NUR 252 Pain and Thermoregulation

what is the term for unpleasant sensory and emotional experience associated with actual or potential tissue damage supported by the client's expression of the experience?

pain

what are the interrelated concepts for pain?

culture, development, functional ability, mobility, tissue integrity, fatigue, sleep, mood and affect, spirituality

what is the term for cells of free nerve endings in the skin and peripheral organs that are receptors for the sensation of pain?

nociceptors

nociceptors are found in al tissues except for where?

CNS

what injury activates nociceptors to transmit pain and information to the somatosensory system?

tissue

what is it called when tissue injury activates nociceptors to transmit pain information to the somatosensory system?

nociception

is the experience of pain subjective or objective?

subjective

what is released from damaged cells in the process of pain?

prostaglandins, bradykinin, substance P, glutamate, other chemical mediators

what does the prostaglandins, bradykinin, substance P, glutamate, and other chemical mediators attach to in the process of pain?

nociceptor

when the prostaglandins, bradykinin, substance P, glutamate, and other chemical mediators attach to a nociceptor, what opens?

sodium channels

what does the opening of sodium channels cause?

action potential (transduction)

in the process of pain, what pathway fibers carry impulses to the spinal cord?

afferent

what is it called when afferent pathway fibers carry impulses to the spinal cord?

transmission

what are three types of afferent pathway fibers?

a-delta, c, a-beta

what fibers are associated with acute pain sensations and are fast and sharp?

a-delta

what fibers are associated with chronic pain and are dull and achy?

c

what fibers don't carry pain sensations, but touch and vibration, and often help to decrease pain because the body focuses on the sensation and closes off some channels?

a-beta

adter the spinal cord, where do impulses go in the pain process?

interpretive centers in the brain

in the pain process, what pathways carry signals back?

efferent

in the pain process, when efferent pathways carry signals back, what is released?

endorphins, serotonin, GABA, other substances

what do enorphins, serotonin, GABA, and other substances try to do?

inhibit (modulate) pain impulses

what is initiated in the pain process after the release of endorphins serotonin, GABA, and other substances?

stress response

what theory deals with pain interpretation?

neuromatrix

what theory involves the brain producing patterns of nerve impulses drawn from various inputs including genetic, psychologic, and cognitive experiences?

neuromatrix

in the neuromatrix theory, pain is perceived and interpreted based on past what?

experiences, beliefs, attitudes, and meaning

in the neuromatrix theory, is pain subjective or objective?

subjective

what is the threshold?

minimum pain

what is tolerance?

maximum pain

what theory deals with pain control?

gate control theory

in what theory does non-painful input close "pain gates" to painful input in the dorsal horn and prevents transmission to the CNS?

gate control

in the gate control theory, what stimuli can decrease transmission of pain?

non-noxious

what are the four types of pain?

nociceptive, chronic, neuropathic, nociplastic

what pain has expected transmission and is acute?

nociceptive

what are the three types of nociceptive pain?

somatic, visceral, referred

what is sharp, aching, or throbbing pain localized to a specific area?

somatic

what is pain within a body cavity, that is a response to stretching, swelling, and oxygen deprivation?

visceral

what is pain is felt in an area distant from its point of origin?

referred

what pain is longer than 3-6 months and is out of proportion to an observable injury?

chronic

what pain results from pathology of the somatosensory system and includes phantom pain- burning, sharp, shooting?

neuropathic

what pain comes from diseased pain receptors?

neuropathic

what pain is caused by altered nociception despite no clear evidence of disease causing pain?

nociplastic

what type of pain can last from hours to weeks and is associated with acute tissue damage, trauma, inflammation, or brief disease process?

acute

what pain can be somatic or visceral depending on the area?

acute

what is the expectation of acute pain?

it will stop when healing complete and/or few days to weeks after affected procedure completed

what are some exampes of acute pain?

labor pain, surgical/trauma/wound pain

what pain persists for months or years and is associated with chronic diseases or after resolution of acute injury/inflammation?

chronic

what are some examples oof chronic recurrent pain?

headache/migraine pain, sickle cell pain

what are some examples of chronic progressive pain?

cancer pain, osteoarthritis pain

what are some examples of chronic intractable benign pain?

neck/back/sciatic pain, fibromyalgia pain

what is a common chronic recurrent pain that has many causes?

headache

what chronic recurrent pain includes episodic exacerbations of unilateral pulsating, throbbing pain with other associated neurologic symptoms (moderate or severe pain)?

migraine

what is the strong genetic component of migraines?

altered brain excitability, spreads across cortical gray matter, innervate cerebra vessels, and active trigeminal nociceptors

what releases pain-producing chemical mediators including substance P, and neurokinin?

migraine

does a migraine result in vasodilation or vasoconstriction?

vasodilation

what are the three types of migraines?

with aura, without aura, chronic

true or false; migraines can be triggered

true

what type of migraines have warning symptoms/signs before the onset of the migraine?

with aura

what are the clinical phases of a migraine?

prodrome phase, migraine, aura (only some), headache phase, recovery (postdrome) phase

what phase is a few days before a migraine and has symptoms like irritation and fatigue?

prodrome

what phase of a migraine occurs a few hours before the onset?

aura

what phase of a migraine is a full blown out migraine?

headache

what phase of a migraine is after the onset with some lingering symptoms?

recovery/postdrome

how often do chronic migraines occur?

at least 15 days in 1 month for more than 3 months

what is a genetic condition where the gene is damaged, Hgb can bind to oxygen but when released the cell collapses into a sicke shape?

sickle cell disease

in what disease are cells prone to grouping/clumping together, causing obstruction and occluding further blood flow and oxygenation?

sickle cell

what are some signs/symptoms of sickle cell disease?

palor, pain, fatigue

what crisis in sickle cel disease includes vasospasm, logjam effect, and can lead to infarction?

vasooclusive

in cancer pain, what causes inflammation?

cancer cells invade healthy tissue

where can cancer pain occur at the site of?

distant metastatic lesions

why can pain occur due to cancer treatment?

rapid cell death (cancer cells and healthy cells)

what pain will get worse unless there is intervention?

cancer

what is the most common form of arthritis?

osteoarthritis

what percent of the world's population 65 and older does osteoarthritis affect?

50%

what is can be idiopathic or secondary?

osteroarthritis

what can be ocalized or generalized?

osteoarthritis

what results in cartilage breakdown, allowing bones to rub against each other?

aging

what lead to pain and inflammation with osteoarthritis?

bone spurs (osteophytes)

what is seen on an x-ray for osteoarthritis

bone degeneration

what are some signs/symptoms of osteoarthritis?

tenderness, swelling, crepitus

what pain is very common benign pain?

back and neck pain

what are risk factors for back and neck pain?

poor posture, decreased fitness levels, poor body mechanics

what are some specific back disorders?

intervertebral disk degeneration, herniated/ruptured disk, sciatica

what degeneration includes a decrease in cushion in disks, and the nerves can be compressed and swell?

intervertebral disk

what is it called when a disk ruptures, fluid leaks, and impinges on nearby nerves, and can lead to sciatica?

herniated/ruptured disk

what includes low back pain along the distribution of a lumbar nerve root?

sciatica

what deficits with sciatica include tingling, numbness and weakness in various parts of the leg and foot?

neurosensory and motor deficits

what is the most common cause of widespread, muscoskeletal pain?

fibromyalgia

what pain lasts longer than 3 months and can also have fatigue, cognitive impairment, and stiffness?

chronic intractable benign pain/fibromyalgia

what pain starts in one area and can become widespread?

chronic intractable benign pain/fibromyalgia

how many symmetric tender points are in chronic intractable benign pain/fibromyalgia?

18 (9 pairs)

how many painful areas are there in chronic intractable benign pain/fibromyalgia that are sensitive to tactile stimulation?

19

what might have abnormal nociceptive pathways?

fibromyalgia

what is exacerbated by physical or emotional trauma and stress, and is a considerable impact on daily life?

fibromyalgia

what pain is neuropathic

phantom pain

what is included in phantom pain?

paresthesias, phantom sensations, telescoping

what is the term for numbness, tingling, and burning sensations?

parethesias

what is the term for sensations of movement and twitching of the amputated limb?

phantom sensations

what pain has a ower threshold for activation of nociceptors?

phantom

what pain has a reduced number or activity of inhibitory neurons

neuropathic

what pain has changes in neural pathways secondary to amputation?

phantom