25 JUNE 2019 Flashcards
start of chapter thirteen end of chatper twelve
list the four mechanisms of neurpathetic pain:
ecpotic foci
ephatic transmission
central sensitivity
structural reorganization
ecpotic foci means
pain that occurs from somewhere else
steps of ecpotic foci:
- damaged neuron will try to get a signal out
(through demyelination or death) - it creates (modality or ligand) gated channels
- creates a misfiring of pain
what dx could be explained by ecpotic foci?
tinels sign in carpal tunnel syndrome
what is tinels sign in carpal tunnel syndrome?
when you tap on your thumb and there is no pain, but then when you tap on your wrist there is pain
works because the your tapping on axon cell body: misfiring into pain receptors of your thumb
ephatic transmission means
a short circuit
steps of ephatic transmission:
a beta touch receptors will JUMP to a c-fiber free nerve ending and create a (ecptopic foci) to activate pain
an dx example of ephatic transmission is
guillain -barre
what neuropathetic problem could be explained by ephatic transmission?
allodynia
allodynia could be explained by what two things?
ephatic transmission and
structural reorganization
secondary hyperalygesia could be explained by
central sensitization
what does central sensitization do?
reorganizes: increases excitatory transmitters and receptors
how does central sensitization start?
a strong or long lasting stimulus
list the steps of central sensitization:
- a strong or long lasting stimulus
- NS says “oh you must want more of that”
- NS reorganizes so that you get increase stimulus:
- increases excitatory trans and receptors
* ***through LTP - then a mild stimulus can generate an AP at that synapse because the NS decreased the threshold.
name sites that could generate pain?
- peripheral neurons
- ectopic foci
- ephatic transmission - central neurons
what three ways explain phantom limb pain
- collatoral sprouting
- denervation hypersensitivity
- both
phantom pain vs phantom sensation?
if nerve dies in pain pathway = pain
if nerve dies in sensory pathway = sensation
steps of structural reorganization:
- c fiber withdrawals from neuron
- that neuron isn’t getting enough attention so calls for more stimulus
- a -beta fiber will collateral sprout in order to synapse w/ neuron
- touch (from a -beta) will now stimulate pain (from c-fiber)
structural reorganization take home message
touch will activate pain
dead pain cells will synapse
somewhere in the cauda medulla
list five ways to help central sensitivity syndrome:
- acknowledge pain
- provide a supportive caring environment
- education pt on pain
- physical activity
- rewiring activities
((also meds))
motor planning occurs where?
frontal lobe
decision making occurs where?
cerebral hemisphere
the control circuits occurs where?
basal ganglia + cerebellum
motor tracts start and end where?
start in cortex end in the spinal cord
motor neurons start and end where?
start in spinal cord
end in the muscle
what is the target of motor plannign:
the skeletal muscle
list from top to bottom the steps of motor planning:
- motor planning - frontal lobe
- decision - cerebral hemisphere
- control circuits - basal ganaglia + cerebellum
- motor tracts - cortex to spinal cord
- motor neurons - spinal cord to muscle
- target = skeletal muscle
motor tracts are also called
UMN
motor neurons are also called:
LMN
what happens in central sensitivity syndrome and what is the goal to stop it
- decreased antinoception increased propronoception
2. increased antinoception decreased proponecption
where are motor neurons located in the spinal cord?
ventral horn
presynaptically what happens in central sensitivity syndrome?
inhibition and facilitation
what approach is central sensitivity syndrome?
top down
presynaptic activity leads to what in central sensitivity syndrome?
LTP
- which is when the syndrome actually occurs
why is uncertainty (fear of the unknown) a problem in central sensitivity syndrome
because our primal brain treats it as a THREAT so it reorganizes in order to never feel that pain again = increases pain stimulus
