Physical Interventions Quiz 1

d. nociceptors

pain receptors in the body are called ______________:

a. Meissner's corpuscles

b. Krause's end bulbs

c. Pacinian corpuscles

d. nociceptors

a. substance P

which of the following facilitates transmission of sensations of pain?

a. substance P

b. enkephalin

c. dynorphin

d. serotonin

a. large-diameter fibers

which of the following is/are characteristics of AB fibers?

a. large-diameter fibers

b. slow conduction velocities

c. transmission of brief, localized pain

d. all of the above

b. AB

TENS results in stimulation of the enkephalin interneurons in the dorsal horn via the depolarization of _____________ primary afferent nerve fibers.

a. Aa

b. AB

c. AS

d. C

a. hypothalamus

second-order afferent nerves terminate in all of the following regions except the ____________.

a. hypothalamus

b. thalamus

c. reticular formation

d. periaqueductal gray region of the midbrain

c. both a and b

which of the following affects pain perception?

a. clinical depression

b. past pain experiences

c. both a and b

d. neither a nor b

false

t/f: afferent nerve fibers conduct impulses from the brain to peripheral sites

true

t/f: enkephalins inhibit synaptic transmission in the dorsal horn

false

t/f: electrons tend to flow from areas of low concentration to areas of high concentration

true

t/f: insulators resist current flow

true

t/f: the greater the voltage, the greater the amplitude is

true

t/f: the cathode is the negatively charged electrode in a DC system

b. electron

a particle of matter with very little mass and a negative charge is a(n):

a. ion

b. electron

c. neutron

d. proton

c. volt

what is the name of the unit measuring the force necessary to produce electron movement?

a. ampere

b. coulomb

c. volt

d. watt

a. alternating

in ______________ current, electron flow constantly changes direction

a. alternating

b. direct

c. pulsatile

d. galvanic

b. ramping

when the current increases gradually to a maximal amplitude, it is known as:

a. burst

b. ramping

c. modulation

d. galvanic

d. series

in ____________ circuits, electrons have only one path to follow

a. galvanic

b. parallel

c. resistor

d. series

d. all of the above

physiological responses to electrical current include:

a. thermal

b. chemical

c. physiologic

d. all of the above

b. increase, further apart

to _____________ current density in deeper tissue, the electrodes must be placed ____________

a. increase, closer

b. increase, further apart

c. decrease, closer

d. decrease, further apart

c. opiate pain control theory

electrical stimulation may release enkephalin and endorphin to cause pain relief. what is the name of this pain control method?

a. gate control theory

b. central biasing theory

c. opiate pain control theory

d. placebo effects

a. destructive interference

two currents combine and the amplitude decreases. this is called:

a. destructive interference

b. constructive interference

c. heterodyne current

d. beat current

d. Russian

which of the following currents is a pulsatile biphasic wave, generated in bursts, designed to create muscle contraction?

a. LIS

b. iontophoresis

c. IFC

d. Russian

d. medical galvanism

increased blood flow between electrodes is an effect of which of the following?

a. IFC

b. function electrical stimulation

c. LIS

d. medical galvanism

pain is a multiple system output that is activated by an individual’s specific neural signature, which is activated whenever a person perceives a threat

what is the modern pain definition

an unpleasant sensory and emotional experience associated with or resembling actual or potential tissue damage

what is the old pain definition

acute pain

pain of sudden onset

chronic pain

pain lasting for more than 6 months and may see as low as 3 months

referred pain

pain that is perceived to be in an area that seems to have little relation to the existing pathology

radiating pain

pain caused by irritating nerve roots and extending distally (ex. intervertebral disc herniation)

deep somatic pain

pain associated with a segment of bone innervated by a spinal segment that is a pain (ex. deeper ache like “bone pain”)

nociceptive pain

pain from a normal process that results in noxious stimuli being perceived as painful; the normal physical response to actual or threatened tissue damage to the body

numeric pain rating scale (NPRS)

most common acute pain rating scale, rate on a scale from 1-10

neuropathic pain

pain from damage to neurons of either the peripheral or central nervous system

nociplastic (chronic or central pain)

chronic pain caused by altered nervous system function rather than clear tissue damage or nerve injury

A alpha

type of first order neuron that is proprioceptive and large/fast

A beta

type of first order neuron that is cutaneous and large/fast

A delta

type of first order neuron that is mechano/thermo/nociceptor and carries “fast pain”; is small mylenated/slower

C

type of first order neuron that is mechano/thermo and carries “slow pain”; is small unmylenated/slow

first order/primary afferents

transmit impulses from the sensory receptor to the dorsal horn of the spinal cord

wide dynamic range or nociceptive specific (pain)

what are second order neurons classified as

wide dynamic range

second order afferents that receive input from A beta, A delta, and C fibers

nociceptive specific

second order afferents that respond exclusively to noxious stimulation

A delta and C fibers

what do nociceptice specific second order afferent neurons receive input from

third order neurons

all neurons synapse with what to carry information to various brain centers where the input is integrated, interpreted and acted upon

thalamas to different parts of the brain like the somatosensory cortex

where do the third order neurons typically run

neurotransitters or non-true neurotransmitters that can facilitate or inhibit synaptic activity related to pain

for information to pass between neurons, what must be released that enters the synaptic cleft, and attaches to a receptor site on the next neuron

serotonin

non true neurotransmitter that is active in descending pathways

norepinephrine

non true neurotransmitter that inhibits pain transmission between 1st and 2nd order neurons

substance P

non true neurotransmitter that comes from small-diameter primary afferent neurons in the dorsal portion of spinal cord

enkephalin

non true neurotransmitter that is the opiod active in descending pathways

B-endorphin and dynorphin

what is the opiod endogenous to the CNS

nociceptive neuron

peripheral pain receptor that transmits pain signals

lowers the nerve’s threshold to noxious stimuli

when a cell is injured, what does the release of substance P, prostaglandins, and leukotrines cause that is also known as primary hyperalgesia

secondary hyperalgesia

what is it called when the chemicals spread to increase the size of the pain area to cause hypersensitivity

receptors located in skin

where do A delta fibers originate from to transmit “fast pain”

superficial tissue (skin) and deeper (ligaments and muscle)

where do C fibers originate from to transmit “slow pain”

lateral spinothalamic tract

what is the primary pathway that 2nd order neurons ascend to higher brain centers

gate control theory

stimulation from ascending A beta afferents results in blocking impulses at the spinal cord level of pain messages carried along A delta and C afferent fibers

substantia gelatinosa

what does the gate control theory stimulate at the dorsal horn of the spinal cord

descending mechanisms

stimulation of descending pathways in the dorsolateral tract of the spinal cord which results in a blocking of the impulses carried along the A delta and C afferent fibers; closes gait from the top

release of substance P from A delta and C fibers

what does the activation of enkephalin interneuron synapses by serotonin suppress the release of during descending pain control mechanisms

release of endogenous opioids

the prolonged stimulation of A delta and C afferent fibers causing the release of endogenous opiods (B-endorphin), resulting in a prolonged activation of descending analgesic pathways

beta endorphin

what is the endogenous opioid that is released from the hypothalamus

dynorphin

what is the endogenous opioid that is released from the periaqueductal grey matter within the PAG, medulla, and dorsal horn and may be responsible to noxious mechanical stimulation

overlapping mechanisms

what is pain control the result of so pain relief may result from a combination of all three of these mechanisms

conventional TENS, massage, and analgesic balms

what therapeutic modalities can be used to stimulate the large-diameter A beta fibers afferently through the gate control theory

cold treatments

what therapeutic modality decreases pain fiber transmission velocity

acupressure, deep massage, TENS

what therapeutic modality can be used to stimulate the small-diameter afferent fibers and descending pain control mechanisms (descending control)

low rate TENS

what therapeutic modality can be used to stimulate endogenous opioids through prolonged small diameter fiber stimulation of acupuncture or trigger points (opiate release)

threat

the perception of the threat that determines output, not the tissue damage itself or threat to the tissues

chronic pain/ central sensitization

encompassses altered sensory processing in the brain and malfunction of pain-inhibitory mechanism (constant threat or fear); CNS pain pathways stay active even in absence of peripheral stimulation

education and reducing threat and fear by “turning down the volume”

how do you treat chronic pain/central sensitization

biological, psychological, AND social components

what does pain always encompass

pain

the interpretation of nociceptive signals by the brain

nociception

activity that occurs in the nervous system, peripheral or central, in response to a noxious stimulus

ampere

rate at which electrons flow; volume of electrical current flow

ampere

what is also known as the current

voltage

force resulting from potential difference

voltage

what actually causes the flow or current by pushing it along and is the “electromotive force”

volt

what is the unit of measurement of voltage

resistance

opposition of electron flow; could be conductor or insulator

ohm

what is the unit of measurement of resistance

conductors

have an abundance of free electrons; muscles, nerves, blood

insulators

have very few free electrons; bones and fat

direct current

uninterrupted, unidirectional flow, monophasic, galvanic; dangerous if applied inapropriately

alternating current

continuous flow of electrons that is constantly changing directions, biphasic

pulsatile current

three or more pulses grouped together, polyphasic; could be direct or alternating

sinusoidal, rectangular, square, and triangular

what are the different types of waveforms

pulse

individual waveform

cycle

applies to biphasic currents only and is the “up and down” of one waveform

phase

portion of the pulse that rises in one direction

pulse width/duration

length of time current is flowing in one cycle

phase duration

what is considered the pulse width/duration for monophasic currents

combined phase durations = cycle duration

what is considered the pulse width/duration for biphasic currents

uncomfortable

the wider the pulse width, the more _______________ the stimulation is because it reaches more fibers

pulse rate/frequency

number of cycles or impulses/second; as it gets lower, the more you can identify each pulse (Hz)

cathode (-)

which polarity traditionally gets placed more distally: (cathode or anode)

intensity/amplitude

increasing this can increase the number of nerve fibers depolarized by causing a deeprer reach into the tissue and higher depolarization thresholds

burst modulation

used in pulsatile currents with an interburst interval that can be changed to any length of time

bipolar, unipolar, and quadripolar

what are the common electrode placement types