The Physiology of Pain sensation, Stress Response, and Temperature Changes

1. Describe the physiological mechanisms of

pain.

Pain is:
o Sensory & emotional
experience, unique to the
individual.
o Affected by past experiences,
beliefs about pain, fear or
anxiety.
Pain transmission = complex
peripheral & central processes.
Involves interactions:
o Nociceptors: sensory receptors
Noxious (unpleasant
stimuli)
Body (skins, visceral, mm,
joints)
o Primary afferent fibres: A &
C
o Dorsal horn of spinal cord
Ascending tract
o Brain Stem
Pain transmission can be modulated
via inhibitory pathways
o Gate Control Theory:
Inhibited at spinal cord
level, rubbing head
A fibers activated, via
endorphins to close gate
2.

3. Identify the neurological pathways for

pain.
4. 1) Sensory/ discriminative
Strength, intensity, temporal & spatial
limits of pain (afferent fibers spinal
cord brain stem)
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7. 2) Motivational/ affective
Conditioned, learned
approach/avoidance emotional
behaviors (limbic system)
8. 3) Cognitive/ evaluative

Learned behaviors concerning

experience: interpretation (higher
centers)
9. Discuss threshold, tolerance, & identify the
age & gender differences for these terms.

Threshold - Point when stimulus is

perceived as pain, does not vary
overtime
Perceptual dominance - Pain at
one locations increases
sensitivity in another
Children: depends on cognition,
language developmental level &
personality
Elderly: diseases (DM, CVA,
CNS disorders, can affect
perception
Pain threshold increases w/ age
Tolerance- time before person
initiates pain response
o Affected by culture, mind,
society
o Decreased w/ age

10.

11. Differentiate between acute, chronic pain,

malignant pain & neuropathic pain.
12. Types of Pain:
1) Nociceptive: pain resulting from
activation of 1 afferent Nociceptors by
mechanical, thermal or chemical stimuli
Acute & chronic pain
a. Intermittent pain- chronic pain w/
physiologic response
2) Neuropathic (nn fibers)
a. caused by nn damage in CNS/PNS
b. triggered by trauma, surgery, DM,
chemotherapy, ischemia, infections,
malignancy
c. spontaneous burning, electric shock
type
3) Cancer pain acute/chronic
13.

14. Acute pain - short-term, protective,

relieved w/ removal of stimulus,
physiologic response

15. S/S: same for stress (fight/flight

response)
16. Fear, anxiety, nausea, gastric acid,
tachycardia, HTN, pupil dilation, pale
skin
17. Diaphoresis (sweating), hyperglycemia
Somatic: skin or body, skeletal mm,
joints sharp & localized, throbbing,
aching, constant Tx =NSAIDS
Visceral: internal organs, abds, smooth
mm, poorly localized, referred pain,
vomiting, hypotension, shock, radiates.
Tx= opioid analgesics
18.
19. Chronic pain- persistent ~6months,
unknown cause, no physiologic
response, depression
20. Types:
21. - perisistant low back pain,
22. - myofascial pain ( mm spasm, stiffness)
23. - neuralgias, hyperesthesias
24. - phantom limb, cancer, post- op
25.
26. Identify stress response mechanisms & the
pathological effects of stress.

27. Stress
Demands exceeds persons coping
abilities
Results in disturbance of cognition,
emotion & behavior that negatively
affects well-being
Body attempts to restore homeostasis
Reactive, anticipatory, conditional
response to stress
28.
29. General Adaption Syndrome (GAS)
30. - Bodys response to stress
31. 3 Stages: Ar, Sr & Se
1) Alarm rxn arousal of body
defenses
2) Resistance fight /flight, adaptation
3) Exhaustion continued stress for
some time, body gradually reduces
resistance or collapses
32.
33. GAS activation:

1) Triggers HPA (hypothalamicpituitary-adrenal) axis

sympathetic ns
2) Begins w/ actions of adrenal
hormones
3) Occurs only if stress continues &
adaptation is not successful
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52. Recall the common medications used for
pain, stress, and fever
53.
54. Non- pharmacologic
Massage
Electrical stimulation
Ice!
Attention & distractions
55. Pharmacologic
Non-narcotics
Opiates (Schedule II-III)
o Tolerance, addictions,
respiration depression!
56. Pain Meds.
Analgesics: opioids & local
anesthetics
o Opioids affects sensation &
perception
Ex: morphine, codeine,
dilaudid, Demerol,

oxycodone, methadone
Morphine: depresses cough
center & respiration
Ax: bind to opioid receptors in
CNS
Side effects: constipation,
sedation, respiratory
depression, nausea, vomiting
Routes: IV, IM, PO
Non-opioids: Acetaminophen
o Inhibits PG synthesis in

57.

CNS/PNS
o Minimal anti-inflammatory effect
NSAIDS: Aspirin (ASA)
o Inhibits COX enzymes reduce
PGs
o Anti inflammatory, anti-pyretic
(hypothalamus) , analgesic
o ASA: inhibits platelet
aggregation
o GI & kidney toxicity d/t COX1