Chronic Pain Syndromes Flashcards
The spinothalamic tract is the _________ pathway of the ________
direct, anterolateral system (ALS)
The spinoreticulothalamic tract is the _________ pathway of the _____________
indirect, anterolateral system (ALS)
The ______________ runs from the spinal cord to the VPL nucleus of the thalamus and mediates sensory-discriminative aspects of pain (what, where, when). It is processes well-localized signals
spinothalamic tract (direct pathway of the ALS)
The ______________ runs from the spinal cord to the intralaminar thalamic nucleus via reticular formation. It mediates affective-motivational aspects of pain and is poor at localizing pain
spinoreticulothalamic tract
The cell bodies of first-order neurons in the spinoreticulothalamic tract are in the _______ and they are ________.
PRG, bipolar
Second order neurons of the spinoreticulothalamic tract have their cell bodies in the _________ and their axons enter the ____________ before synapsing in the ____________ and then finally in the __________
posterior horn of the spinal cord, contralateral ALS, reticular formation (brainstem), medial thalamus
__________ are 3rd order neurons of the spinoreticulothalamic tract that have their cell bodies in the __________.
Their axons enter the ____________ and project to diverse cortical areas
thalamocortical neurons, intralaminar nuclei of the thalamus, posterior limb of internal capsule
The primary sensory neuron of the spinoreticulothalamic tract has the following electrophysiological classification: ________ and a diameter that is _________ than any other peripheral neuron. They are __________ mechanoreceptors, thermoreceptors, and nociceptors
C, smaller, high-threshhold
Pain receptors of the spinoreticulothalamic tract are __________ and have a ________ receptive field
pseudounipolar unmyelinated C fibers, small
PRG = _________
posterior root ganglion
Central process of pain receptors of spinoreticulothalamic tract enter spinal cord in the ________ of the __________. Branches then enter the ____________
lateral division, posterior root entry zone, posterolateral fasciculus
descending branches of the posterolateral fasciclulus participate in ___________
cutaneous spinal reflexes
C fibers of pain sensors of spinoreticulothalamic (SRT) tract ascend in the _________ and synapse mainly in ___________ which contains interneurons that project to _________
posterolateral fasciculus, lamina II (substantia gelatinosa), lamina V
_________ contains projection neurons whose axons decussate and travel to ALS fibers to brainstem and thalamic targets
lamina V (in the spinal cord)
lamina V receives C fiber input via _________
interneurons in lamina II
Axons of lamina V neurons decussate in the ____________ and axons ascend rostrally over ______ segments as they decussate
anterior white commissure, 2-3
__________ fibers synapse in the reticular formation and then these reticulothalamic fibers project to ___________
spinoreticular fibers, intralaminar nuclei of thalamus
spinoreticular fibers are responsible for ______________ of pain
emotional-affective aspects
__________ fibers of the ALS project to periaqueductal gray (pain modulation)
spinomesencephalic fibers
intralaminar nuclei of the thalamus include _______ and ________ as well as others
centromedian (CM), parafascicular (PF)
intralaminar nuclei of the medial thalamus project to _________ and the _________ among others
anterior cingulate cortex, insular cortex
The ________ is important in discriminating the quality and intensity of stimuli (interoception), as well as monitors motivational and affective (emotional) aspects of pain
insular cortex
A word for the discrimination of quality and intensity of stimuli is:
interoception
The ________ (Brodmann area ____) is part of the limbic system for emotions and activation increases when stimuli are judged to be more unsettling and unpleasant
anterior cingulate cortex, 24
A-delta fibers of _______ project via ____________ tract to the _______ nucleus of the thalamus and then to ____________ cortex
lamina I (sensory-discriminative pain), spinothalamic tract, VPL, primary somatosensory cortex (S1)
congenital analgesia which is due to ______________ is a condition where a person has insensitivity to pain
A mutation in a tyrosine kinase receptor (NGF receptor)
The most common reason for seeking medial attention is _________
persistent pain
_________ has no purpose and is best described as a ‘disease’
chronic pain
__________ is pain that results from direct injury to PNS or CNS nerves, and it is considered _______ pain
neuropathic pain, chronic
__________ describes the phenomenon where nerve loss due to injury produces chronic hypersensitivity to painful stimuli (hyperalgesia) and innocuous stimuli (allodynia)
neuropathic pain paradox
________ and _______ are the most common clinical manifestations of chronic pain
hyperalgesia, allodynia
Complex regional pain syndrome I (CRPS I) is a type of __________ where the cause is __________
neuropathic pain paradox, unknown due to no definable nerve lesion
______________ cause excruciating pain often described as burning, aching, pricking, or shooting and may be increased in emotional or physical stress.
Complex regional pain syndrome II (CRPS II)
A patient presents with severe emotional distress and an excruciating shooting pain in in his extremity. What is the diagnosis?
CRPS II
The 2 types of peripheral pain conditions are:
phantom limb pain, CRPS
The 2 types of central pain conditions are:
central post-stroke pain, spinal cord injury (30-50% of all central pain conditions)
The only somatic pain condition we cover in this course is ________
fibromyalgia
The most common form of somatic pain condition is _______ and is in the same category as _________
arthritis, fibromyalgia
The _______ pain pathway regulates sensory aspects of pain, while the _________ pathway regulates emotional/motivational aspects
lateral, medial
The __________ and _________ in the pons are associated with the medial pain pathway which regulates emotional and motivational aspects of pain
locus ceruleus, parabrachial nucleus
Pain sensory fibers in the lateral pain pathway are _________, while fibers in the medial pathway are ________
A-delta fibers, C fibers
The ________ of the medial pain system have _________ receptive fields but these fields are ______ in number
C fibers, large, fewer
C fibers in the medial pain system synapse in ________ and release _________
laminae I and II, substance P
allodynia results from collateral sprouting onto superficial laminae of _______ fibers
A-beta
The _________ tract has direct projections to limbic structures
spinolimbic
spinolimbic tract fibers have direct projections to the ________, ________, and _________
anterior cingulate cortex, insular cortex, amygdala
The _________ tract provides a mechanism for nociceptive signals to influence the limbic loop of brain structures
spinolimbic tract
Brodman areas ____ and ______ receive afferent inputs from the spinolimbic fibers of the medial pain system
24, 25
Brodman areas 24 and 25 are part of the ________ and are activated _________ to pain stimuli
medial pain system, bilaterally
stimulation of Brodmann area 24 produces ______, ______, and ________
fear, pleasure, agitation
Brodmann areas 24 and 25 refer to the _________ cortex
anterior cingulate cortex (ACC)
Ablation of the _________ eliminates emotional responses to noxious stimuli but leaves sensory localization intact and does not change the perception of pain intensity
anterior cingulate cortex (ACC)
Patients with ______ and _______ have altered activity in the anterior cingulate cortex (ACC)
CRPS, fibromyalgia
The ________ cortex is part of the medial pain system and is the integrative center for sensory, affective, and cognitive components of pain; implicated in the experience of acute anxiety
insular cortex
Lesion of the __________ cortex produces asymbolia for pain
insular cortex
A patient lacks the awareness of the painful or hurtful nature of painful stimuli and so have fewer of the normal emotional, motor, or verbal responses to it. What is the diagnosis?
lesion of the insular cortex
aysmbolia is clinically noticable as _________
analagnosia
The ________ of the amygdala is for nociceptive processing
central nucleus (CeA)
The central nucleus of the amygdala receives afferent inputs from __________, __________, and _________
parabrachial nucleus, locus ceruleus (part of ARAS), basolateral amygdala (reciprocal connections with ACC and insular cortices)
The __________ receives polymodal sensory inputs. It has reciprocal connections with the ACC and insular cortex and is one of the afferents to the ___________
basolateral amygdala, central nucleus (CeA) of the amydala
The medial pain system spinoreticular tract starts in the spinal cord and projects to multiple nuclei of the ___________.
The __________ then project to the midline and intralaminar nuclei in the thalamus. From here the thalamic nuclei project to _________ and _________ in the cerebrum.
brainstem reticular formation, medullary reticular nuclei, limbic cortices, amygdala
The _______ contributes to general arousal/attention and regulates physiological resposes to pain via the __________
ascending reticular activating system (ARAS)
The spinoreticular tract carries projections from the spinal cord to these 3 nuclei:
multiple reticular nuclei, parabrachial nucleus (PBN), locus ceruleus (LC)
The _______ contains neurons responsive to cutaneous and visceral pain (part of the central autonomic network: CAN). It receives visceral inputs from the solitary nucleus
parabrachial nucleus (PBN)
The ________________ is the mechanism by which nociceptive signals enter limbic system and it integrates autonomic functions with sterotyped emotional movements and gestures
The parabrachial nucleus (PBN)
The __________ projects to the amygdala (CeA) and insular cortex
PBN
The locus ceruleus (LC) in the pons is part of the descending modulatory system for pain via projections from _____ and _______
ACC, PAG
The 2 nuclei of the medulla that receive nociceptive signals from the posterior horn of the spinal cord via the reticular formation are:
nucleus raphe magnus (NuRaM) and gigantocellular reticular nucleus (GigRetNu)
The gigantocellular reticular nucleus (GigRetN) is ________ in relation to the nucleus raphe magnus (NuRaM)
lateral
The 2 reticular nuclei in the pons that participate in the medial pain system are
Lateral parabrachial nucleus (PNuL) and Medial parabrachial nucleus (PNuM)
Intralaminar thalamic nuclei project to __________ and ____________
anterior cingulate cortex, insular cortex
A delta fibers of the direct pathway for pain ascend in _________, while C fibers of indirect pathway ascend in ___________
lamina I (very lateral in spinal column), lamina V (very medial in spinal column)
__________ pain is due to central nervous structures, while ___________ pain is due to extremely peripheral structures
neuropathic, nociceptive
A lesion to the anterior thalamus will produce ___________ symptoms, while lesion to the posterior thalamus will produce __________ symptoms
motor, sensory
