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BB2 > 7 - Anatomy and Physiology of Pain > Flashcards

7 - Anatomy and Physiology of Pain Flashcards

1
Q

4 Physiological mechanisms of pain

A

Transduction
Transmission
Perception
Modulation

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2
Q

TRPV1 receptor

A

Heat & Acid

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3
Q

ASIC

A

Acid

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4
Q

TRPM8

A

Cold/menthol

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5
Q

What is transduction

A

When noxious stimuli is converted into electrical activity at sensory nerve endings

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6
Q

Transmission

A

Propagation of impulses along pain pathways

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7
Q

Perception

A

Discrimination/affect/motivatoin

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8
Q

Modulation

A

Where 1-3 are modified

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9
Q

Pain

A

Unpleasant sensory and emotional experience

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10
Q

Nociceptor pain

A

Normal pain caused by tissue damage
activity of a nociceptor
receptor proteins on membranes of nociceptor allow response to tissue damaging stimuli

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11
Q

Loss of transduction/transmission malfunction

A

Loss of NaV1.7

Congenital indifference to pain

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12
Q

Loss of C fibres

A

TrkA - NGF receptor mutation
congenital insensitivity to pain
with anhydrosis CIPA

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13
Q

What are Adelta nociceptors

A

Sharp pricking fast pain
Precise location of insult/stimulus
Reflex withdrawal

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14
Q

What are C fibres

A

Slow burning pain affect

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15
Q

Peptidergic C fibres

A

Release substance P/CGRP - Vasoactive

Promotes inflammatory response

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16
Q

Peptide poor C fibres

A

Have distinct receptors - P2X3 ATP

mechanical nociception

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17
Q

What lamina do C fibres innervate

A

I and interneurons II

also V via interneurons

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18
Q

What lamina do Adelta fibres innervate

A

Laminae I and V

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19
Q

Where do projection neurons decussate

A

Close to where the nociceptors enter the spinal cord

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20
Q

Projection neurons

A

Second order neurons

Carry pain message onwards from the primary afferent

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21
Q

Function of the neospinothalamic tract

A

To protect you e.g move your arm when faced with pain

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22
Q

What is the input to the ASST

A

Ad and C fibres (indirect)

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23
Q

What lamina do the projection neurones travel in the ASST

A

lamina V

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24
Q

What parts of the thalamus does the ASST inntervate

A

VPL - Ventral Posterior Lateral
VPM - Ventral Posterior Medial
VPI - Ventral posterior Inferior
CL - Central lateral

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25
Q

Which parts of the thalamus project to primary somatosensory cortex

A

VPL

VPM

26
Q

Which parts of the thalamus project to the secondary somatosensory cortex

A

VPI
ACC
CL

27
Q

What is the function of the paleospinothalamic tract

A

Slow feeling of pain

Punishing aspect

28
Q

What are the primary afferents of the LSST and what lamina do the projection neurons travel in

A

C fibres
some Ad fibres
Lamina I

29
Q

What part of the thalamus does the LSST innervate

A

MDvc - Mediodorsal ventro caudal
POm - Posterior nucleus - medial subnucleus
VMpo - Ventral medial nucleus posterior

30
Q

What does MDvc project to

A

Anterior Cingulate Cortex

31
Q

What does the posterior thalamus (POm and VMpo) project to

A

Anterior or rostal insula

32
Q

What does the limbic system mediate

A

Subjective sensations of pain and pleasure

33
Q

What does the midbrain reticular formation mediate

A

Pain - induced arousal and descending control of nociceptor output

34
Q

What does the Intralaminar nuclei of the thalamus mediate

A

Alterting the cerebral cortex and focus of attention on pain

35
Q

Collateral projections of the LSST and their function

A 
Spinal Circuitry - Reflexes
Reticular formation(arousal and alerting cortex)
Periaqueductal Grey (PAG) - Midbrain, descending pain modulation
Parabrachial nucleus - inpons, on to amygdala
36
Q

ACC

A

Emotional reaction/motivation

37
Q

PFC

A

Evaluation

cognition

38
Q

Insula

A

Pain map, emotion

39
Q

Amygdala

A

Emotional memory and response

40
Q

Primary Somatosensory Cortex

A

Somatosensory discrimination
Location
Intensity

41
Q

Reason for peripheral sensitation

A

Enables protection and facilitated healing

42
Q

4 cardinal signs of infalmmation

A

Calor - heat
Rubor - redness
Dolor - pain
Tumor - swelling

43
Q

What happens in peripheral sensitisation

A

Due to effects of inflammatory mediators
Reduce in activation threshold
Increase in responsiveness

44
Q

How does peripheral sensitisation occur

A

Na channels - NaV1.8 and 1.9 change thresholds for opening and kinetics
TRPV1 channels increase sensitivity to heat

45
Q

How are prostaglandins formed

A

Phospholipase A2 releases arachidonic acid (driven by inflammatory mediators)
COX-1 and COX-2 enzymes use arachidonic acid as a substrate for PG synthesis

46
Q

Which COX is present in tissues all the time?

A

COX-1

47
Q

How do PGs sensitise C fibres

A

Increase the number of other receptors and increase the no of sodium channels

48
Q

What causes central sensitisation

A

Prolonged nociceptor input onto dorsal horn neuron projection neurons

49
Q

Chronic Pain

A

Pain of more than 12 weeks

Can become maladaptive

50
Q

What is neuropathic pain

A

pain due to abnormality in the PNS or CNS

51
Q

what are the characteristics of malladaptive pain

A

Hyperalgesia
Allodynia
Spontaneous pain

52
Q

How would you treat maladaptive pain

A

Anticonvulsants

Anti-depressants

53
Q

What/where are the inhibitory interneurons

A

At lamina II

Modulate the transmission of ascending pain signals

54
Q

Counter stimulation Analgesi

A

Stimulation of Ab fibres that stimulation inhibitory lamina II
reduced C fibre transmission
Uses convergence which is the idea that 2 different sensory inputs fuse into 1 when travelling up the spinal cord)

55
Q

How does acupuncture work

A

Via activation of Ad fibres
stimulates via PAG mediated Diffuse Noxious Inhibitory Control of pain
Pain can inhibit pain

56
Q

TENS

A

Transcutaneous electrical nerve simulators
Used to stimulate Ab fibres - discriminative touch
Stimulate inhibitory lamina II interneurons

57
Q

What does the PAG stimulate

A

Locus coerulus
Nucleus raphe magnus
Reticular Formation

58
Q

Locus Coeruleus

A

Transmits NA

59
Q

Nucleus raphe magnus

A

Transmits serotonin and encephalin

60
Q

Reticular formation

A

Sympathetic arousal
NA release
Activation of inhibitory lamina II

BB2 (27 decks)

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