Term
|
Definition
| perception of an unpleasant sensation that originates from a specific region |
|
|
Term
| Anterolateral: spinothalamic tract |
|
Definition
| cross and project into thalamus |
|
|
Term
| Anterolateral: Spinoreticular tract |
|
Definition
some crossed some uncrossed fibers
project to reticular formation of medulla/pons |
|
|
Term
| anterolateral: spinomesencephalic |
|
Definition
| project to midbrain reticular formation and periaqueductal gray with connections to limbic and hypothalamus |
|
|
Term
| Modulation of Nociceptive Info |
|
Definition
Interneuron activated in substantia gelatinosa by Abeta
results in presynaptic inhibition of Adelta/C transmission to projection neurons
decreased projection neuron activity decreases perception of pain |
|
|
Term
| Adelta/C stimulation in Modulation |
|
Definition
| could result in activation of interneuron to block substantia gelatinosa interneuron block presynaptic inhibition and increasing perception of pain |
|
|
Term
|
Definition
4 classes of neurons in dorsal horn
C, Abeta, projection, inhibitory neurons
projection neuron excited by nociceptive and non-nociceptive neurons-->intensity of pain
inhibitory interneuron spontaneously active and normally inhibits projection neuron to reduce pain intensity |
|
|
Term
|
Definition
mu (most opiods), delta, kappa = GPCR
coupled to inhibitory G protein Gi to inhibit adenyly cyclase, hyperpolarization, and suppression of Ca gates |
|
|
Term
|
Definition
suppress pain during stress
long half life
analgesia called "runners high"
Enkephalin, Endorphins, Dynorphins
POMC |
|
|
Term
|
Definition
endorphins inhibit dorsal horn pain mediation, promote prostaglandin/bradykinin break down, stimulate periventricular/periaqueductal gray areas
endorphins released into blood stream
exogenous opiates bind to same sites resulting in opioids |
|
|
Term
| Pain Syndromes due to injured peripheral nerves |
|
Definition
absence of nociceptor activity
burning/electric pain in dermatomes
hyperactive dorsal horn cells
Phantom Pain: amputation, chronic activity |
|
|
Term
|
Definition
pain arises from nociceptors in deep visceral structures but felt at differnt sites
convergence of visceral/cutaneous nocicpetor on same dorsal horn cell
higher cortical areas can't differentiate location |
|
|
Term
|
Definition
pain shooting down back of leg due to injury at spine
curshing nerve fiber rather than receptor ending
AP generated at injury- 2nd order neurons active |
|
|
Term
|
Definition
efferent fibers of sympathetic NS active following peripheral nerve injury
vasoconstriction and burning pain
direct activation of damaged nociceptive afferents or by nonsynaptic electrical cross talk (postgang fibers and C pain fibers)
RSD blocked by blocking sympathetic activity |
|
|
Term
| Thalamic pain syndrome/central pain |
|
Definition
lesions in thalamus/ascending nocicpetive path
intractable pain, spontaneous aching, shooting, pain, numbness, unsettling sensation |
|
|
Term
|
Definition
no physical cause
no physical origin |
|
|
Term
| Clinical Application for Opioids |
|
Definition
moderate to severe pain-acute/post surgical, chronic pain associated with CA
unique analgesia to alter perception of pain
natural-morhphine, codeine
semi-synthetic- heroin
synthetic- meperidine, fentanyl |
|
|
Term
Opioid Classification:
agonist, partial agonist, antagonist |
|
Definition
full agonist: 100% response
partial agonist: 50% response
antagonist
mixed agonist-antagonist: agonist response on one receptor type and partial or antagonist effect on another |
|
|
Term
| Opioid response at Mu Receptors |
|
Definition
Full agonist: Morphine
Partial Agonist: Codeine
Mixed: Nalbuphine |
|
|
Term
|
Definition
| fentanyl, hydromorphone, meperidine, morphine, methadone |
|
|
Term
|
Definition
| codeine, hydrocodone, oxycodone |
|
|
Term
|
Definition
oral- most effective given at regular intervals
epidural, intrathecal- optimal for pain after surgery
transdermal patch- maintain blood levels |
|
|
Term
Dosing Strategies
Loading dose
demand dose
lockout time
successful vs total demands |
|
Definition
loading dose: single large dose given initially to establish analgesia
demand dose: amount of drug self administered when client activates pump
lockout time: min amount of time allowed between self admin doses
successful vs total demands- may indicate parameters are not effective |
|
|
Term
| Concerns in rehab with opioid use |
|
Definition
schedule PT when drugs meet peak effects
respiratory response to exercise
chemoreceptors less responsive
hypoxia= decreased O2
hypercapnia= increased CO2 |
|
|
Term
|
Definition
Transient activate (minutes to hours)
phenomenon called acute tolerance or desensitization specific for receptor and disappears with clearance of agonist
no withdrawal |
|
|
Term
|
Definition
chronic administration leads to progressive loss of drug effect
reduction in maximal achievable effect (right shift in dose-effect curve)
dependance occurs |
|
|
Term
| Receptor disposition- withdrawal mechanism |
|
Definition
loss of effect not related to density of membrane receptors
lack of desensitization |
|
|
Term
| Adaptation of intracellular signaling mechanisms (withdrawal) |
|
Definition
chronic opioid effect initiates adaptive counter regulatory change
up-regulation/superactivation of cAMP |
|
|
Term
|
Definition
analgesia: opioids block sensory and emotional responses of pain
euphoria: pleasant floating sensation and freedom from anxiety
respiratory depression, little amnesia
miosis: constriction of pupils-no tolerance develops |
|
|
Term
|
Definition
| mental slowness, drowsiness, euphoria, respiratory depression, orthostatic hypotension, GI distress, constipation |
|
|
