Pain Flashcards

Question

Describe the gate control theory.

Answer 1

Damage results in AP sent along nociceptor into dorsal horn. If provide mechanical stimulation to same area, will travel through A-beta fibers, and will therefore transmit APs faster than A-delta fibers, so travel along the fiber and stimulate inhibitory neurons, resulting in presynaptic inhibition of pain information, so mechanoreceptors will stimulate target cell as opposed to the nociceptor.

Answer 2

Transcutaneous electrical nerve stimulator sometimes used for patients suffering from neuropathic pain post-shingles or secondary to diabetes, also in the early stages of labor. Overall effect is to block noxious stimulus.

Answer 3

Two aspects: 1. Earliest “Ow!” response 2. Fine distinction, interindividual variation (modulated by past experience)

Answer 4

End result, where neuronal activity becomes a conscious experience. Past experience, current situation, understanding, all modulate that conscious experience (somatosensory cortex).

Answer 5

* Reticular system elicits an autonomic response (thus patients with chest patient may also have nausea, sweating...) * Limbic system links perception of pain with mood

Answer 6

Chronic condition can lead to depression and anxiety

Answer 7

• Visceral nociceptors (usually C fibers) respond to distension or ischaemia

Answer 8

VISCERAL PAIN - Visceral primary afferents will activate multiple second order neurones (unlike somatic, one nociceptor activates one second order neuron) - C vibers from viscera converge on second order neurones with somatic input (e.g. second order neuron may also be getting A-delta fiber from shoulder, so pain may refer to the shoulder) REFERRED PAIN (convergence)

Answer 9

Visceral pain more diffuse (less well localised)

Answer 10

Gall bladder and diaphragm

Answer 11

``` Associated features (remember Autonomic NS) • Sweating • Pallor • Nausea • Tachycardia • Hypertension ```

Answer 12

Preparation and Prevention Recognise Assessment Treatment

Answer 13

• Anticipation and simple adjustments (e.g. damaged hand take ring off due to incoming swelling, elevate hand, ice packs to minimize swelling) • Distraction • Education (e.g. if patient with shoulder pain had relative with similar pain who had MI, reassure them if appropriate that's it's only Musculoskeletal) • Challenge misconceptions (that all pain is bad) • Re-branding: -"pain should be too strong a word but you will be tender" -"you shouldn't feel pain but you will feel heavy, heavy pressure" • Patient control ("raise a hand if you want me to stop") • Ametop, EMLA (topical local anesthetics, can be used in venapuncture, arterial blood gases, wait 30 mins after application)

Answer 14

THROUGH • History (patient tells you) • Observation (way patient is moving, behaving e.g. non verbal patient need to observe for any changes in behavior/mood) • Physiological parameters (acute pain- tachyC, hyperT) • Autonomic symptoms (pale, sweaty, nauseated) MORE CHALLENGING IN FOLLOWING GROUPS - Children- 2 and under non-verbal - Elderly with dementia- difficulty to express fact they have pain - Learning disability- may be non-verbal

Answer 15

SOCRATES + Impact of the pain...what does it stop the patient doing + Treatment history (compliance, S-E, benefits) + Psycho-social history and awareness of yellow flags

Answer 16

Back pain and temperature | Woken up in middle of night with back pain

Answer 17

``` May affect cause of pain Affects prescription (renal impairment- avoid NSAIDS, opioids) ```

Answer 18

Things which are likely to make acute pain become chronic pain

Answer 19

Maximum score is 15. Limitations: pain is multidimensional and this scale is very unidimensional

Answer 20

* Identify and manage the underlying cause * WHO ladder of pain * Involve non-pharma treatments if appropriate

Answer 21

* Developed for cancer pain * Emphasises oral treatment * Treats nociceptive pain * May need other medications for neuropathic pain

Answer 22

A pain arising as a direct consequence of a lesion or a disease affecting the somatosensory system • Difficult to describe...shooting, lancinating, stabbing

Answer 23

Fairly common (3-18%)

Answer 24

Tricyclics (e.g. Amitriptyline) and Anticonvulsants (e.g. Gabapentinoids)

Answer 25

Traumatic (phantom limb pain) Diabetic neuropathy (absence of sensation can cause feet damage) Postherpetic neuralgia Trigeminal neuralgia Post-stroke pain

Answer 26

Changes in colour (e.g. of limb) | Changes in sensation

Answer 27

POSITIVE PHENOMENA ⚪Spontaneous pain (pain without stimulus) -Continuous (cutaneous, deep, visceral) -Paroxysmal ⚪Evoked pain (pain with stimulus, which is usually non-noxious) - Allodynia (qualitative abnormalities: mechanical, which can be dynamic or static, and thermal) - Hyperalgia (quantitative abnormalities) - Hyperpathia (spatial and temporal abnormalities) AUTONOMIC DYSFUNCTION ⚪Vasomotor (vascular dysfunction) ⚪Sudomotor (sweat and hair dysfunction) NEGATIVE PHENOMENA ⚪Sensory loss (thermal, vibration, soft touch)

Answer 28

PARA: abnormal sensation, whether spontaneous or evoked DYS: unpleasant abnormal sensation, whether spontaneous or evoked

Answer 29

Pain due to stimulus that does not normally provoke pain

Answer 30

Painful syndrome characterised by abnormally painful reaction to a stimulus, especially a repetitive stimulus, as well as an increased treshold.

Answer 31

Pain in the anatomical distribution of a nerve or nerves.

Answer 32

Pain persisting beyond the usual healing time of the acute injury (usually beyond three months (12 weeks)) Common

Answer 33

• Significant socio-economic burden (e.g. time off work)

Answer 34

Peripherally • Prolonged inflammatory response results in decreased pain threshold in primary afferents • Increased production of substance P and CGRP (and sensitising nociceptor) • Recruitment of NMDA receptors • Wakes up WDR • “wind-up” phenomenon Spinal cord • Changes in gene and receptor expression in DRG and dorsal horn neurons

Answer 35

Refer to graph on slide 41. Fear-Avoidance Model: ``` INJURY ↓ PAIN EXPERICENCE ↓ PAIN CATASTROPHIZING (input also from negative affectivity and threatening illness information) ↓ PAIN-RELATED FEAR ↓ AVOIDANCE+HYPERVIGILANCE ↓ DISUSE, DEP, DISABILITY ↓ PAIN EXPERIENCE ``` or ``` INJURY ↓ PAIN EXPERIENCE ↓ NO FEAR ↓ CONFRONTATION ↓ RECOVERY ``` Example: Bad cycle: Injury to my L arm, have past experience of relative having heart attacks and pain radiating to L shoulder, think you might have an MI, and be dying. Focus on it a lot, get scared, notice every-time it changes, stop using your arm (because every time use it, it causes pain and makes you aware of it) which makes it sorer, decrease in mood and down that spiral. Good cycle: If patient has been educated earlier on, reassured appropriately earlier on, no fear, happy it's simply musculoskeletal pain, happy by using limb they won’t do any harm, confrontation and use of the limb and eventually recovery

Answer 36

MODIFIABLE - Past experience of pain (that site and others) - Anxiety and Depression - Catastrophizing beliefs - Surgical approach (some can minimise chronic pain post-op) - Attitudes (patients that passively want to be cured more likely to enter chronic pain cycle than patients who are actively engaging in physio, yoga etc. to help pain) - Communication NON-MODIFIABLE - Gender (female) - Age (older, although for some surgeries e.g. inguinal hernia, opposite trend with younger males tending to get more chronic pain while in mastectomy older more likely) - Genetic prediposition - Lower socio-economic status - Occupational factors (if unhappy at work and perceive lack of support in work, can be a maintaining factor) - History of abuse (e.g. women's refuge) - Compensation (if benefiting from pain, unlikely to resolve until legal resolve)

Answer 37

* Severe continuous neuropathic pain * Abnormal sensation (either evoked positive symptoms of neuropathic pain, or negative phenomena and decreased sensation) * Vasomotor change (e.g. different color) * Sudomotor change (i.e. increased or decreased sweatiness) * Motor / trophic change (e.g. hair changes) * Regionally restricted e.g. hand * Disproportionate to the trauma (e.g. after fracture which would take 6 w, get this syndrome instead)

Answer 38

``` Brawny discoloration Shiny skin Cyanotic fingers Brittle ridged fingernails Swollen hand ```

Answer 39

Budapest Criteria 1. Patients must report continuing pain disproportionate to the trauma 2. Patients must report at least one symptom in three of the four following categories: (a) Sensory: hyperalgesia (that is, exaggerated pain to a painful stimulus, such as pinprick) and/or allodynia (that is, pain elicited by a normally non-painful stimulus, such as light touch) (b) Vasomotor: skin colour and/or temperature changes/asymmetry (c) Sudomotor/oedema: swelling and/or sweating changes or asymmetry (d) Motor/trophic: weakness, tremor, dystonia, decreased range of motion and/or trophic changes/asymmetry involving nails, skin and/or hair 3. Patients must display one sign in two of the categories above 4. Signs and symptoms must not be better explained by another diagnosis.

Pain Flashcards

(63 cards)