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Psychopharmacology > Chapter 9: Chronic pain > Flashcards

Chapter 9: Chronic pain Flashcards

1
Q

where does peripheral pain originate

A

outside the CNS

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2
Q

what happens when peripheral pain becomes chronic

A

it causes changes in CNS pain mechanisms that enhance/perpetuate the original pain

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3
Q

what are 3 pain conditions that start centrally

A

depression
anxiety
fibromyalgia

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4
Q

nociceptive pain pathway

A

series of neurons that begins with noxious stimuli and ends with the perception of pain

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5
Q

location of nociceptive pain pathway

A

starts in the periphery, enters the spinal cord, and projects to the brain

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6
Q

which neurons detect sensory input

A

primary afferent neurons

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7
Q

location of nociceptive pathways neuronal cell bodies

A

dorsal root ganglion along the spinal column

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8
Q

are primary afferent neurons peripheral or central

A

peripheral

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9
Q

three types of nociceptive pain pathways to the spinal cord

A

AB
C
Aẟ

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10
Q

what does the AB nociceptive pain pathway to the spinal cord detect

A

detects small movements, light touch, hair movement, and vibrations

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11
Q

C nociceptive pain pathway to the spinal cord

A

bare nerve endings that are only activated by noxious, mechanical, thermal, or chemical stimuli

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12
Q

Aẟ nociceptive pain pathways to the spinal cord

A

somewhere in between AB and C pathways. Senses noxious and subnoxious stimuli

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13
Q

what causes pain input

A

activation of primary afferent neurons

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14
Q

transduction of the nociceptive pain pathway to the spinal cord

A
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15
Q

how does transduction of pain signals begin

A

specialized membrane proteins along the peripheral projections of afferent neurons detect a stimulus and generate a voltage change

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16
Q

how is the action potential that moves along the neurons to the spinal cord generated

A

strong pain stimulus lowers the voltage membrane enough to activate VSSCs and trigger the action potential

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17
Q

how can you reduce/stop nociceptive impulse flow from primary afferent neurons into the CNS

A

block VSSCs with a local anesthetic

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18
Q

what type of neuron makes up the nociceptive pain pathways from the spine to the brain

A

dorsal horn neurons

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19
Q

function of dorsal horn neurons

A

receive input from primary afferent neurons and project to higher centers

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20
Q

location of nociceptive pain pathway from spinal cord to the brain

A

located entirely in the CNS

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21
Q

3 classes of dorsal horn neurons

A

-receive input
-interneurons
-project up

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22
Q

location of sensory/discriminatory nociceptive pain pathway from the spine to the brain

A

-thalamocortical pathway
-dorsal horn neurons ascend to spinothalamic tract
-thalamic neurons project to primary somatosensory cortex

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23
Q

which pain pathway is thought to convey the precise location of the stimulus and its intensity

A

thalamocortical nociceptive pain pathway from the spinal to the brain

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24
Q

emotional/motivational nociceptive pain pathway from spine to brain

A

-limbic pathway
-dorsal horn neurons ascend to the brainstem nuclei in the spinobulbar tract and then project to the thalamus and limbic regions

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25
Q

what is thought to be the purpose of the limbic nociceptive pathway from the spine to the brain

A

convey affective component that painful stimuli evokes

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26
Q

the combination of what two pathways results in the subjective feeling of pain

A

thalamocortical and limbic nociceptive pain pathways from the spine to the brain

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27
Q

definition of neuropathic pain

A

pain from damage to or dysfunction of any part of the PNS/CNS

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28
Q

transduction/conduction of peripheral afferent neurons in neuropathic pain states

A

can be hijacked so that nociceptive signaling is maintained in the absence of noxious stimuli

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29
Q

peripheral sensitization in neuropathic pain

A

neuronal damage by disease/trauma can alter electrical activity of neurons, allow cross-talk between neurons, and initiate inflammatory processes

30
Q

peripheral mechanisms in neuropathic pain

A

-hijacked transduction/conduction in peripheral afferent neurons
-peripheral sensitization

31
Q

central mechanisms in neuropathic pain

A

-phosphorylation of key membrane receptors/channels
-segmental central sensitization
-suprasegmental central sensitization

32
Q

how does phosphorylation of key membrane receptors/channels in the dorsal horn increase synaptic efficiency

A

-trips a “master switch” opening the gate to the pain pathway and turning on central sensitization

33
Q

what is central sensitization

A

perception of pain is created/amplified in the absence of pain input from the periphery

34
Q

what causes segmental central sensitization

A

when plastic changes occur in the dorsal horn

35
Q

plasticity in segmental central sensitization

A

activity- or use-dependent because it requires constant firing of the pain pathway in the dorsal horn

36
Q

consequences of constant pain input

A

-exaggerated/prolonged response to noxious stimuli
-painful response to normally innocuous stimuli

37
Q

suprasegmental central sensitization

A

plastic changes that take place in brain sites within the nociceptive pain pathway in the presence of a known peripheral cause or in the absence of a trigger (especially in the thalamus or cortex)

38
Q

2 ways to accomplish suprasegmental central sensitization

A

-peripherally activated
-pain that originates w/o peripheral input

39
Q

peripherally activated suprasegmental central sensitization

A

the brain “learns” from the experience of pain and decides to keep it going, enhance it, and make it permanent

40
Q

conditions hypothesized to be caused by suprasegmental central sensitization (originating in the brain without evidence of peripheral pain)

A

fibromyalgia
physical pain sx of depression and anxiety (especially PTSD)

41
Q

what type of disorder is pain with and without emotional symptoms

A

without - neurological
with - psychiatric

42
Q

pain in fibromyalgia is linked to..

A

malfunctioning thalamus

43
Q

physical fatigue in fibromyalgia linked to dysfunction of..

A

striatum and spinal cord

44
Q

fibro-fog and mental fatigue linked to what malfunctioning brain circuits

A

PFC (especially DLPFC)

45
Q

fatigue, low energy, and lack of interest in fibromyalgia may be d/t malfunctioning of what brain circuit

A

PFC but may also be r/t nucleus accumbens

46
Q

malfunctioning brain circuit in fibromyalgia that causes disturbances in sleep/appetite

A

hypothalamus

47
Q

malfunctioning brain areas responsible for the depressed mood of fibromyalgia

A

amygdala and orbital frontal index

48
Q

malfunctioning area of the brain causing anxiety symptoms in fibromyalgia

A

amygdala

49
Q

what are the main non=pain sx of fibro

A

fatigue
anxiety
depression
sleep disturbance
concentration problems

50
Q

chronic pain may result in gray matter loss in which areas of the brain

A

DLPFC
thalamus
temporal cortex

51
Q

periaqueductal gray

A

site of origin and regulation of much of the descending inhibition that projects down the spinal cord to the dorsal horn

52
Q

main functions of the periaqueductal gray

A

-integrates input from nociceptive pain pathways and limbic structures (amygdala, limbic cortex)
-sends output to brainstem nuclei and rostroventromedial medulla to drive descending inhibitory pathways

53
Q

u-opioid receptors in which areas are targets for opioid analgesics

A

spinal
periaqueductal gray

54
Q

where does the descending spinal norepinephrine pathway originate and what does it do

A

-locus coeruleus
-descending NE neurons inhibit neurotransmitter release from primary afferents

55
Q

where does the serotonergic descending spinal pathway originate

A

in the nucleus raphe magnus of the rostroventromedial medulla

56
Q

how does 5HT inhibit primary afferent terminals in the descending spinal serotonergic pathway

A

by indirectly influencing ion channels to hyperpolarize the nerve terminal and inhibit nociceptive neurotransmitter release via postsynaptic 5HT1B and 5HT1D G-protein coupled receptors

57
Q

what other pathway is serotonin a major neurotransmitter for

A

descending facilitation pathways to the spinal cord

58
Q

what pain syndromes are SNRIs approved for

A

fibromyalgia
diabetic peripheral neuropathy

59
Q

what does descending inhibition of the spinal serotonergic pathway accomplish

A

active at rest to mask perception of irrelevant nociceptive input like peristalsis and joint movement

60
Q

what physiologica mechanism causes pain when there is no trauma

A

descending inhibition of the spinal serotonergic pathway is not working correctly to filter out irrelevant nociceptive input so you experience pain from input that is usually ignored

61
Q

how do SNRIs work to treat pain

A

enhance the descending inhibition of the spinal serotonergic pathway so that innocuous stimuli can once again be ignored

62
Q

when is descending inhibition of the spinal serotonergic pathway activated

A

during severe injury and in dangerous situations

63
Q

what happens when descending inhibition of the spinal serotonergic pathway is activated

A

-release of endogenous opioid peptides, serotonin, and norepinephrine
-reduces release of nociceptive neurotransmitters in the dorsal horn
-reduces transmission of nociceptive impulses up the spinal cord to the brain

64
Q

what happens when central sensitization occurs at the spinal or segmental levels

A

likely linked to neurotransmitters released there

65
Q

what happens when central sensitization occurs at the suprasegmental level in the thalamus and cortex

A

likely linked to the release of mostly glutamate

65
Q

what hypothetically happens in states of central sensitization

A

there is excessive and uneccessary ongoing nociceptive activity causing neuropathic pain

66
Q

what does blocking VSCCs with ligands do

A

inhibits release of neurotransmitters in the dorsal horn, thalamus, and cortex to treat neuropathic pain

67
Q

what are ligands used for in fibromyalgia

A

reduce anxiety
improve slow-wave sleep disorder

68
Q

how do SNRIs work to treat fibromyalgia

A

reduces depression/anxiety
treats fatigue and cognitive sx

69
Q

how do SNRIs decrease fibro fog

A

increasing dopamine in the DLPFC

70
Q

what are some other strategies for decreasing fibro fog besides SNRIs

A

modafinil/armodafinil
NDRIs (Wellbutrin)
stimulants

71
Q

2nd line treatments for fibromyalgia

A

-sedating drugs for depression (mirtazapine, TCAs)
-tricyclic muscle relaxant cyclobenzaprine
-sleep aids

Psychopharmacology (13 decks)

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