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BB2 > Anatomy and Physiology of Pain > Flashcards

Anatomy and Physiology of Pain Flashcards

1
Q

4 processes of pain signalling

A

transduction
transmission
perception
modulation

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2
Q

transduction of pain

A

noxious stimuli translated into electrical activity at sensory nerve endings

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3
Q

transmission of pain

A

propagation of impulses along pain pathways

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4
Q

how many neurones of the pain pathway

A

3

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5
Q

what do nociceptors detect

A

tissue damage

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6
Q

which organ has no nociceptors

A

brain

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7
Q

what activates TRPV1 channels

A

heat, acid, capsaicin, mustard, wasabi

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8
Q

what activates TRPM8 channels

A

cold, menthol

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9
Q

what activates ASIC channels

A

h+ - Acid Sensing Ion Channel

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10
Q

what family of channels are important in temperature nociception

A

TRP family

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11
Q

what happens when a nociceptor is activated

A

signals sent along primary afferent sensory neurone

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12
Q

what effects speed of transmission along a neurone

A

myelination
axon diameter

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13
Q

which axon types carry ‘1st pain’ and ‘2nd pain’

A

1st - A delta
2nd - C

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14
Q

what are remak bundles

A

clusters of C fibres

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15
Q

what are NaVs and how many subtypes are there

A

voltage gated sodium channels
9

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16
Q

which NaV is heavily implicated in pain transmission

A

NaV1.7

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17
Q

what conditions are caused by gain of function and loss of function mutations in NaV1.7 channels

A

gain - inherited erythromelalgia
loss - congenital insensitivity to pain

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18
Q

congenital insensitivity to pain

A

rare condition where patient cannot feel pain

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19
Q

inherited erythromelalgia

A

neuropathy causing severe chronic burning pain in hands and feet

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20
Q

risks of congenital insensitivity to pain

A

wounds, broken bones, and health issues not detected
bone breaks heal badly as not treated
babies chew fingers, lips, tongue, etc

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21
Q

congenital insensitivity to pain with anhidrosis

A

inability to feel pain and temperature, and decreased or absent sweating

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22
Q

what causes congenital insensitivity to pain with anhidrosis

A

TRKA gene mutation -> decreased nerve growth factor -> decr A delta and C fibres

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23
Q

what causes diabetic neuropathy and where are effects most common

A

high or fluctuating blood glucose damage nerves
legs and feet

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24
Q

how many laminae in the dorsal horn, and entire spinal cord

A

5 in dorsal horn
10 across whole cord

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25
which laminae of the dorsal horn do A delta nociceptor axons synapse to and what NT is released
lamina I glutamate
26
what cells do C fibre nociceptor axons synapse to to indirectly activate lamina I cells
lamina II interneurons
27
what is caused when lamina II interneurons become spontaneously active
neuropathic pain
28
what part of the spinal cord do axons of projection neurons decussate in
anterior white commissure
29
projection neuron
second order neurones with cell body in dorsal horn
30
2 major ascending pathways carrying sensory info to the brain
spinothalamic tract DCML
31
2 sub tracts within the spinothalamic tract
anterior spinothalamic lateral spinothalamic
32
which spinothalamic tract mainly conducts crude light touch and pressure
anterior spinothalamic
33
which axon types give inputs to the anterior spinothalamic tract
A beta A delta C
34
where do 2nd order neurones in the anterior spinothalamic tract synapse to 3rd order neurones
thalamus - ventral posterior lateral and ventral posterior inferior nuclei
35
what information do 3rd order neurones in the anterior spinothalamic tract convey to the somatosensory cortex
exact localisation and physical intensity of noxious stimulus
36
which spinothalamic tract mainly conveys pain and temperature
lateral spinothalamic tract
37
which axon types input to the lateral spinothalamic tract
A delta C
38
where do 2nd order neurones in the lateral spinothalamic tract synapse to 3rd order neurones
thalamus - mediodorsal, ventral posterolateral, and ventral posterior inferior nuclei
39
which parts of the cortex does the anterior spinothalamic tract innervate
primary and secondary somatosensory cortices
40
which parts of the cortex does the lateral spinothalamic tract innervate
anterior cingulate and rostral insular cortex
41
which spinothalamic tract also synapses to the limbic system, intralaminar nuclei of the thalamus, periaqueductal grey, and reticular formation other than the thalamus
lateral spinothalamic
42
role of the limbic system, intralaminar nuclei of the thalamus, periaqueductal grey, and reticular formation in pain perception
limbic - subjective sensations of pain and pleasure INoT - arousal and desc control of nociceptor input PAG - desc pain modulation RF - alterting cerebral cortex and focus attention on pain
43
which brain region is responsible for the unpleasant nature of pain
limbic system
44
which spinothalamic tract controls sensory-discriminative/intensity of pain and which controls affective motivational/unpleasantness of pain
sens-disc anterior spinothalamic aff-mot lateral spinothalamic
45
brain areas activated by pain
somatosensory cortex cingulate cortex amygdala insula
46
what part of pain perception is controlled by the anterior cingulate cortex
emotional reaction
47
what part of pain perception is controlled by the pre frontal cortex
evaluation and cognition
48
what part of pain perception is controlled by the insula
pain mapping, interoception, homeostatic adjustment, emotion
49
what part of pain perception is controlled by the primary somatosensory cortex
location and intensity
50
what part of pain perception is controlled by the amygdala
aversion, emotional memory and response
51
3 major brain regions in pain modulation
peri aqueductal grey locus coeruleus raphe nucleus
52
role of descending inhibitory system to modulate pain
intrinsic analgesic response to prevent continuous pain
53
where is the periaqueductal grey and what effect is caused by its stimulation
around cerebral aqueduct in brainstem analgesia
54
Natural methods of pain modulation
lamina II inhibitory neurons endogenous opioids A beta afferents
55
how are lamina II inhibitory neurons activated to modulate pain
axons descending spinal cord activate lamina II inhibitory interneurons -> release serotonin and noradrenaline -> inhib neurone activation
56
role of lamina II inhibitory neurones
block/dampen incoming nociceptive signals by releasing GAB and enkephalins which bind to A delta axons and lamina I dendrites
57
endogenous opioids
endorphins enkephalins dynorphins
58
3 opioid receptors
mu delta kappa
59
what cells release endogenous opioids
interneurons
60
how does opioid receptor activation reduce nociceptive transmission
decrease excitation at dorsal horn
61
why do people often not immediately feel pain after severe trauma
massive enkephalin release
62
how can activation of A beta fibres dampen pain
overwhelm secondary afferent neurons inhibiting nociceptive signal transmission can synapse on lamina inhibitory neurones
63
how can activation of A beta fibres dampen pain
overwhelm secondary afferent neurons inhibiting nociceptive signal transmission can synapse on lamina II inhibitory neurones
64
how does rubbing area reduce pain
activation of A beta afferents
65
how long does chronic pain last
over 3 months
66
allodynia
sensitised state where pain is caused by a non noxious stimulus
67
hyperalgesia
abnormal increased pain sensitivity is caused by a noxious stimulus
68
peripheral sensitisation
increased sensitivity to an afferent nerve stimuli at the peripheral site
69
central sensitisation
increased sensitisation to an afferent nerve stimuli at the CNS site
70
what causes peripheral sensitisation
Sensitisation of sensory primary afferent fibres inflammatory mediators stimulate nocioceptive and up regulate ion channels in sensory fibres increasing membrane potential closer to depolarisation threshold
71
what causes central sensitisation
Sensitisation of projection neurones continuous activation of projection neurones upregulates ion channels increasing depolarisation closer to threshold
72
2 types of peripheral sensitisation
ectopic activity ephatic transmission
73
where can collateral sprouting induced pain occur
dorsal horn
74
what does Braak staging asses
distribution of Tau tangles in brain
75
what are Tau tangles made up of
hyperphosphorylated Tau
76
normal function of Tau
stabilises microtubules
77
how does hyperphosphorylation of Tau cause neurone death
microtubules not stabilised -> decr axonal support -> neurone fdeath
78
what gene encodes Tau
MAPT
79
how does level of beta amyloid and Tau in the CSF change in dementia
beta amyloid decr Tau incr
80
why does CSF beta amyloid decrease in dementia -amyloid sink hypothesis
amyloid deposited in brain so not in CSF
81
how can dementia brain changes be assessed
MRI
82
how long before symptoms arise do pathological changes start to occur in dementia
~20 years

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