Analgesia and Pain

Question 1

what two drugs completely block both A-delta and C fibers

Answer 1

local blocks and ketamine

Question 2

what is pain

Answer 2

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

Question 3

T/F the pain pathway involves decussation at the grey matter of the spinal cord

Answer 3

T

Question 4

what starts the signal transduction pathway

Answer 4

thermal, mechanical and chemical signals (ex. inflammatory molecules)

Question 5

what are the 4 overarching body responses to pain and why do we need to know about them from a pharmacology/anesthesiology pov

Answer 5

• increase in hr/bp
• increase in metabolism
• increase in coagulability
• decrease in immune function

We need to be aware that some of our drugs will modify the responses to pain

Question 6

T/F the more chronic the stimulus, the more the effects of pain

Answer 6

T

Question 7

what is nociception

Answer 7

the event of sensing mechanical, chemical and thermal stimuli by nociceptors (neuronal structures)

Question 8

what is the difference between pain and nociception

Answer 8

pain includes nociception as well as the emotional and psychological consequences

Question 9

describe the relationship of pain, perception and nociception

Answer 9

pain includes nociception and perception

nociception does not include perception

Question 10

what are the types of pain

Answer 10

pain can be physiologic or pathologic. physiologic pain is called nociceptive/inflammatory. pathologic pain can be neuropathic or nociplastic

Question 11

acute pain:
- type of fibers

chronic pain:
- type of fibers

Answer 11

acute: large diameter, myelinated, Aδ fibers

chronic: small diameter, unmyelinated, C fibers

Question 12

somatic pain involves what systems and what fibers?

visceral pain involves what systems and what fibers?

Answer 12

somatic: skin and musculoskeletal; Aδ fibers

visceral: organs; C fibers

Question 13

somatic pain is ______ pain and visceral pain is ____ pain

Answer 13

fast; slow

Question 14

transmission of pain goes from _________ to the ______

Answer 14

nociceptors; brain

Question 15

where are first order neurons

Answer 15

from nociceptors to the spinal cord

Question 16

fast pain is activated by __________ stimuli whereas slow pain is activated by ___________

Answer 16

thermal and mechanical; thermal, mechanical and chemical

Question 17

does Aδ or C fibers transmit signals with a faster velocity

Answer 17

Aδ (because they are large and myelinated)

Question 18

what are the nociceptive fibers

Answer 18

Aδ and C fibers

Question 19

what is the neurotransmitter for A-delta fibers

Answer 19

glutamate

Question 20

what is the neurotransmitter for C fibers

Answer 20

substance P and glutamate

Question 21

where do Aδ and C fibers go in the spinal cord

Answer 21

dorsal horn

Question 22

what laminae in the spinal cord to the following go to:

Aβ (touch):
Aδ (fast pain):
C (slow pain):

Answer 22

Aβ: laminae II and IV
Aδ: laminae I (II also mentioned)
C: laminae I and II

Question 23

what is important about wide dynamic range neurons and what is this pain called

Answer 23

can convert touch sensation to pain; nociplastic pain

Question 24

what is alodynia

Answer 24

pain due to a stimulus which does not normally result in pain

Question 25

what is hyperalgesia

Answer 25

increased response to a stimulus that usually results in pain

Question 26

glutamate and substance P are both excitatory or inhibitory

Answer 26

excitatory

Question 27

what are the characteristics of glutamate

Answer 27

- excitatory - lasts for a few milliseconds - acts rapidly

Question 28

what are the characteristics of substance P

Answer 28

- excitatory - released over a period of seconds or minutes

Question 29

how does the DOUBLE PAIN sensation work

Answer 29

glutamate gives the faster pain sensation, followed by the lagging pain sensation of substance P

Question 30

what fibers are involved in the following tracts: - neospinal thalmic - paleospinal thalmic - archispinal thamlic

Answer 30

- neospinal thalmic: Aδ (fast pain) - paleospinal thalmic: C (slow pain) - archispinal thalmic: C (slow pain)

Question 31

what type of tract is visceral pain

Answer 31

involves C fibers: paleospinothalmic and archispinothalmic

Question 32

what type of tract is somatic pain

Answer 32

can be sharp (Aδ, neospinothalmic) or dull/aching (C fibers, paleospinothalmic and archispinothalmic)

Question 33

what type of tract is the trigeminal system

Answer 33

neospinothalmic tract

Question 34

what ganglion does the trigeminal system synapse in

Answer 34

the trigeminal ganglion

Question 35

what responses to pain are mediated by the paleospinalthamic tract? what about the archispinalthamic tract?

Answer 35

paleo: emotional and visceral response to pain archi: emotional, visceral and autonomic response to pain

Question 36

what is the pathway from nociceptors to the somatosensory cortex (5 main words)

Answer 36

transduction -> transmission -> modulation -> projection -> perception

Question 37

T/F transduction involves a signal threshold, and the strength and duration of the stimulus will affect the action potential that is ultimately created

Answer 37

T

Question 38

T/F nociceptors express a good ability to adapt

Answer 38

F; adapt very little or not at all

Question 39

what is the important implication of the non-adapting nature of nociceptors

Answer 39

the excitation of pain fibers becomes progressively greater as the pain stimulus continues (it wont calm itself down), leading to hyperalgesia or allodynia

Question 40

T/F Aδ and C fibers are carried by both sympathetic and parasympathetic nerves

Answer 40

T

Question 41

what is a key location of the brain involved in: - perception - integration - modulation

Answer 41

perception: cortex integration: thalamus modulation: periaqueductal gray (PAG)

Question 42

T/F the thalamus is physically located close to systems involved in fear, anxiety and memory

Answer 42

T

Question 43

what causes peripheral sensitization

Answer 43

tissue damage and inflammation

Question 44

what causes central sensitization

Answer 44

frequent or severe peripheral nociceptor input

Question 45

wind-up involves what receptors and build-up of what

Answer 45

AMPA -> NMDA; build up of Ca2+ in pre-synaptic terminal

Question 46

T/F neuropathic pain involves stimulating the nociceptive system without specifically stimulating the receptors

Answer 46

T