  - Acetaminophen (e.g., Tylenol): analgesia, antipyretic. Side effects: GI irritation, occult bleeding, tinnitus, dizziness, confusion, liver toxicity.
  - NSAIDs (Non-steroidal Anti-inflammatory drugs): prevent prostaglandin synthesis. Used for rheumatoid arthritis, osteoarthritis, mild to moderate pain, primary dysmenorrhea, fever.
- Opioid Analgesics:
  - Used to relieve moderate to severe pain.
  - Side effects: nausea, vomiting, constipation, sedation, respiratory depression.
Adjuvant Analgesics:
- Drugs that enhance the efficacy of opioid analgesics or target other pain mechanisms.
- Examples: antidepressants, anticonvulsants, corticosteroids.

Neurosurgical Procedures For Pain Control

Performed for intractable pain of high intensity.
Involves surgical destruction of nerve pathways to block pain transmission.
Procedures:
- Neurectomy
- Rhizotomy
- Cordotomy
- Dorsal Root Entry Zone (DREZ) Lesion
- Laparoscopic Presacral Neurectomy (LPSN)

Neurectomy

Interruption of cranial or peripheral nerves by incision or injection to alleviate localized pain.

Rhizotomy

Surgical procedure to sever nerve roots in the spinal cord.
Required for:
- Trigeminal Neuralgia: inflammation of the trigeminal nerve causing extreme pain and muscle spasms in the face.
- Severing of the sensory root fibers to block pain signals to the brain.
- Motor root, which controls chewing muscles, is preserved.

Cordotomy

Interruption of pain-conducting pathways within the spinal cord.
May be done via needle insertion or laminectomy.
Interrupts conduction of pain and temperature sense in affected areas.
Used for pain felt in the legs and trunk.

Dorsal Root Entry Zone (DREZ) Lesion

Radiofrequency ablation of the dorsal root entry, which is a specific area in the dorsal horn of the spinal cord where pain signals enter.
Helps treat chronic pain, especially neuropathic pain, that has not responded to other treatments.

Laparoscopic Presacral Neurectomy (LPSN)

Surgical removal of the presacral plexus, a group of nerves that conduct pain signals from the uterus to the brain.
Used to treat central dysmenorrhea (painful periods), adenomyosis, and endometriosis.

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Description

Test your understanding of pain mechanisms, theories, and management strategies. This quiz covers key concepts from neurobiology and pain pathways, including the Gate Control Theory and opioid function. Perfect for students studying pain management or medical terminology.