Hard Sciences (Applied Pathophysiology)

Essential Pain Management

What is the cost-effective and multidisciplinary system for managing pain and teaching others about pain management?

Improve pain knowledge, implement a simple framework, and address pain management

What are the three main goals of the EPM system?

42 percent

What percentage of all adults experience pain daily?

Cardiac medications

What is the most common drug class prescribed overall, ranking just above pain medications?

10.4 percent

What is the prevalence rate of chronic pain in the Philippines, affecting approximately 11 million people?

Acute pain problems

What is the most frequent reason patients seek help from doctors in emergency rooms and sports medicine?

Inadequate knowledge of pharmacology, poor assessment practices, and focus on curing disease rather than treating pain

What are three major physician-related barriers to the treatment of pain?

S2 License

What specific license must a physician apply for to be legally authorized to prescribe opioid narcotics?

Joint Commission International

Which international accrediting body sets standards for making pain management a hospital priority?

Unpleasant sensory and emotional experience

How did the International Association for the Study of Pain originally define pain?

Actual or potential tissue damage

Pain is described as being associated with what kind of injury, whether visible or not?

2019

In what year was the definition of pain updated to include the term "aversive"?

Aversive

Which term in the updated pain definition refers to it being a negative or repellent experience?

Subjective

Because the definition uses the word "experience," it implies that pain is always what?

Potential injury

Pain can be described in terms of damage even if it is not immediately visible, which is referred to as what?

Nociception

What is the objective, physiological term for the neural response to traumatic or noxious stimuli?

Pain

While nociception describes the neural response, which term describes the actual subjective experience?

Allodynia

What is the perception of pain from an ordinarily non-noxious stimulus, such as light touch or wind?

Analgesia

What term defines the complete absence of pain perception?

Anesthesia

What term defines the complete absence of all sensation?

Anesthesia Dolorosa

What is the term for pain occurring in an area that otherwise lacks sensation?

Dysesthesia

What is an unpleasant or abnormal sensation that can occur with or without a stimulus?

Hypoalgesia

What is a diminished response to noxious stimulation?

Hyperalgesia

What is an increased response to a stimulus that is normally painful?

Hyperesthesia

What is an increased response to mild stimulation, excluding the special senses?

Hyperpathia

What term describes the presence of hyperesthesia, allodynia, and hyperalgesia with persistence after the stimulus?

Hypoesthesia

What is a reduced cutaneous sensation, such as light touch or pressure?

Neuralgia

What is pain occurring in the distribution of a nerve or a group of nerves?

Paresthesia

What is an abnormal sensation perceived without an apparent stimulus?

Radiculopathy

What is a functional abnormality of one or more nerve roots?

Neuritis

What is the medical term for the inflammation of a nerve?

Neuropathy

What is a disturbance of function or pathological change in a nerve?

Total Pain Care

Which principle states that pain is multi-dimensional and includes physical, psychological, spiritual, and social aspects?

Physical pain

In the clinical setting, where do doctors usually start when addressing the four aspects of Total Pain Care?

Addiction

What is a behavioral pattern characterized by compulsive drug use, securing supply, and high tendency to relapse?

Behavior

Is addiction defined by the physiological effects of a medication or by the behavior of the patient?

Physical dependence

Which pharmacological property is characterized by a withdrawal syndrome following the abrupt discontinuation of a drug?

Abrupt discontinuation

Physical dependence follows the administration of an antagonist or what other action regarding a substance?

Opposite effect

In physical dependence, stopping an opioid substance tends to have what physiological effect, such as tachycardia?

Addiction is psychological, Physical dependence is physiological

What is the fundamental difference between addiction and physical dependence?

Suffering

What is the reaction to pain involving feelings of uncontrollability, helplessness, and a threat to self-identity?

Tolerance

What is the physiologic state where a patient requires an increased dosage of a substance to sustain a desired effect?

Medications are not addressing the pain

If a patient requires more opioids because the cause of pain is still present, what does this indicate regarding their psychological state?

Based on Anatomy

Which pain classification categorizes pain as headache, low back pain, or pelvic pain?

Cancer pain

Which pain classification is associated with disease progression, metastasis, or chemotherapy?

Non-cancer pain

Which pain classification refers to pain due to tissue injury that is not related to malignancy?

Myofascial

Which body system-based pain involves the fascia and the muscles?

Rheumatologic

Which body system-based pain involves the joints, soft tissues, and connective tissues?

Causalgic

What term describes a burning pain resulting from injury to peripheral nerves?

Complex Regional Pain Syndrome

Causalgic pain is considered a part of which specific syndrome?

Recurrent pain

What are episodic or intermittent occurrences of pain with pain-free periods, such as migraines?

Transient pain

What pain is elicited by the activation of nociceptors in the absence of significant local tissue damage?

Acute pain

What pain is elicited by tissue injury, lasts for a limited time, and remits when the pathology resolves?

Less than 3 months

What is the temporal threshold used to define acute pain?

Chronic pain

What pain extends for a long period of time and represents underlying pathology that does not explain the extent of pain?

Greater than 3 months

What is the temporal threshold used to define chronic pain?

Remote from the originating cause

Chronic pain may be caused by factors that are physically and pathogenetically what?

neural pathway changes

In chronic pain lasting decades, the person experiences what type of modifications in how the brain processes information?

Somatogenic

Which pain etiology is established by the identification of positive organic findings?

Psychogenic

Which pain etiology is indicated only in the absence of positive organic signs?

0 to 10 point scale

What is the standard numeric scale used to assess pain severity?

Numeric Rating Scale

What is the official name of the 0-10 scale used for severity?

Check treatment progress

Why is it important to ask a patient to label pain as mild, moderate, or severe over time?

Nociceptive pain

Which mechanism-based pain involves obvious tissue injury and is often called physiological or inflammatory?

Sharp or dull

How do patients typically describe the quality of nociceptive pain?

Well-localizable

Is nociceptive pain usually described as well-localized or poorly localized?

Somatic pain

Which nociceptive subtype originates from injury to tissues, muscles, and bones?

Visceral pain

Which nociceptive subtype originates from internal organs and is often referred or poorly localized?

Neuropathic pain

Which mechanism-based pain is caused by a lesion or disease of the sensory nervous system?

Burning or shooting

What are two common sensory descriptors for neuropathic pain?

No protective function

Unlike acute nociceptive pain, neuropathic pain serves what protective function?

Nociplastic pain

What is the newest category of pain that arises from altered nociception despite no clear tissue damage?

Fibromyalgia, tension headaches, or chronic low back pain

Name an example of nociplastic pain.

Nociceptors, Ascending tracts, Higher centers, and Descending pathways

What is the correct four-step sequence of the pain pathway?

Inflammatory mediators

Tissue injury initiates nociception by releasing what type of substances?

Histamine, Serotonin, Bradykinin, Prostaglandin, and Substance P

Name five specific inflammatory mediators released during tissue injury.

Nociceptors

What are the free nerve terminals of primary afferent fibers that respond to injurious stimuli?

Chemical, mechanical, and thermal

Nociceptors transduce which three types of injurious signals?

Somatic and visceral

Nociceptors are present in both of which two types of body structures?

A-Delta and C-fibers

What are the two primary classes of nociceptors?

A-Delta fibers

Which nociceptor fibers are thinly myelinated and conduct at 2 to 30 m/sec?

C-fibers

Which nociceptor fibers are unmyelinated and conduct at less than 2 m/sec?

Mechano- and thermoreceptors

What two types of receptors do A-Delta fibers primarily innervate?

Mechano-, thermoreceptors, and sympathetic postganglionic

What three types of structures do C-fibers innervate?

A-Delta fibers

Which fiber type provides more accurate pain localization?

C-fibers

Which fiber type produces long-lasting, burning pain?

Laminae I and V

Where do A-Delta fibers terminate in the Rexed Laminae of the spinal cord?

Lamina II

Where do C-fibers primarily terminate in the Rexed Laminae?

Excitatory neuromediators

Which class of neuromediators, such as Glutamate, is responsible for promoting pain signals?

Inhibitory neuromediators

Which class of neuromediators, such as GABA, is responsible for lessening pain?

Glutamate and Aspartate

Name two amino acid excitatory neuromediators.

Substance P and CGRP

Name two neuropeptide excitatory neuromediators.

Enkephalin and Beta-endorphins

Name two endogenous inhibitory opioids.

GABA and Glycine

Name two inhibitory amino acids.

Rexed Laminae

The gray matter of the spinal cord is organized into 10 layered zones called what?

Laminae I to VI

Which laminae collectively make up the sensory gateway or dorsal horn of the gray matter?

Lissauer's tract

Pain fibers enter the spinal cord via which specific posterolateral tract?

Dorsal horn

Where do first-order neurons primarily synapse with second-order neurons?

Spinothalamic tract

What is the most important ascending pathway for the transmission of nociceptive stimuli?

Anterolateral quadrant

Where is the spinothalamic tract located within the spinal cord?