Pain pathways

Define perception (pain pathway)

processing and recognition of pain in the brain

Define transmission (pain pathway)

conduction of impulses from the peripheral pain receptors to the spinal cord

define modulation(pain pathway)

amplification or suppression of pain impulses by neurons in the spinal cord

Define transduction (pain pathway)

noxious stimuli are transformed into electrical signals by nociceptors

define noxious stimuli (3ish)

chemical, thermal, or mechanical stimuli

what is the goal of analgesics

to stop as many pathways as possible so the patient doesn’t feel pain

what is the pain pathway route (4)

transduction → transmission → modulation → perception

where does transduction occur

receptors

where does transmission occur

peripheral nerves

where does modulation occur

spinal cord

where does perception occur

brain

define nociception

Detection by the nervous system of the potential for or the actual occurrence of tissue injury

define physiologic pain

the protective sensation of pain that normally occurs when there is a possibility of or actual tissue injury

Physiologic pain is — pain because it promotes survival by preventing injury and by promoting healing of the injured body part.

adaptive

define pathologic pain

pain that is amplified and persistent

pathologic pain is pain that is due to …

malfunction of or damage to the nervous system

Inflammatory pain occurs at the site of — —

tissue injury

Neuropathic pain results from injury to the — —

nervous system

define acute pain

refers to pain that has an immediate onset after a tissue injury and resolves when healing is complete

define chronic pain

lasts weeks, months, or years, and persists after the tissues have healed or when they will not heal

define visceral pain

Pain can originate from organs

define somatic pain

pain from the musculoskeletal system

What drugs inhibit Transduction (4)

1. Local anaesthetics

2. Opioids

3. NSAIDs

4. Corticosteroids

What drugs inhibit Transmission (2)

1. Local anaesthetics

2. $\\alpha_2$-agonists

What drugs inhibit Modulation (5)

1. Local anaesthetics

2. Opioids

3. $\\alpha_2$-agonists

4. NMDA antagonists

5. NSAIDs

What drugs inhibit perception (4)

1. Anaesthetics

2. Opioids

3. $\\alpha_2$-agonists

4. Benzodiazepines

what are the consequences of untreated pain (10)

1. Catabolic state

2. Suppresses the immune response

3. Pain promotes inflammation

4. Increased anesthetic risk due to increased doses of anesthetic agents needed to maintain anesthesia

5. Patient suffering

6. Harder to get pain under control when pain meds are given

7. allodynia, a phenomenon in which an area close to the site of tissue injury is painful if stimulated with a normally non-noxious stimulus

8. Leads to windup

9. Decrease in quality of life (five freedoms)

10. Stressful for caregivers and clients

Pain produces a — state

catabolic

what changes (physically/vitally) when there is an increased anesthetic risk (6)

1. higher blood pressure

2. RR high

3. tidal volume low due to short breaths

4. hyperventilating

5. CO2 high

6. effects pH to brain

define allodynia

a phenomenon in which an area close to the site of tissue injury is painful if stimulated with a normally non-noxious stimulus

define windup

receptors got shot so much they kinda just go “EVERYTHING PAIN”

what drugs help stop/reverse windup (2)

1. ketamine

2. methadone

what med is best to stop/prevent windup

ketamine

what are the 5 freedoms

1. Freedom from hunger and thirst

2. Freedom from discomfort

3. Freedom from disease

4. Freedom from injury

5. Freedom from pain

cardiovascular signs of pain (4)

1. Hypertension

2. Tachycardia

3. Tachyarrhythmias

4. Peripheral vasoconstriction (pale mm’s)

respiratory signs of pain (6)

1. Tachypnea

2. Shallow breathing

3. Exaggerated abdominal breathing

4. Panting

5. Open mouth breathing

6. Dilated Pupils

movement behaviour signs of pain (7)

1. Changes in gait

2. Changes in activity level

3. Development of exercise intolerance

4. Decreased performance

5. Reluctance to jump or do stairs

6. Shifting weight

7. Standing or laying in abnormal positions

reactions behaviour signs of pain (4)

1. Vocalization (groaning, purring)

2. Growling

3. Biting

4. Kicking

general appearence behaviour signs of pain (8)

1. Facial expressions

2. Appearance

3. Attitude (ADR)

4. Grinding teeth

5. Altered head carriage

6. Lack of grooming

7. Uninterested in surrounds

8. Hiding

define Emergence delirium

a temporary state of mental confusion, agitation, and restless behavior that occurs when a person wakes up from general anesthesia.

how to test Emergence Delirium vs Pain

if you put preassure on pain, and dont react = not pain