Pain
Define pain
The unpleasant sensory and emotional experience associated with actual or potential tissue damage supported by the client's expression of the experience.
What hormones are released to try and inhibit pain impulses? And what response is initiated?
-endorphins and serotonin
-The stress response
What is acute pain? What are some examples? Is it somatic, visceral, or both?
-Can last from hours to weeks and is associated with acute tissue damage, trauma, inflammation, or brief disease process.
-Ex: labor pain, surgical pain, trauma pain, wound pain (expectation is pain will stop when healing is complete/ a few days to weeks after affected procedure is completed.
-Can be somatic or visceral depending on area (BOTH)
Chronic Intractable Benign Pain- explain neck/back/sciatic pain; what are some risk factors? What are some specific back disorders?
-Risk factors: poor posture, decreased fitness levels, poor body mechanics
-Specific Back disorders:
-Intervertebral disk degeneration (decrease in cushion in disks, nerves can be compressed and swell)
-Herniated/Ruptured disk (when disk ruptures, fluid leaks and impinges on nearby nerves, can lead to sciatica)
-Sciatica (low back pain along the distribution of lumber nerve root)
Describe the process/what occurs during heat production, conservation, and loss.
-Heat production: produced through metabolic activity by chemical reactions occurring in cells. The greatest amount of activity occurs in the muscles and liver. Our basal metabolic rate decreases with age.
-Heat Conservation: Shivering (a way to produce heat through muscle contraction); peripheral vasoconstriction
-Heat loss: Vasodilation (increased heat loss through conduction); sweat glands increase in activity.
What occurs when a cell attaches to a nociceptor?
sodium channels are opened which causes an action potential.
What is the Gate Control Theory (Pain control)?
Non-painful input closes "pain gates" to painful input in dorsal horn, which prevents transmission to CNS.
-Non-noxious stimuli can decrease transmission of pain (ex: TENS therapy, hot/cold pack, massage therapy, etc.)
Chronic Recurrent pain: Describe migraines and sickle cell pain
Migraine: episodic exacerbations of unilateral throbbing pain and other associated neurologic symptoms
Sickle Cell pain: a genetic condition where the gene is damaged so Hgb can bind with oxygen but when it's released the cell collapses into a sickle shape. CELLS PRONE TO CLUMPING/GROUPING TOGETHER
Define thermoregulation
The balance between heat that is produced and lost from the body in an effort to maintain an average core body temperature of 37 C or 98.6 F.
What is a fever? What are exogenous and endogenous pyrogens?
-Exogenous pyrogens: bacterial endotoxins, viruses, trigger endogenous pyrogens.
-Endogenous pyrogens: produced by our white blood cells; immunes system's response to pyrogens (fever-producing agents)- triggers the hypothalamus in the brain to increase the set point.
What are nociceptors? Where are they found?
- cells of free nerve endings in the skin and peripheral organs that are activated to transmit pain information to the somatosensory system when there is a tissue injury.
-Located in all tissues except the CNS
What is the Neuromatrix Theory (Pain interpretation)?
-Pain is perceived and interpreted based on past experiences, beliefs, attitudes, and meaning. PAIN IS SUBJECTIVE!!
What is chronic pain? What are the three types? Give examples
-Increases in intensity over time and persists for months or years; associated with chronic diseases or after resolution of acute injury/inflammation
-Chronic recurrent pain (ex: headache, sickle cell pain)
-Chronic progressive pain (ex: cancer pain, osteoarthritis pain)
-Chronic intractable benign pain (ex: neck/back/sciatic pain, fibromyalgia pain)
-most common cause of widespread, musculoskeletal pain
-Pain lasts longer than 3 months; also can have fatigue, cognitive impairment
-There are 18 symmetric tender points (9 pairs); these are all sensitive to tactile stimulation.
Explain Hypothermia. What is accidental and what is induced?
-Excessive heat loss, insufficient production of heat, or dysfunction of hypothalamus (*below 36.2 C or 95 F)
-Accidental: environmental exposure
-Induced: Targeted temperature management- intentionally set to reduce metabolism and preserve tissue
What are the main chemical mediators released when a cell is damaged?
prostaglandins, bradykinin, substance P, and glutamate
What is Neuropathic pain? What are mixed pain syndromes?
-Neuropathic: diseased pain receptors that result from the pathology of the somatosensory system (includes phantom pain- burning, sharp, shooting)
-Mixed pain syndromes: a combination of nociceptive and neuropathic pain
Chronic Progressive Pain- explain Osteoarthritis
-MOST COMMON FORM OF ARTHRITIS
-can be idiopathic or secondary/ localized or generalized
-Aging results in cartilage breakdown, allowing bones to rub against each other. Bone spurs lead to pain and inflammation.
What three things are involved in thermoregulation? (structure, system, receptor)
-Hypothalamus
-Negative feedback loop
-Thermoreceptors throughout the body
What are some unique ways that newborns thermoregulate?
-They have brown fat (INFANTS DON'T SHIVER)
-Dependent on environmental temperature to keep warm
-They have a greater risk of heat loss
-Their blood vessels are closer to skin
-They have a thin layer of subcutaneous fat
What fibers carry impulses to the spinal cord?
-A-delta fibers
-A-beta fibers
-C fibers
What is nociceptive pain? What are the two different types?
-expected pain transmission
-Somatic: sharp, aching, or throbbing pain, localized to a SPECIFIC AREA
-Visceral: within body cavity, response to stretching, swelling, oxygen deprivation.
Chronic Progressive pain- explain cancer pain
-Nociceptors are stimulated by tissues/organs experiencing pressure and ischemia from solid tumors.
-Inflammation: cancer cells invade healthy tissue
-Pain can also occur at site of distant metastatic lesions
-Pain can occur due to cancer treatment
Explain the three types of phantom pain (paresthesias, phantom sensations, and telescoping). Why does neuropathic pain occur?
-Paresthesias: numbness, tingling, burning sensations
-Phantom sensations: sensations of movement, twitching of the amputated limb
-Telescoping: sensation that the distal part of missing limb is approaching the limb stump.
-Causes: changes in neural pathways secondary to amputation. There is a lower threshold for activation of nociceptors and a reduction in number or activity of inhibitory neurons.
Explain hyperthermia. What the difference between heat exhaustion and a heat stroke?
-Excessive heat production, inadequate ability to cool, or hypothalamic regulator dysfunction.
-Heat exhaustion is milder while a heat stroke causes an alteration in mental status, hot and dry skin, nausea, bradycardia and leads to destruction of cell mitochondria.