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Pain pathway is a chain of _____ neurons.
neuronal the neurons in the pain pathway?
- first order neuron
- second order neuron
- third order neuron
Where does the first order neuron originate? Where does it carry the signal?
- Originates in the periphery
- carries signal to the spinal cord
Where does the second order neuron carry the signal?
Carries the signal up the spinal cord
Where does the third order neuron carry the signal?
Carries the signal to the cerebral cortex
What does the more complex level of pain pathway involve?
Involves a network of branches and communication with other neurons (afferent, sensory) which modulate, or modify the transmission of painful stimuli
Decribe the anatomy of a pain neuron.
- Cell bodies - located in dorsal root ganglia
- fibers or axons
What are nociceptors?
Specialized nerve endings that detect painful stimuli
What do nociceptors signal?
Actual or potential tissue injury
What are the differen types of pain axons?
- A - delta fibers
- C - fibers
Where are fibers or axons located?
- joint capsule
- blood vessels
What do A-delta fibers look like?
- Large diameter
- thinly myelinated axons
A-delta fibers conduct impulses very _____.
A-delta is considered the _____.
What do C-fibers look like?
- unmyelinated axons
How does the C-fibers transmit?
C-fibers are considered the _____.
Where do the neurons interact?
At synapses in spinal cord or brain
What does nociceptions include?
Transduction, transmission, modulation, and perception by the brain of pain
What is transduction?
The translation of noxious stimuli into electrical activity at the peripheral nociceptor
What is transmission?
The propagation of nerve impulses through the peripheral nervous system
What is modulation? Where does it occur?
- Modification of pain impulses (inhibit or excite)
- occurs in the dorsal horn of the spinal cord
What is perception? Where does it occur?
- Conscious pain is experienced by the patient
- occurs in cerebral cortex
What are the different strategies of pain management?
- Preemptive analgesia
- multimodal analgesia
- postoperative analgesia
It is easier to _____ pain than to _____ pain.
What is the purpose of preemptive analgesia? When do we use it?
- Cannot eliminate post op pain but can help prevent peripheral and CNS sensitization during surgery
- makes patient easier to handle
- decreases anesthetic requirements during surgery
What's another term for multimodal analgesia?
What is multimodal analgesia?
Simultaneous administration of two or more analgesic drug classes or techniques
Combination multimodal analgesia often have what? What does this do?
- Combinations often have additive or synergistic effects
- doses can be lowered and minimizes risk of side effects
What are the different mechanisms that the inhibition of nociception that can be achieved at the different points of the pain pathway?
What does transduction do in the multimodal analgesia? Which pain meds do this?
- Inhibits peripheral sensitization of nociceptors
- local anesthetics, opioids, NSAIDS, corticosteroid
What is transmission in multimodal analgesia? Which pain meds do this?
- Inhibits impulse conduction
- local anesthetics, alpha 2 agonists
What does modulation do in multimodal analgesia? Which drugs do this?
- Inhibits center all sensitization
- local anesthetics, opioids, alpha 2 agonists, tricyclic antidepressants, cholinesterase inhibitiors, dissociative anesthetics, NSAIDS, anticonvulsants
What does perception do in multimodal analgesia and which drugs do this?
- Inhibit perception
- general anesthetics, opioids, alpha 2 agonists, benzodiazepines, phenothiazines