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2MBChB Musculoskeletal > 2MBChB Musculoskeletal Physiology: Physiology of Pain > Flashcards

2MBChB Musculoskeletal Physiology: Physiology of Pain Flashcards

1
Q

What are 3 types of pain?

Adaptive or maladaptive?

A 
Nociceptive = Adaptive
Inflammatory = Adaptive
Pathological = Maladaptive
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2
Q

Are nociceptors receptors? If not, what are they?

A

Nociceptors are not receptors, but specialised peripheral primary sensory neurones activated preferentially by intense noxious stimuli

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3
Q

Is nociceptive pain high or low threshold?

A

High threshold from high intensity of noxious stimuli

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4
Q

2 effects of inflammatory pain?

A

Pain hypersensitivity

Allodynia

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5
Q

Difference between pain hypersensitivity and allodynia?

A 
Hypersensitivity = Heightened sensitivity to noxious stimuli
Allodynia = Innocuous stimuli also now elicits pain
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6
Q

Is inflammatory pain high or low threshold? Why?

A

Low threshold due to pain hypersensitivity and allodynia

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7
Q

How does inflammatory pain help in healing?

A

Discouragement of:

(a) physical contact with wound
(b) physical movement of injured part

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8
Q

Is pathological pain high or low threshold?

A

Low threshold

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9
Q

Two types of pathological pain?

A

(a) Neuropathic pain

(b) Dysfunctional pain

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10
Q

Characteristics of neuropathic pain?

A

(a) Peripheral nerve damage

(b) Positive or negative symptoms

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11
Q

Characteristics of dysfunctional pain?

A

(a) No neural lesion
(b) No inflammation
(c) Positive symptoms
(d) Transmission not just through nociceptors, but also normal peripheral nerves
(e) Persistence of pain even after healing

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12
Q

Common characteristics of both types of pathological pain (neuropathic and dysfunctional)?

A

(a) Abnormal CNS processing
(b) Spontaneous pain
(c) Pain hypersensitivity

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13
Q

Match the fire alarm analogy for one of these three types of pain (nociceptive, inflammatory and pathological)

System is working as intended and is only activated by intense heat

A

Nociceptive pain

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14
Q

Match the fire alarm analogy for one of these three types of pain (nociceptive, inflammatory and pathological)

System is activated by warm temperatures

A

Inflammatory pain

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15
Q

Match the fire alarm analogy for one of these three types of pain (nociceptive, inflammatory and pathological)

System is malfunctioning and sounding false alarms

A

Pathological pain

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16
Q

What is the pathology behind congenital insensitivity to pain (CIP)?

A

Loss of function mutation encoding a particular voltage-activated Na+ channel, highly expressed in nociceptive receptors

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17
Q

What kinds of noxious stimuli can nociceptors be activated by?

A

Mechanical
Thermal
Chemical

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18
Q

What are the subtypes of nociceptors?

A

Aδ-fibres

C-fibres

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19
Q

What are the characteristics of Aδ-fibres?

(a) Myelinated / non-myelinated?
(b) What kinds of stimuli?
(c) Mediate fast or slow pain?

A

(a) Thinly-myelinated
(b) Noxious mechanical and thermal stimuli
(c) Fast pain

20
Q

What are the characteristics of C-fibres?

(a) Myelinated / non-myelinated?
(b) What kinds of stimuli?
(c) Mediate fast or slow pain?

A

(a) Non-myelinated
(b) All noxious stimuli
(c) Slow pain

21
Q

In polymodal nociceptors, which receptors / channels are activated by mechanical stimuli?

A

Uncertain (Piezo 2?)

22
Q

In polymodal nociceptors, which receptors / channels are activated by thermal stimuli?

A

TRPV1 (transient receptor potential vanilloid receptor 1)

23
Q

In polymodal nociceptors, which receptors / channels are activated by chemical stimuli, such as H+, ATP and bradykinin?

A

For H+, acid sensing ion channels (ASICs)
For ATP, P2X and P2Y receptors (P for purine)
For bradykinin, B2 receptors

24
Q

In the peripheral nerve terminals,

(a) is amplitude of generator potential all-or-none or graded?
(b) is it proportional to stimulus intensity?

A

(a) Graded

(b) Yes

25
Q

How is the amplitude of the generator / receptor potential related to the triggering of the APs?

A

All-or-none APs are triggered at a frequency proportional to the amplitude of the receptor potential.

Non-linear relationship though. Greatest sensitivity to change at lower stimulus strengths.

26
Q

Where do the first order and second order neurones of the nociceptive pathway meet?

A

Dorsal (posterior) horn of the spinal cord, in the various laminae of Rexed

27
Q

What are the names of the pathways which the second order neurones take via the spinal cord?

A

Spinothalamic tract

Spinoreticulothalamic tract

28
Q

Which specific type of nociceptors have both afferent and efferent functions?

What class of nociceptors are they?

A

Peptidergic polymodal nociceptors

Subset of C-fibres

29
Q

Neurotransmitters used by peptidergic polymodal nociceptors at the dorsal horn?

A

Glutamate

Peptides like Substance P and Neurokinin A

30
Q

At which levels of the spinal cord do decussation of peptidergic polymodal nociceptors take place?

A

All levels of the spinal cord

31
Q

What is the efferent effect of peptidergic polymodal nociceptors when activated?

Give examples of the effectors.

A

Neurogenic inflammation through release of pro-inflammatory mediators like calcitonin gene-related peptide (CGRP) and substance P

32
Q

What are the long term effects of noxious stimulation?

A

Hyperalgesia (abnormally heightened sensitivity to pain)

Allodynia (Innocuous stimuli also now elicits pain)

33
Q

Effects of substance P?

A

(a) acts on mast cells and neutrophils, causing them to release histamine and nerve growth factor (NGF)
(b) causes blood vessels to become leaky, resulting in extravasation and loss of plasma proteins into surrounding tissues, ultimately resulting in reinforcement of inflammation by histamine and NGF

34
Q

Effects of calcitonin gene-related peptide (CGRP)

A

Causes vasodilation of blood vessels, resulting in extravasation and loss of plasma proteins into surrounding tissues, ultimately resulting in reinforcement of inflammation by histamine and NGF

35
Q

Inflammatory mediators released by injured tissues?

What are their effects on nociceptors?

A 
Bradykinin
5-HT
Prostaglandins like PGE2
ATP
H+

All of them act back on the nerve terminal and either excite it directly, or make it more sensitive

36
Q

Explain why substance P and calcitonin gene-related peptide is an example of positive feedback

A

Release of SP and CGRP increases the sensitivity of the nociceptor terminal

37
Q

What are the receptors found on the second order neurones in the nociceptive pathway?

Which is more important during high frequency stimulation?

A

AMPA and NMDA

NMDA is more important during high-frequency stimulation

38
Q

Where are the cell bodies of the primary afferent nociceptors?

A

Dorsal root ganglia

39
Q

Which laminae do nociceptive Aδ-fibres terminate?

A

Laminae I, II and V

40
Q

Which laminae do nociceptive C-fibres terminate?

A

Laminae I and II

41
Q

Which laminae do Aβ-fibres terminate?

A

Laminae III, IV and V

42
Q

Which kinds of fibres do nociceptor-specific (NS) cells synapse with?

A

Aδ- and C-fibres

43
Q

Which kinds of fibres do wide dynamic range (WDR) neurones synapse with?

A

Aβ-, Aδ- and C-fibres

44
Q

(a) Which of the two tracts is involved in pain perception?

(b) Which two pathways within this tract are involved simultaneously?
Which lamina does the second order neurone originate from?
Which first-order fibres are involved?
Where does the second order neurone terminate?

A

(a) Spinothalamic tract

Pathway 1
Projection neurones originating from lamina I (fast fibre Aδ pain) terminate in posterior nucleus of the thalamus

Pathway 2
Projection neurones originating from lamina V (WDR neurones) terminate in posterior and ventroposterior nuclei of the thalamus

45
Q

Spinoreticular tract:

(a) Carries what kind of information?
(b) Where does it terminate?
(c) What is it involved in?

A

(a) Slow C-fibre pain
(b) Makes extensive connections with reticular nuclei in the brainstem
(c) Involved in autonomic responses to pain, arousal, emotional responses, fear of pain

2MBChB Musculoskeletal (5 decks)

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