What is neuropathic pain, and how does it originate?
Direct injury or dysfunction of the sensory axons of peripheral or central nerves
Caused by injury to tissues
What nociceptive pain, and how does it originate?
Activation of nociceptors (nerve endings) in response to actual or impending tissue damage
Caused by direct injury to nerves
How do afferent and efferent neurons contribute to pain sensation and motor responses?
Afferent: sensory nerves that carry pain, temp, touch, proprioception, vibration and pressure sensations to the SC and brain (Up)
Efferent: Motor neurons that exit the spinal cord and extend to the myos (Down)
Describe the role of nociceptors in the pain pathway.
Nociception: The response of the nervous system to painful stimuli
1. Starts with nociceptors in the skin, myo, CT, bone, circulatory system, thoracic/abd/ pelvic viscera
2. Signal is brought to spinal cord
3. SC carries signal to thalamus then to sensory area for interpretation
4. Signals are transmitted along nerve paths when neurotransmitters are released from 1 neuron and set to another
Explain the Gate Control Theory of pain and how it accounts for variations in pain perception.
- Pain is not necessarily proportional to the amount of tissue injury
- Sensation travels both to and from the brain
How do acute and chronic pain differ in their duration, symptoms, and physiological responses?
Acute: short duration, protective pain, causes appropriate response to reduce/remove source of tissue damage. Causes sympathetic response ( increase BP and RR and Pulse
Chronic: longer and persistant, non protective pain, leading cause of disability, associated with loss of sleep, appetite and depression
What is the Neuromatrix Theory, and how does it expand on the Gate Control Theory?
NMT emphasizes the brains influence in experiences of pain
GCT expands- the brain can generate painful sensations independently
What is nociceptive pain and how can it be distinguished?
protective pain that stimulates from injuries/pain
What is somatic, pain and how can it be distinguished?
produces sharp, localized sensations to the body
What is visceral pain, and how can it be distinguished?
produced generalized dull and internal throbbing/aching pain
What is neuropathic pain, and how can it be distinguished?
caused by direct tissue injuries (damage to SC or peripheral nerves and causes pins/needles, bussing feeling, bugs crawling, burning pain
Explain the concept of referred pain and provide an example.
pain perceived in a site different from injury, stays in the same spinal segment (dematome)- left arm pain from heart
What is the purpose of a pain assessment, and how do tools like OLDCART or OPQRST improve pain evaluation?
- To guide the course of treatment
- gives more definitive evidence of pain (location, onset, relieving factors ect. )
What does OLD CART stand for
O- onset
L- location
D- Duration, direction
C- Characteristics, Count (0-10)
A- Associated/Aggravting factors
R- relieving factos
T- treatments tried, time
How does the perception and reporting of pain differ in neonates or cognitively impaired individuals?
may have not developed/lost the development of the perception/communication skills
Describe the characteristics and treatment of pain syndrome such as post-herpetic neuralgia
- Occurs after shingles
- Pain develops afteer rash subsides, often much worse when area is touched or when air blows on it
- Pain can last months or years
Describe the characteristics of pain syndrome such as fibromyalgia.
- Long term all over joint and body pain
- Pain in at least 11/18 trigger points
- Cause is unknown
What causes neuropathic pain, and how does it manifest in conditions like diabetic peripheral neuropathy?
- Increased glucose and atherosclerosis affect both afferent and efferent distal nerves
- Decreased sensation, paresthesias in feet
- Decreased sense of balance and wound healing (due to poor circulation)
- Severely increases risk of wounds and infection in feet
How does cancer pain differ from other types of pain in terms of its mechanisms and impact on patients?
- Very painful
- Always treat at the highest level of drugs possible
- Can be dehabilitating
What are the unique features of trigeminal neuralgia?
- Stabbing/electric shock pain in CN V (trigeminal nerve)
- Unilateral
- Chewing/wind can cause pain and some people can have it be recurrent
What are the unique features of complex regional pain syndrome
- Severe, progessive, pain, edema, discoloration and changes in the skin, starts with 1 limb and may progress to others
- Causes dysfunction of the autonomic nervous system
- Treatment is NSAIDs, adjuvant pain meds, corticosteroids, nerve blocking agents
What is the primary purpose of inflammation, and how does it contribute to tissue repair?
- It is protective coordinated response of the body to an injurious agent
- Eliminates initial cause of cell injury, removes the damaged tissue, generates new tissue
- It also boosts immunity
Describe the vascular stages of acute inflammation.
- Vasodilation occurs and causes congestion and erythema
- Increased permeability of the micro-vasculature pushed fluid into extra vascular spaces
3- Intravascular fluid is more contracted, increased clotting which localizes spread of microorganisms, decreases pH and dilutes toxins
Describe cellular stages of acute inflammation.
- Leukocytes increase (leukocytosis)
1. Migration: aderance to the epithelium
2. Transmigration: across endothelium
3. Chemotaxis: mvm of cells towards an area of infection
4. Activation and phagocytosis
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