Pain/Pain Management + Inflammation & Stages of Tissue Healing (wk 1)

What are the 5 cardinal signs of inflammation?

1. Redness

2. Swelling

3. Pain

4. Heat

5. Loss of Function

What are the 5 cardinal signs of inflammation in Latin?

1. Heat = “calor”

2. Redness = “rubor”

3. Swelling = “tumor”

4. Pain = “dolor”

5. Loss of function = “functio laesa”

What days of the tissue healing sequence does inflammation typically occur?

Days 1-6

What is the primary goal of the acute inflammation phase regarding the pathological insult/trauma?

Restoring function by eliminating the pathological or physical insult

T/F: Tissue healing can take place even if no inflammation occurs.

False
- Inflammation is necessary in preparation for healing because it cleans up the site.

What are platelets responsible for?

Coagulating (sticking together) & blocking off an injured area during the inflammation phase

What are neutrophils responsible for?

Responsible for fighting off infection during the inflammation phase

What are macrophages responsible for?

Removing dead cells from the injured site during the inflammation phase

What is hyperemia in the context of tissue injury?

An increase in blood in a given area, leading to heat & redness (vessels vasodilator, allowing more blood & more permeable vessels)

What is rheumatoid arthritis (RA)?

A chronic inflammatory condition characterized by an autoimmune response that destroys joints

What is a potential negative consequence of chronic inflammation (too much inflammation) involving fibroblasts?

Increased fibroblast proliferation (body produces more & more fibroblasts long after they are needed), which produces a surplus of collagen

• leading to excessive scar tissue & adhesion formation (excessive collage causes different layers of tissue to stick together)

• can lead to loss of function since balance between optimal, tensile, strength, & mobility of tissues is lost

How long does the proliferation phase of tissue healing generally occur?

3-20 days

What are the 2 primary goals of the proliferation phase?

1. Cover the wound (aka scab formation)

2. Imparting strength (aka creating a structural scaffold) to the injury site

What is neovascularization? What is the other term for it?

The process of forming new capillaries during the proliferation phase; angiogenesis

During the proliferation phase, tensile strength may be as low as _____ % of normal tissue, despite it having the _______ amount of collagen.

15%; greatest

Why is it important to avoid overusing tissue during the proliferation phase?

The newly formed tissue is fragile and possesses low tensile strength

Generally, how long does the maturation (remodeling) phase of tissue healing last?

Day 9-2 years

A scar appearing redder or darker than the surrounding tissue is an indicator of what?

That remodeling is still occurring in the scar

How does early controlled movement affect the final tissue structure during the maturation phase?

It’s beneficial as internal & external stresses will help determine the fiber orientation & final strength of the tissue

• Stresses “teach” the new collagen fibers how to align (fiber orientation); without the movement, tissue remains a “disorganized tangle”

• This makes the final scar stronger, more organized, & better at mimicking the original tissue

Which type of wound generally heals faster: a surgical incision or blunt trauma? Why?

Surgical incision; it’s a smaller wound in a cut that the body can try to piece back together

What is considered the most problematic local factor that can negatively affect the healing process?

Infection

Why do soft tissue injuries over bone often experience delayed healing?

They tend to stick (adhere) to bony surfaces, preventing contraction & opposition of wound edges

How does ischemia (decreased oxygen) affect fibroblast activity during healing?

Inhibits fibroblast migration & collagen synthesis

What is the most common reason individuals seek medical attention?

Pain

Pain has 2 components. What are they & briefly describe them?

1. A sensory experience (the actual physical sensation one feels)

2. An affective experience (a person’s reaction/their way of describing the pain)

What are the 2 components of the Central Nervous System (CNS)?

1. Brain

2. Spinal cord

How does the peripheral nervous system (PNS) differ from the CNS?

Consists of the nerves that branch out from the brain & spinal cord to the rest of the body.

What is nociception?

The neural process of our body figuring out what is painful (encoding a noxious stimulus that is intense enough to physically damage tissue.

T/F: A person can experience pain without any peripheral nonciceptive input

True

What are the 3 components of the ‘Vicious Pain Cycle’?

Spasm → Ischemia → Pain

In the Vicious Pain Cycle, how does ischemia lead to increased perception of pain?

Reduced oxygen & nutrients increase noxious stimuli sensory messages sent to the brain

How long is acute pain generally defined as?

6 weeks

What do we categorize as chronic pain?

Pain that has lasted longer than 3-6 months

What is a dermatome?

An area of skin innervated by a specific nerve root

What is a myotome?

An area of muscle innervated by a specific nerve root

What is hyperalgesia?

Excessive sensitivity to pain (increased pain sensitivity), often caused by damage to nerves

What is allodynia?

Pain due to a stimulus that does not normally provoke pain (ex. light touch causing pain)

What is analgesia?

Loss of pain sensation resulting from an interruption in the nervous system pathway

What is visceral pain?

Pain that arises from deep body structures that’s often difficult to localize

What is a trigger point?

A focus of hyperirritability in a tissue, often a palpable nodule that gives rise to referred pain

What is referred pain?

Discomfort you feel in one part of your body while the actual source of the problem/injury is elsewhere

How do physical agents like TENS or cryotherapy “close the gate” to pain transmission?

By supplying non-nociceptive input to sensory nerves to inhibit pain signals at the spinal cord

• Activates A-beta fibers which help inhibit nociceptive transmission

What are A-beta fibers?

Myelin-wrapped fibers that carry safe messages (ex. light touch, vibration, pressure), but NOT pain

What are A-delta fibers?

Myelin-wrapped fibers that transmit fast, sharp, & well-localized nociceptive info (pain info)

What are C-fibers?

Unmyelinated fibers that conduct slower & transmit dull, aching, & burning sensations

• Think of the “second pain” that lingers after an injury

What is considered the “first line of defense of treatment” for moderate or severe acute pain?

Pharmacological management

Name 3 common types of NSAIDs used for pain & inflammation

1. Aspirin

2. Ibuprofen

3. Naproxen sodium

Which common over-the-counter analgesic provides pain relief but lacks anti-inflammatory properties?

Acetaminophen (Tylenol)

What does the acronym RICE stand for in acute pain management?

Rest

Ice

Compression

Elevation

What is the primary purpose of “Ice” in the RICE protocol?

To reduce pain by decreasing inflammation & peripheral sensitization in the tissues

In patient education, what should be reinforced regarding the complete elimination of pain in the short term?

Complete elimination is usually not achievable, but the pain is normal & not inherently dangerous & almost always resolves in time

Which cells are involved in neovascularization?

Newly formed capillaries