Chapter 11 Flashcards
Pain in Dementia
Name three possible explanations for the very low usage of pain medication of demented patients.
(1) Decline in communication, (2) Decline in memory for pain and (3) Changes in pain processing pathways.
Name the two different types of pain and describe them in more detail.
(1) Nociceptive pain: nociceptor is stimulated by a chemical, thermal or mechanical event that could cause tissue damage.
(2) Neuropathic pain: due to PNS itself (neurogenic), CNS (due to damage). E.g. allodynia
Describe the developmental process of allodynia.
Chronic stress / anxiety leads to a neuroinflammation in the spinal cord. This, in turn, leads to a mechanical hypersensitivity (allodynia), which is mediated by cholecystokinin descending facilitatory pathways.
Name the two pain systems and describe their characteristics when it comes to pain experience.
(1) Medial (paleospinothalamic) system: cognitive-evaluative as well as motivational-affective aspects.
(2) Lateral (neospinothalamic) system: sensori-discriminative aspects.
In AD, patients report experiencing less pain. In how far is this related to the pain system?
AD patients may experience a decrease in the motivational/affective aspects of pain, while maintaining sensory/discriminative capacities. This coincides with the degeneration of most medial pain areas.
In VaD, patients report experiencing more pain. In how far is this related to the pain system?
In VaD, a disconnection between cortical areas and between cortical and subcortical areas might occur, leading to a so-called “deafferentiation pain” (central, neuropathic pain).
How do FTD patients experience pain? How can this be explained?
FTD patients report significantly less pain than AD or VaD patients. This can be explained by the large frontal damage (medial pathway) that often occurs in FTD. Moreover, there is a marked decrease in blood flow to the PFC and ACC.
How do Parkinson patients experience pain? How can this be explained?
Parkinson patients show a significant association between the progression of the disease and an increase in pain. This can be explained by the (early) degeneration of the pain inhibiting descending pathways (Periaqueductal gray, Locus Coeruleus) leading to central, neuropathic pain.
