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Lifespans > Chronic Pain 2 > Flashcards

Chronic Pain 2 Flashcards

1
Q

What is sensitization?

A

Repeated or intense noxious stimulus causes changes in the SC and brain

  • Lowers threshold for activation
  • Amplifies subsequent inputs, even for benign stimuli

**Basically, the nervous system adapts and becomes over-effective where anything can cause a big rxn

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2
Q

Sensitization is adaptive. Why is this important?

A
  • becomes hyper-alert to potentially damaging conditions

- The problem is that this is NO LONGER ABOUT PROTECTION

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3
Q

Sensitization produces these:

A
  • Allodynia
  • Hyperalgesia or hypersensitization
  • Secondary hyperalgesia
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4
Q

Allodynia

A

Pain produced by a normally innocuous stimulus

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5
Q

Hyperalgesia or hypersensitization

A
  • Exaggerated and prolonged response

- Primary hyperalgesia is part of a normal process. Secondary is NOT

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6
Q

Secondary hyperalgesia

A
  • Spread beyond site of stimulation or injury

- Also known as “referred pain”

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7
Q

With peripheral sensitization, there is an increased responsiveness of:

A
  • Nociceptors at area of injury

- greater sensitivity around injury area

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8
Q

With peripheral sensitization, the injury causes the release of

A

Sensitizing soup

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9
Q

What is sensitizing soup?

A
  • neuropeptide cascade

- inflammatory process increases release of neuropeptides

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10
Q

Peripheral sensitization causes a reduction in

A

Threshold for nociceptors

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11
Q

Peripheral sensitization and DOMS

A

Get crazy pain with DOMS and trigger points

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12
Q

Peripheral sensitization mechanisms

A

brief (lasting days) muscle hyperalgesia

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13
Q

When does brief muscle hyperalgesia with peripheral sensitization?

A
  • induced after eccentric exercise
  • soreness after 1-2 days (DOMS)
  • model for hyperalgesic trigger points
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14
Q

Central sensitization is the uncoupling of pain from

A

Peripheral stimuli

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15
Q

Synaptic transmission and central sensitization

A

Get changes to synaptic transmission to the SC

  • membrane excitability
  • synaptic recruitment
  • decreased inhibition
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16
Q

Central sensitization: nociceptive pathways

A
  • get novel inputs to nociceptive pathways

- activates A-beta large low threshold mechanoreceptor pathways

17
Q

What is the functional shift that occurs with central sensitization?

A

High threshold mechanoreceptors now respond to low threshold input

18
Q

What are the two mechanisms of central sensitization?

A
  • enhancement

- changes in the brain

19
Q

Some studies show that the PAG is (larger/smaller) in individuals with chronic pain

A

Smaller

20
Q

In addition to central sensitization, PAG is linked with these problems

A

Depression in chronic pain

21
Q

Central sensitization: enhancement

A
  • increased membrane excitability in dorsal horn

- synaptic efficacy » neuronal plasticity

22
Q

What are the changes in the brain that occur with central sensitization?

A
  • Reduced inhibition of descending system
  • Impaired motor control of spinal muscles
  • Effect on dorsal horn neurons in SC
  • Receptive field expansion
23
Q

Reduced inhibition of descending system

A

Periaqueductal grey matter doesn’t inhibit pain as it should

24
Q

PAG function

A
  • blocks unnecessary information

- If not working, all info ends up in the cortex

25
Q

Changes in the brain with central sensitization: Effect on dorsal horn neurons of the SC

A
  • Increase in spontaneous activity
  • Lowered threshold of activity
  • Increased response to stimulation
  • Enlargement of receptive field
26
Q

Changes in the brain with central sensitization: receptive field expansion

A
  • Sleeping neurons become activated

- Over-efficiency of all neurons

27
Q

Central sensitization is ________ dependent.

A

Activity

28
Q

For central sensitization to occur, a noxious stimulus must be:

A
  • intense
  • repeated
  • sustained
29
Q

These are malleable (central sensitization)

A

Somatosensory neuron receptive fields

30
Q

What is the basis for the effects of central sensitization?

A

Plasticity

31
Q

There are many factors that contribute to your perception of pain

A
  • biological
  • psychological
  • social
  • cultural
32
Q

What is important to realize about pain and degeneration?

A
  • Just because you have pain, it doesn’t mean there is any significant damage or degeneration occurring in the body
  • Learning this can be very relieving for people who are afraid they might have a serious problem
33
Q

Which produces the best results with chronic pain pts: strengthening or conditioning?

A

Strengthening (but a combo of both is better)

34
Q

Risk factors: This is the 4th greatest risk factor for chronic pain

A

Sedentary behavior

35
Q

How does exercise target central and peripheral trigger?

A
  • affecting the nociceptive inhibition

- targeting depression

Lifespans (17 decks)

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