Pain

Question 1

A-delta vs. C fibers

Answer 1

A delta: Sharp, localized transmission, FAST

C: Dull, aching, diffuse, SLOW

Question 2

Gate Control Theory

Answer 2

A-alpha and A-beta fibers inhibit pain signals to the brain by stimulating an interneuron. E-stim and massage take advantage of gate theory.

Question 3

Opiopeptins

Answer 3

AKA endorphins
Bind to opioid receptors > inhibit pain

Direct effect: control amount of Ca and K moving into and out of nerve during depolarization

Indirect effect: Inhibit GABA (GABA usually inhibits pain controlling structures like A-beta fibers)

Question 4

McGill pain questionnaire

Answer 4

1. Pt marks where pain is on body diagram
2. Pt chooses one word to describe pain from each of twenty categories
3. Pt describes pattern of pain, aggs and eases
4. Pt rates intensity of pain 0-5

Valid, reliable, most widely used

Question 5

Viscerogenic pain

Answer 5

• Thought to mimic musculoskeletal pain due to viscerosomatic convergence
• Doesn’t change with movement/positioning
• Often diffuse, poorly localized
• May be accompanied by other systemic symptoms (N/V, weight loss, pallor, diaphoresis)

Question 6

Common sites of viscerogenic pain

Answer 6

shoulder, scapula, back, chest, pelvis, SI, groin, hip

Question 7

MI referred pain

Answer 7

chest, mid back, shoulder, arm, neck, jaw

Heart innervation: C3-T4

Question 8

Kehr’s sign

Answer 8

Pressure to upper abdomen, or supine positioning, recreates left shoulder pain

(Due to accumulation of blood in abdomen irritating diaphragm. Phrenic nerve = C345. Often due to splenic rupture)

Question 9

Gall stone referred pain

Answer 9

Right upper abdomen, interscapular region. Sometimes right shoulder if diaphragm is irritated.

Gallbladder innervation = midthoracic spinal segments

Question 10

Empty end feels

Answer 10

Joint inflammation
Fracture
Bursitis

Question 11

Firm end feels (abnormal)

Answer 11

Increased tone
Tightening of capsule
Ligament shortening

Question 12

Hard end feels (abnormal)

Answer 12

Fracture
OA
Osteophyte formation

Question 13

Soft end feels (abnormal)

Answer 13

Edema
Synovitis
Ligament instability/tear