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Phase I Medicine > B5 CNS: Pain and Nociception > Flashcards

B5 CNS: Pain and Nociception Flashcards

1
Q

What is pain?

A

Unpleasant sensory and emotional experience associated with actual or potential tissue damage

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2
Q

What is nociception?

A

The neural process of detecting, encoding and processing noxious stimuli

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3
Q

What is the difference between pain and nociception?

A

Pain - subjective response

Nociception - physiological response

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4
Q

Why can pain be good?

A

Early cue to protect body from serious harm
Protective- allows us to sense damaging stimuli
Teaches us to avoid harmful situations
Forces us to rest an injured part of the body allowing for tissue repair

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5
Q

Why can pain be bad?

A

Serves no useful function in instances of chronic pain, cancer etc.
Persists even when the tissues have healed

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6
Q

What are the different types of pain?

A

Somatic

Visceral

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7
Q

What are the divisions of somatic pain?

A

Superficial

Deep

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8
Q

Where is deep pain felt?

A

Muscles, joints, deep skin layers, connective tissue

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9
Q

Where is superficial pain felt?

A

Skin

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10
Q

Where is visceral pain felt?

A

Organs of thorax and abdominal cavity

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11
Q

How is superficial pain characterised?

A

Pinching, pin pricking, cut

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12
Q

How is deep pain characterised?

A

Muscle cramp, headaches

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13
Q

How is visceral pain characterised?

A

Appendicitis, biliary colic, ulcers

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14
Q

What is acute pain?

A

Pain which resolves when the injury heals

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15
Q

What are the characteristics of acute pain?

A

Recent, well-defined onset.

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16
Q

What is chronic pain?

A

Pain that persists (for over 3 months with medical intervention) and has an ill-defined onset.

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17
Q

What are the problems with chronic pain?

A

No apparent biological function
Resting doesn’t improve pain
Persists after tissue healing
Poorly treatable

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18
Q

Give examples of acute pain

A 
Skin abraisons
Skin lacerations
Superficial skin burns
Muscle, ligament, tendon damage
Dental pain
Childbirth
Post-operative pain
Sports injuries
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19
Q

Give examples of chronic pain

A

Musculoskeletal pain (e.g. lower back pain)
Inflammatory pain
(Rheumatoid arthritis)
Migraine/ headache
Cancer pain
Central pain (pain resulting from damage to brain/ spinal cord)
Neuropathic pain (diabetic neuropathy, trigeminal neuralgia, amputation pain)
Visceral pain (pain from deep structrures)

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20
Q

What structure is responsible for pain perception?

A

Higher brain centres

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21
Q

What do nociceptors consist of?

A

Unspecialised nerve cell endings/ free nerve endings

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22
Q

True or false? Nociception is due to the overstimulation of somatosensory receptors

A

False - It’s a completely different pathway

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23
Q

Does the brain have nociceptors?

A

No

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24
Q

What are the different types of nociceptors?

A 
Thermal
Mechanical
Chemical
Polymodal
Sleeping/silent
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25
What are thermal nociceptors activated by?
Extreme temperature (heat or cold)
26
What are mechanical nociceptors activated by?
Excess pressure/ mechanical deformation
27
What are chemical nociceptors activated by?
Chemical stimulants
28
What are polymodal nociceptors activated by?
All the above
29
What are sleeping/ silent nociceptors activated by?
Inflammation
30
What are the thinnest fibres in the body?
C fibres
31
What fibres do thermal and mechanical nociceptors have?
A-delta fibres
32
What fibres do polymodal nociceptors have?
C fibres
33
What fibre is responsible for the first pain you experience?
A-delta
34
What fibre is responsible for the second pain you experience?
C fibres
35
What nociceptors are associated with first pain?
Mechanical/ thermal
36
What nociceptor is associated with the second pain?
Polymodal
37
Can you selectively anaesthetise receptors?
Yes
38
What causes congenital analgesia?
Mutation encoding sodium channels which are specific to nociceptors
39
What is congenital analgesia?
Insensitivity to internal and external pain since birth
40
What are the associated symptoms of congenital analgesia?
Limb and joint deformities from improperly healed bones Missing body parts (tongue tip/fingertips) Reduced life expectancy
41
What is lamina II known as?
Substantia gelatinosa
42
Where do the C fibres terminally end in the dorsal horn of the spinal cord?
Lamina II
43
Where do the A delta fibres terminally end in the dorsal horn of the spinal cord?
Lamina I
44
What happens to second order neurons in the nociceptive pathways?
Axons cross the midline and go up to the brain
45
What is the nociceptive pathway also known as?
Spinothalamic pathway
46
What neurotransmitters are released at the synapse involving the afferent pain fibre and the second order neuron?
Glutamate | Substance P
47
Why does referred pain happen?
Few neurons in the dorsal horn are specialised solely for transmission of visceral pain -> Overlapping dermotomes with viscera -> Cross wiring
48
Where might you experience referred pain of the heart?
Chest Left arm Neck Back
49
What is a common example of why you might experience referred pain of the heart?
Angina
50
With appenciditis, where might you experience referred pain?
Abdominal wall around navel
51
With bladder problems, where might you experience referred pain?
Perineum
52
A patient complains of pain in their lower back and abdomen... With reference to referred pain, what could the problem involve?
Left ureter
53
With right prostate problems, where might a male experience referred pain?
Lower trunk and legs
54
What is phantom limb?
Sensation that a missing limb is still attached to the body and moving appropriately
55
What is phantom limb pain?
Chronic pain involving stabbing or burning pain of the phantom limb; it could also be contorted in an uncomfortable position
56
What treatment is offered for phantom pain?
Pain killers Mirror therapy Stump stimulation to reverse remapping
57
What is the theory surrounding phantom pain?
Re-organisation of brain resources to different parts of the body causes the pain
58
What is the Gate theory of pain?
Interneurons in spinal cord act as a 'gate' Co-activation of mechanoreceptors (A alpha and beta) with nociceptors (C-fibres) suppresses activation of the projection neuron by C-fibres
59
What does the Gate theory explain?
Why pain is reduced by stimulating mechanoreceptors
60
What things can suppress pain?
``` Pressure Strong emotions Distractions Stress Placebo effect Painkillers ```
61
What is hyperalgesia?
Increased sensitivity to pain from a stimulus that normally provokes pain
62
What is allodynia?
Pain from a stimulus that does not normally evoke pain, like touch
63
What chemical mediators are involved in pain and hyperalgesia?
Substance P Prostaglandins Bradykinin Histamine
64
What is the difference between primary and secondary hyperalgesia?
Primary - in the site of tissue damage | Secondary- around the site of tissue damage
65
What is fibromyalgia?
Disorder characterised by chronic widespread pain and allodynia
66
What are treatments for fibromyalgia?
Analgesics Antidepressants Counselling Exercise
67
What are the psychological methods of pain relief?
Placebo Hypnosis Cognitive
68
What do cognitive methods of pain relief include?
Coping strategies Relaxation techniques Meditation
69
How can neurosurgery deal with pain?
Create a physical break in the nociceptive pathway Cut dorsal roots Spinal cord hemisection
70
What are opioids?
Any substance that produces morphine-like effects
71
How do opioids work?
Bind to opioid receptors in the brain | Reducing neurotransmitter afferent pain fibres can release
72
What are the three types of opioid receptors?
Mu Delta Kappa
73
Where do the 'endogenous analgesic pathways descend from?
Periaqueductal grey matter | Raphe nuclei
74
Which drug can prevent opioid overdose?
Naloxone
75
How does naloxone work?
Selectively antagonises opiod receptors
76
When would you not give a patient in severe pain morphine?
Acute respiratory depression | Acute alcoholism

Phase I Medicine (46 decks)

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