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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
Q

What are thermal nociceptors activated by?

A

Extreme temperature (heat or cold)

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26
Q

What are mechanical nociceptors activated by?

A

Excess pressure/ mechanical deformation

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27
Q

What are chemical nociceptors activated by?

A

Chemical stimulants

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28
Q

What are polymodal nociceptors activated by?

A

All the above

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29
Q

What are sleeping/ silent nociceptors activated by?

A

Inflammation

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30
Q

What are the thinnest fibres in the body?

A

C fibres

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31
Q

What fibres do thermal and mechanical nociceptors have?

A

A-delta fibres

32
Q

What fibres do polymodal nociceptors have?

A

C fibres

33
Q

What fibre is responsible for the first pain you experience?

A

A-delta

34
Q

What fibre is responsible for the second pain you experience?

A

C fibres

35
Q

What nociceptors are associated with first pain?

A

Mechanical/ thermal

36
Q

What nociceptor is associated with the second pain?

A

Polymodal

37
Q

Can you selectively anaesthetise receptors?

A

Yes

38
Q

What causes congenital analgesia?

A

Mutation encoding sodium channels which are specific to nociceptors

39
Q

What is congenital analgesia?

A

Insensitivity to internal and external pain since birth

40
Q

What are the associated symptoms of congenital analgesia?

A

Limb and joint deformities from improperly healed bones
Missing body parts (tongue tip/fingertips)
Reduced life expectancy

41
Q

What is lamina II known as?

A

Substantia gelatinosa

42
Q

Where do the C fibres terminally end in the dorsal horn of the spinal cord?

A

Lamina II

43
Q

Where do the A delta fibres terminally end in the dorsal horn of the spinal cord?

A

Lamina I

44
Q

What happens to second order neurons in the nociceptive pathways?

A

Axons cross the midline and go up to the brain

45
Q

What is the nociceptive pathway also known as?

A

Spinothalamic pathway

46
Q

What neurotransmitters are released at the synapse involving the afferent pain fibre and the second order neuron?

A

Glutamate

Substance P

47
Q

Why does referred pain happen?

A

Few neurons in the dorsal horn are specialised solely for transmission of visceral pain -> Overlapping dermotomes with viscera -> Cross wiring

48
Q

Where might you experience referred pain of the heart?

A

Chest
Left arm
Neck
Back

49
Q

What is a common example of why you might experience referred pain of the heart?

A

Angina

50
Q

With appenciditis, where might you experience referred pain?

A

Abdominal wall around navel

51
Q

With bladder problems, where might you experience referred pain?

A

Perineum

52
Q

A patient complains of pain in their lower back and abdomen… With reference to referred pain, what could the problem involve?

A

Left ureter

53
Q

With right prostate problems, where might a male experience referred pain?

A

Lower trunk and legs

54
Q

What is phantom limb?

A

Sensation that a missing limb is still attached to the body and moving appropriately

55
Q

What is phantom limb pain?

A

Chronic pain involving stabbing or burning pain of the phantom limb; it could also be contorted in an uncomfortable position

56
Q

What treatment is offered for phantom pain?

A

Pain killers
Mirror therapy
Stump stimulation to reverse remapping

57
Q

What is the theory surrounding phantom pain?

A

Re-organisation of brain resources to different parts of the body causes the pain

58
Q

What is the Gate theory of pain?

A

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
Q

What does the Gate theory explain?

A

Why pain is reduced by stimulating mechanoreceptors

60
Q

What things can suppress pain?

A 
Pressure
Strong emotions
Distractions
Stress
Placebo effect
Painkillers
61
Q

What is hyperalgesia?

A

Increased sensitivity to pain from a stimulus that normally provokes pain

62
Q

What is allodynia?

A

Pain from a stimulus that does not normally evoke pain, like touch

63
Q

What chemical mediators are involved in pain and hyperalgesia?

A

Substance P
Prostaglandins
Bradykinin
Histamine

64
Q

What is the difference between primary and secondary hyperalgesia?

A

Primary - in the site of tissue damage

Secondary- around the site of tissue damage

65
Q

What is fibromyalgia?

A

Disorder characterised by chronic widespread pain and allodynia

66
Q

What are treatments for fibromyalgia?

A

Analgesics
Antidepressants
Counselling
Exercise

67
Q

What are the psychological methods of pain relief?

A

Placebo
Hypnosis
Cognitive

68
Q

What do cognitive methods of pain relief include?

A

Coping strategies
Relaxation techniques
Meditation

69
Q

How can neurosurgery deal with pain?

A

Create a physical break in the nociceptive pathway
Cut dorsal roots
Spinal cord hemisection

70
Q

What are opioids?

A

Any substance that produces morphine-like effects

71
Q

How do opioids work?

A

Bind to opioid receptors in the brain

Reducing neurotransmitter afferent pain fibres can release

72
Q

What are the three types of opioid receptors?

A

Mu
Delta
Kappa

73
Q

Where do the ‘endogenous analgesic pathways descend from?

A

Periaqueductal grey matter

Raphe nuclei

74
Q

Which drug can prevent opioid overdose?

A

Naloxone

75
Q

How does naloxone work?

A

Selectively antagonises opiod receptors

76
Q

When would you not give a patient in severe pain morphine?

A

Acute respiratory depression

Acute alcoholism

Phase I Medicine (46 decks)

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