Opioids
True or False: opioid medication is safe to take for a long time
False
true or false: when part of your body is injured, special pain receptors convey the pain message to your brain
no, not receptors, we have nociceptor fibers not pain receptor fibers
true or false: is it possible to have pain and not know about it
false: pain is a brain construct.
Its possible to not know about an INJURY but not possible to know about pain
true or false: the body tells the brain when it is in pain
false: the body depends on many different factors and it is the brain that decides whether something hurt or not (also tells us how much attention to give it (sprained ankle when bus is coming at you example))
what ways does our body make our brain more efficient at detecting pain
lowering threshold of action potential, increasing abnormal impulse generating sites, increasing G proteins (signaling proteins transmitting external stimuli to cells interior causing signaling cascades)
True or False: overdose can still happen even if taking medication as directed by doctor
True
DO c fibers and a delta fibers conduct pain?
No, or all injuries would hurt, an injury could lead to a potentially life threatening event.
C-fibers respond to chemical, mechanical, and thermal stimuli, and are associated with the lingering pain that follows the initial pain sensation. They also cause a burning feeling of cold pain
A-delta fibers are responsible for the initial perception of pain, which is typically sharp, immediate, and relatively short-lasting.
true or false: pain correlates to tissue damage
false
True or false: the only conclusion we can make is that the brain will interpret whether there is pain or not, cannot say how much pain/severity of pain
true
why is it important for our body to make changes that make our brain more efficient at detecting pain
during acute pain we then know to stay off that injured area, then things are more sensitive in that area for a while because we do not want to reinjure the area
True or False: high doses of an opioid medication are more risky than lower doses of the same medication
False: when you have a lower dose of the medication you just take it more often. Example: taking a 50 mg tablet rather than a 100 mg tablet. Just have to take it more frequently, patients think "im taking the lower dose im safer" but no still at risk for over dose. could take at wrong time, forget if you take it, take more, take too soon, too frequently etc.
true or false: nerves can adapt by increasing their resting level of excitement
true: action potential threshold can change, body becomes more efficient at producing pain - body wants to know when its in pain and becomes more efficient
true or false: it is possible to have tissue damage
true (based on context, SDOH, trauma, stress, anxiety, etc.)
true or false: pain can depend on past experiences
true: people can interpret the color red as being hot and blue as being cold
Why is exercise such a powerful tool in changing ion channels and how does this help our patients with chronic pain
If pain is persistent then changes to the ion channels (such as stress/pain receptors) stay around longer, keep regenerating. Since ion channels have 48 hr lifespan, if we get someone moving and realizing they dont feel pain, we educate them and decrease that pain threshold, those ion channels can change, having less pain/stress ion channels.
Fentanyl is _____ times more potent than morphine
100 times more
true or false: nerves can adapt by making more ion channels (sensors)
true: ion channels only live about 48 hours, depending on genetic code but also what brain thinks is important for you to survive (sports/high contact cause ion channels to be less sensitive to this since it happens frequently, living in poor SDOH conditions - constant state of stress may include more channels)
what is an abnormal impulse generating site?
myelin stripped off due to injury or stress, nerve is injured, there is now more area for ion channels to concentration. if person in traumatic event, then more stress ion channels can occur there that can cause more pain (more ion channels doesnt necessarily mean more pain, it depends on the type of ion channel)
true or false: nociception occurs all the time but does not always result in pain
true (a nociception danger signal could be to fix your leg position if you cut off circulation and now its numb and you have the pins and needles sensation)
explain how central sensitization works
If there is constant C-fiber activation, some interneurons may die due to the high level of amino acids -> ability to modulate and control information is lost -> increase information to the brain. One impulse becomes 2 impulses to the brain.
explain the pathway from input of noxious stimuli to release of endogenous opioids
Acute injury -> A delta and C fibers send danger signals -> interneurons process the information -> brain gets signal and interprets pain -> send endogenous opioids to decrease pain and suppress danger input.
(In order to pass the interneuron blockade, a signal impulse needs to be passed onto second order neurons. )
mechanical, chemical, temperature, stress, movement immunity, blood flow
true or false: nerves can adapt by making ion channels stay open longer
true: G proteins (signaling proteins transmitting external stimuli to cells interior causing signaling cascades) can stay open for a lot longer than our normal ions (most only open for milliseconds at a time - G proteins can stay open for several minutes) this allows for ion channels to be more efficient in passing on nociceptive information to the brain
With continued stimulation from the periphery, changes to the spinal cord _______ ______ ______ and brain pathways leads to heightened sensitization.
second order neurons
how does second order ion channel upregulation work?
Lot of pain signals -> second order receptor change to allow more info to be processed - > then replaces with receptors that facilitate signals being sent to the brain (ex: under constant stress = more stress ion channels created), receptors with quick/short open time are replaced with G proteins (signaling proteins causing signaling cascades), -> second order neurons then more easily stimulated -> more action potentials made