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Opioids I
1
53
Nursing
Graduate
10/12/2015

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Term
Alogesia
Definition
Increasd sensitivity to pain
Term
Algogenic
Definition
Pain producing
Term
Allodynia
Definition
Normally non-harmful stimulus is perceived as pain
Term
Analgesia
Definition
The absence of pain in the presence of a normally painful stimulus
Term
Dysethesia
Definition
Unpleasant painful abnormal sensation, whether evoked or spontaneous
Term
Hyperalgesia
Definition
Heightened response to a normally painful stimuli
Term
Neuralgia
Definition
Pain in the distribution of a peripheral nerve
Term
Neuropathy
Definition
An abnormal disturbance in the function of a nerve
Term
Parathesia
Definition
Abnormal sensation, whether spontaneous or evoked
Term
Nociception
Definition

Transduction

 

Transmission

 

Perception

 

Modulation 

Term
Types of Pain
Definition

Nociceptive

 

Neuropathic

 

Idiopathic or pyschogenic 

Term
Neuropathic Pain
Definition

Dysfunction of CNS

 

Allows for spontaneous excitment

 

Burning, tingling, shock like 

Term
Transduction
Definition
Stimuli is transformed into electrical energy
Term
Transmission
Definition
Signal is sent from periphery to CNS
Term
Perception
Definition
Signal recognized by brain
Term
Modulation
Definition
Descending mechanism modulate signal transmission in spinal cord
Term
Endogenous Chemicals that Generate Action Potential
Definition

Bradykinins

 

Serotonin

 

H+

 

Prostaglandins

 

Histamine

 

Substance P

Term
Substance P
Definition

Peptide released from C fibers

 

Vasodilation

 

Extravasation of plasma proteins

 

Degraulation of mast cells

 

Sensitizes nerve 

Term
Glutamate
Definition

Neurotrasmitter released from A delta and C fibers 

 

Fast, sharp pain 

Term
Bradykinin
Definition
Peptide with direct analgesic affect on nociceptors
Term
Histamine
Definition

Released from Mast cells, basophils, and plts when subtance P binds to receptors

 

Produces edema and vasodilation

Term
Serotonin
Definition

Released from plts with tissue injury

 

Direct analgesic effect on nociceptors 

Term
Prostaglandins
Definition
Sensitize peripheral nociceptors- hyperalgesia
Term
Cytokines
Definition

Released from inflammatory response

 

Increases the production of prostaglandins

 

Sensitize nociceptors 

Term
Arachidonic Acid Cascade
Definition

Phospholipase A2 on phospholipid bilayer of cell forms arachidonic acid when tissue injury occurs 

 

Further converts to cyclooxygenase pathway and Lipooxygenase pathway 

Term

Cyclooxygenase Pathway 

 

(COX)

Definition

Converts arachnidonic acid to endoperoxides

 

Endoperoxides form prostacyclin and prostaglandin 

 

Potentiates edema and stimulates direct nerve ending respectively 

Term
Lipooxygenase Pathway
Definition

Arachidonic acid converts to hydroperoxy compounds

 

Converted to leukotrienes

Term
Exteroceptors
Definition
Receive pain stimulus from the skin
Term
Interoceptors
Definition
Receive pain stimulus from walls of viscera
Term
A Delta Fibers
Definition

Recieve mechanical and thermal stimuli

 

Fast pain

 

Small myelinated 

 

Reflex withdrawal response 

Term
C Fibers
Definition

Mechanical, Thermal, and Chemical

 

Slow pain

 

Dull, burning, throbbing, or aching 

Term
A Delta Fiber Pathway
Definition

First order neuron enter the dorsal root ganglia and synapse with second order neuron in Rex Laminae I or V (grey matter) 

 

Second Order Neurons cross to contra lateral spinaothalamic tract (white matter) and then to brain

Term
C Fibers Pathway
Definition

First order neuron enter the dorsal root ganglia and synapse with Interneuron in Rex Laminae II or III (aka substantia gelatinosa) 

 

Interneuron Then Synapses with second order neuron in Rexed Laminae V before crossing over and on to the brain 

Term
Third Order Neurons
Definition
Send axonal projections into sensory cortex
Term
Peripheral Modulation: Hyperalgesia
Definition

Tissue injury releases substance P and glutamate to activate free nerve endings

 

Repeated stimulation causes sensitization 

Term
Primary Hyperalgesia
Definition

Mediated by the release of alogens 

 

Decrease in pain theshold

 

Increase in frequency repsonse to the painful stimuli

 

Decrease in response latency

 

Causes spontaneous firing after stimulus is removed 

Term
Seconday Hyperalgesia
Definition

Neurogenic Inflammation

 

Substance P stimulates release of histamine from mast cells which vasodilated vessels

 

Causes red flush around injury, local tissue edema, and sensitization to noxious stimuli 

Term
Peripheral Modulation Inhibition
Definition
Can be achieved with NSAIDs and COX inhibitors
Term
Central Modulation
Definition

Occurs in the spinal cord when there is a prolonged discharge (peripherally)

 

Cause sensitization to second order neurons which increases frequency of discharge

 

Causes receptor field expansion and adjacent neurons become sensitive 

Term
Neuroplasticity
Definition
Central sensitization of afferent impulses
Term

Central Modulation: Inhibition 

 

Spinal Level 

Definition

Endogenous enkephalins

 

Inhibit the relsease of substance P

 

Block post synaptic response to substance P

Term

Central Modulation: Inhibition 

 

Supraspinal Level

Definition

Affects opioid receptors in the brain

 

"I hurt but I dont care"

Term
Cardiovascular Response to Pain
Definition

Stimulation of SNS

 

Catecholamines, cortisol, and angiotensin II released

 

Increased HR, CO, CMO2, BP

 

Causes myocardial ischemia and dysrhythmias 

 

Increase plt adhesiveness 

 

Decreased fibrinolysis- DVTs

Term
Respiratory System Response to Pain
Definition

Decreased TV, VC, IC, and FRC 

 

Reluctant to cough and deep breathe

 

Causes atelectesis and pneumonia 

 

Ventilation perfusion mismatch

 

Aterial hypoxemia 

Term
GI/GU System Response to Pain
Definition

Increase sympathetic activity

 

Decreased Gastric emptying

 

Decreased Intestinal Motility- Ileus

 

Urinary Retention 

Term
Endocrine System Response to Pain
Definition

Increased ACTH, cortisol, ADH, growth hormone, and glucagon 

 

Decreased release of testosterone and insulin

 

Cause hyperglycemia, Na & H2O retention 

Term
Immune System Response to Pain
Definition

Immune response decreased

 

Healthy individuals can be immunosuppresed 1-2 weeks post-op 

Term
Antidepressants for Pain
Definition

Usually Lower dose than that for antidepressant effect

 

Action due to blocking reuptake of serotonin or NE or both 

Term
Anticonvulsants for Pain
Definition

Blocks voltage gated Na Channels

 

Supresses spontaneous neuronal discharges

 

Good for neuropathic pain- diabetic neuropathy and tirgeminal neuralgia 

Term
Neuroleptics for Pain
Definition

Blocks Dopaminergic Receptors

 

Extrapyramidal effects undesirable

Term
Corticosteroids for Pain
Definition

Antiinflammatory

 

Inhibits prostaglandin production by blocking phospholipase A2 activation 

Term
A2 Adrenergic Agonists for Pain
Definition
Activation of descending inhibitory pathway in dorsal horn
Term
COX inhibitors for Pain
Definition
Inhibits prostaglandin synthesis
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