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BB CC > Anatomy + Physiology of Pain > Flashcards

Anatomy + Physiology of Pain Flashcards

1
Q

Transduction

A

Noxious stimuli translated into electrical activity at sensory nerve endings

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2
Q

Transmission

A

Propagation of impulses along pain pathway

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3
Q

Perception

A

Discrimination/affect/motivation

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4
Q

Pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

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5
Q

Signal transduction

A

Receptor proteins in membrane of nociceptors that allow response to tissue-damaging stimuli

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6
Q

ASIC3

A

Skeletal and cardiac muscle
Acid sensing
Detects pH change with ischaemia

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7
Q

TRPV1

A

Heat

Acid

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8
Q

TRPM8

A

Cold

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9
Q

Loss of transduction/transmission genetic defect

A

Loss of NaV1.7

Congenital indifference to pain

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10
Q

Loss of C fibres

A

trkA-NGF receptor mutation

Congenital insensitivity to pain with anhidrosis CIPA

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11
Q

A Delta nociceptors

A 
MYELINATED
Sharp, pricking, fast pain
Thermal + mechanical nociception
Precise location of insult/stimulus
Reflex withdrawal
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12
Q

C fibres

A

Non-myelinated
Slow burning pain
Peptidergic C fibres
Peptide poor C fibres

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13
Q

Peptidergic C fibres

A

Release peptides peripherally, e.g. substance P/CGRP
Thermal nociception
Vasoactive, promote inflammatory responses + healing

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14
Q

Peptide poor C fibres

A

Have distinct receptors e.g. P2X3 ATP receptors

Mechanical nociception

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15
Q

Lamina I- dorsal horn

A

A delta nociceptors

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16
Q

Lamina I-IIo

A

A delta/C peptidergic fibres

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17
Q

Lamina II

A

C non-peptidergic fibres

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18
Q

Lamina IIi-III

A

A delta hair follicle afferents

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19
Q

Lamina IIi-V

A

A beta hair follicle and tactile afferents

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20
Q

C fibres innervate lamina..

A

Lamina I
Interneurones in Lamina II
Lamina V through interneurones in lamina II

21
Q

A delta fibres innervate lamina…

A

Lamina I and V projection neurones

22
Q

Lamina V

A

A delta
A beta fibres- touch
C fibres- indirectly through interneurones

23
Q

Lateral spinothalamic tract

A

Pain and Temp

24
Q

Limbic system

A

Projections to here from lateral spinothalamic tract mediate unpleasant (painful) character of pain

25
Q

Anterior “neo” spinothalamic tract

A

Primary afferent- A delta as well as C and A Beta
Innervate projection neurones in lamina C
–> after decussating, axons travel in anterior spinothalamic tract
Innervate VPL and VPM in somatosensory thalamus
Innervate VPI and CL nuclei in reticular + limbic associated areas

26
Q

Anterior spinothalamic- projections to cortex

A

VPI –> secondary somatosensory cortex

CL –> anterior cingulate cortex, prefrontal cortex + striatum

27
Q

Anterior spinothalamic function summary

A

Subserves the first, discriminative aspects of pain

28
Q

Lateral spinothalamic tract

A

Primary afferent- C fibres but some A Delta
Innervate projection neurones in lamina 1
–> after decussating, axons travel in lateral spinothalamic tract
Innervate more posterior/medial parts of thalamus
–> mediodorsal nucleus, posterior and ventral medial nuclei

29
Q

Lateral spinothalamic- projections to cortex

A

MDvc –> ACC (amotion, motivation)

POm/VMpo –> anterior and rostral insula (emotion, quality i.e. pain

30
Q

Lateral spinothalamic function summary

A

Subserves second, punishing aspects of pain

31
Q

Primary sensory cortex

A

Somatosensory discrimination- location, intensity

32
Q

Anterior cingulate cortex

A

Emotional reaction/motivation

33
Q

Pre-frontal cortex

A

Evaluation

Cognition

34
Q

insula

A

Pain map, interoception, homeostatic adjustment, emotion

35
Q

Amygdala

A

Aversion, emotional memory + response

36
Q

Peripheral sensitisation

A

Sensitisation of area of injury
Due to effects of inflammatory receptors
–> reduction in activation threshold
–> increase in responsiveness - Na channels change thresholds for opening, K channels close, TRPV1 channels increases sensitivity to heat, some nociceptors become tonically active

37
Q

Hyperalgesia/allodynia/spontaneous pain

A

Enables protection + facilitates healing

Resolves with healing of underlying cause

38
Q

4 Cardinal signs of inflammation

A

Calor
Rubor
Dolor
Tumor

39
Q

Prostaglandin synthesis

A

Phospholipase A2 releases arachidonic acid from cell membranes
COX1 and COX 2 use it as substrate for PG synthesis

40
Q

COX 1

A

Present in tissue at low levels

41
Q

COX 2

A

Induced during inflammation

42
Q

Central sensitisation

A

Prolonged nociceptor input onto dorsal horn neurone projection neurones
Nociceptor afferents release glutamate and peptides
–> increased dorsal horn nociceptive second order neurones to inputs sensitivity

43
Q

Primary thermal hyperalgesia

A

Increased sensitivity to heat induced pain

44
Q

Primary mechanical hyperalgesia

A

Increased sensitivity to pressure pain

45
Q

Chronic pain

A

Pain of more than 12 weeks

46
Q

Maladaptive pain

A

Abnormal activity in NS
- neuropathic pain, dysfunctional pain
Characterised by hyperalgesia, allodynia, spontaneous pain

47
Q

Endogenous modulation

A

Innocuous stimuli lessen pain- rubbing an acute injury

Pain can inhibit pain

48
Q

Acupuncture

A

Activate A delta fibres

Stimulates through PAG mediated Diffuse Noxious Inhibitory control “DNIC” of pain

49
Q

Analgesia through stimulation of non-noxious afferents

A

Non-noxious inputs also stimulate lamina II interneurones

Basis of TENS

BB CC (29 decks)

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