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PHYT 5115 - Intro to MSK > 1 - Pain Pathways and Modulation > Flashcards

1 - Pain Pathways and Modulation Flashcards

1
Q

What is the ICF Model?

A

Line 1 - Health Condition
Line 2 - Body Structure/Function, Activity, Participation
Line 3 - Environmental Factors, Personal Factors

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2
Q

Define or describe functioning in terms of the ICF Model.

A

It is the interaction among the components of the model that contribute to the overall ability to function (positive aspects)

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3
Q

Define or describe disability in terms of the ICF Model.

A

It is the interaction among the components of the model that limit the person’s ability to function (negative aspects)

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4
Q

What is pain?

A

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

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5
Q

What is pain’s function in the body?

A

It informs our brain when something is wrong

It is a survival mechanism

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6
Q

Why study pain?

A

Because it is the number one reason someone will seek out medical attention.
To understand the physiology of pain for context/background.
To understand its complexities and how it can impact our patients lives.

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7
Q

What are the four ways we begin to understand pain? Define them.

A

Transduction: peripheral or physical to the nerve
Transmission: nerve send signal to brain
Perception: brain interprets signal
Modulation: brain sends signal to effectors to react to pain

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8
Q

What comprises the central nervous system?

A

The brain and spinal cord

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9
Q

What makes up the peripheral nervous system?

A

Nerve fibers throughout the body

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10
Q

What parts of the body have free nerve endings?

A

The skin, bones, and muscles

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11
Q

Where in the body are there no pain receptors?

A

Articular Cartilage
Synovial Membrane
Pericardium
Brain

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12
Q

What is an action potential?

A

A signal that travels down the axon of the neuron and causes an all or none response. It then stimulates chemical release at the end of the axon to continue on to the next neuron.

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13
Q

Are afferent pathways ascending or descending?

A

Ascending

They carry messages from the periphery to the CNS

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14
Q

Are efferent pathways ascending or descending?

A

Descending

They carry messages from the CNS to the periphery

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15
Q

Which pathway do nociceptors activate?

A

They activate the afferent pathways.

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16
Q

What is a nociceptor?

A

They are receptors which are sensitive to and respond to noxious stimuli that can cause tissue damage or when tissue damage has taken place
They respond to extremes of mechanical, chemical and thermal stimuli

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17
Q

What are some examples of mechanical pain?

A

Poke, pinch, compression.

Defined as any type of pain that is caused by placing abnormal stress or strain

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18
Q

What is an example of chemical pain?

A

Inflammatory mediators

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19
Q

What are some examples of thermal pain?

A

Extreme heat or cold applied to tissues

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20
Q

What are the steps in the pain pathway?

A
  1. Receptors
  2. Primary afferents (1st order neurons)
  3. Dorsal horn of spinal cord
  4. Ascending fibers (2nd order neurons)
  5. Thalamus
  6. Cortex and other brain areas
21
Q

Do pain receptors adapt to stimuli?

A

No, pain receptors will continue to send signals until the stimulus is removed. They are not like other tissues that adjust to stimuli and decrease their firing (ex. the smell of gas decreases the longer you stay there)

22
Q

What are A-beta fibers?

A

They are found in the periphery of the body. They are cutaneous receptors that do not respond to or transmit pain signals.
Largest and myelinated

23
Q

What are A-delta fibers?

A

They sense pain from the peripheral nociceptors.

They transmit fast pain (sharp, quick) because they are MYELINATED

24
Q

What are C fibers?

A

They sense pain and temperature from the peripheral nociceptors. They transmit slow pain (dull, achey, longer lasting) because they are UNMYELINATED

25
Q

If a non painful stimulus reaches the spinal cord via the 1st order neuron, will it continue to the 2nd order neuron?

A

No, because there are always tonically active inhibitory neurons that inhibit the signal from continuing as it is not a painful stimulus.

26
Q

How does a signal get to the 2nd order neurons/ascending fibers?

A

The pain signal inhibits the inhibitory neuron and the signal is allowed to travel up the spinal cord to the brain via the anterolateral spinalthalamic tract

27
Q

What is the relay station of the brain?

A

The thalamus

28
Q

Where do the 2nd order neurons synapse

A

The thalamus

29
Q

To where does the thalamus send signals?

A

To higher brain regions

30
Q

What part does your prefrontal cortex and anterior cingulate cortex have in pain response?

A

They help plan a response action to the pain stimulus

31
Q

What role does the amygdala play in pain?

A

It senses and responds to fear

32
Q

What center houses our emotional response to pain?

A

Insular Cortex however, it has to work with other regions of the brain to make sense.

33
Q

If you were to flinch, tense up or rub the area in anticipation of pain what are these examples of?

A

Modulation

34
Q

Why do we modulate?

A

As a distraction and to change the sensory input in hopes that it will override the pain signal that is coming

35
Q

What type of fibers block pain impulses at the spinal cord level?

A

A-beta

36
Q

What types of fibers carry pain signals to the spinal cord?

A

A-delta and C

37
Q

If A-beta and A-delta fibers are both stimulated will you sense pain?

A

No, A-beta are larger in diameter and faster so they will reach the spinal cord first, stimulate the inhibitory neuron and block the pain signal from the A-delta fibers from continuing up the spinal cord.

38
Q

If A-delta and C fibers are stimulated at the same time what type of pain will you sense first?

A

Fast, quick, sharp pain. This is because the A-delta fibers are myelinated and the C fibers are unmylinated so the signal travels faster down the A-delta fibers.

39
Q

Will the descending pain control pathway work if the pain signal doesn’t reach the thalamus?

A

No, the signal has to reach the thalamus in order for this pathway to be active.

40
Q

What does the brain release in response to pain perception?

A

Endogenous opioids

41
Q

What do endogenous opioids regulate?

A

Transmission of nociceptive signals

42
Q

What are the three types of endogenous opioids?

A

Enkephalins
Endorphine
Dynorphins

43
Q

What type of effect do endogenous opioids have on nociception?

A

They have an inhibitory effect, it is slower that others but it lasts longer.

44
Q

How do endogenous opioids travel throughout the body?

A

They rely on circulation rather than action potentials via neurons

45
Q

What would you do to stimulate the effects of endogenous opioids for a patient?

A

Prescribe ROM within a pain free range.

46
Q

What are the three letters to remember Melzack’s Pain Experience?
What do they stand for?

A

A - Motivational Affective
C - Cognitive Evaluative
S - Sensory Discriminative

47
Q

What is Motivational Affective in terms of Melzack’s Pain Experience?

A

The unpleasantness of pain

48
Q

What is Cognitive Evaluative in terms of Melzack’s Pain Experience?

A

How someone thinks their pain will be perceived. Maybe they live in a culture where showing signs of pain is linked with weakness

49
Q

What is Sensory Discriminative in terms of Melzack’s Pain Experience?

A

The physiological side of pain and how you feel it

PHYT 5115 - Intro to MSK (11 decks)

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