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T3 SYSTEMS > CNS Class 4 - Central Modulation, Sensitization, Disease & Terminology > Flashcards

CNS Class 4 - Central Modulation, Sensitization, Disease & Terminology Flashcards

1
Q

There are modifiers of ________ transmission as it travels from the tissues to the brain.

A

Afferent

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2
Q

Local inhibition or gating in the dorsal horn and filtering in the thalamus are examples of _________ modulation.

A

Ascending Modulation

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3
Q

T/F - Ascending modulation is often called central modulation.

A

False - DESCENDING modulation is often called central modulation.

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4
Q

While __________ modulation is most often discussed in the context of pain, it can also be used to weaken or suppress sensory experience of other types of stimuli.

A

Descending Modulation

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5
Q

T/F - The understanding of descending mechanisms is still incomplete.

A

True

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6
Q

One of the first major commenters on the phenomena of descending modulation was ____ _______.

A

H.K. Beecher

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7
Q

H.K. Beecher was a WW2 _________ who noted how frequently wounded ________ felt little or no pain, especially initially.

A

Physician
Soldiers

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8
Q

__________ modulation has been observed of injured athletes in the heat of competition.

A

Descending Modulation

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9
Q

The purpose of _______ experience is to bring attention to important matters, often because of a need for ________ or reflection.

A

Sensory
Response

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10
Q

T/F - The sensory experience may be eliminated or weakened in the presence of other purpose or distraction.

A

True

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11
Q

At the brain level, the following are all involved in __________ modulation:
- Parts of the cortex
- Thalamus
- Insula
- Amygdala
- Hypothalamus

A

Descending Modulation

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12
Q

T/F - Exogenous opioids are chemicals released with descending modulation.

A

False - ENDOGENOUS opioids are chemicals released with descending modulation.

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13
Q

__________ and ___________ are the body’s version of morphine or heroin. They are communicated to a group of nuclei in the ________ and brainstem.

A

Endorphins
Enkephalins
Midbrain

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14
Q

T/F - Dopamine is also involved with endogenous opioids and descending modulation.

A

True

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15
Q

Activation of the midbrain’s ______________ ____ area initiates a complex intercommunication process that results in the release of modulators from brainstem zones like the _____ ______.

A

Periaqueductal Gray Area (PAG)
Raphe Nuclei

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16
Q

Modulators released from the PAG include neurotransmitters such as _________ (5-HT), norepinephrine (NE) and endocannabinoid substances such as __________, which is similar to THC.

A

Serotonin (5-HT)
Anandamide

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17
Q

Modulators in turn act on neurons in the dorsal horn by directly inhibiting at the ________ where ___ fibres and ___ delta fibres are attempting to activate second order spinothalamic tract neurons.

A

Synapses
C Fibres
A Delta Fibres

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18
Q

T/F - Modulators activate local inhibitory neurons to “open the gate.”

A

False - Modulators activate local inhibitory neurons to “CLOSE the gate.”

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19
Q

Modulators also inhibit firing of the second order neurons themselves and these local neurons use ______ and _______.

A

GABA
Glycine

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20
Q

T/F - Endorphins and enkephalins cannot produce effects in the spinal cord.

A

False - Endorphins and enkephalins CAN ALSO produce effects in the spinal cord.

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21
Q

Because of the scale of the centres and pathways involved in the descending modulation mechanisms, they can be impaired by any number of traumatic and ____________ causes.

A

Pathological

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22
Q

Types of pathological pain or sensation can result from aberrant ___________ or CNS analysis, or from failure of _______ modulation mechanisms, or both.

A

Nociception
Central Modulation

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23
Q

T/F - Mood states, mental health, traumatic history and chronicity can all alter central modulation in ways that affect sensory experience.

A

True

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24
Q

T/F - The more anxious a person is, the less intense their experience of pain.

A

False - The more anxious a person is, the MORE intense their experience of pain.

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25
Q

Based on the neurochemistry of anxiety and stress, the predominance of ___________ nervous system activation enhances pain perception and pain distress (suffering).

A

Sympathetic Nervous System

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26
Q

T/F - Central modulation is rendered less effective when people are stressed out.

A

True

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27
Q

Central modulation is complex because of the number of individual physical and _______________ factors that come into play, especially if dysfunctional stress becomes entrenched and when _______ illness is present.

A

Psychoemotional
Anxiety

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28
Q

With central _____________, signals coming from sensory receptors along first order neurons are normal and should cause no pain. But at the ______ horn of the spinal cord, they are amplified, and by the time they reach the _____, what should have been a normal message has been turned right up to be a message of pain.

A

Central Sensitization
Dorsal Horn
Brain

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29
Q

A term used to describe situations where a person’s history of physical and/or emotional trauma creates hyperfacilitation of pain and other distressing symptoms along with reduced effectiveness of descending modulation.

A

Central Sensitization

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30
Q

Over time, central _____________ becomes entrenched via causing altered neuron health and function, dysfunctional synapses and various changes in neurochemical production and function.

A

Central Sensitization

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31
Q

_______ pain syndromes, such as fibromyalgia, are interwoven with central sensitization.

A

Chronic Pain Syndromes

32
Q

Central sensitization can be complicated by ____________, meaning that the person is expressing mental or emotional distress as physical symptoms.

A

Somatization

33
Q

Anxiety, central sensitization and depression are ______________ and often present in varying degrees in the same person over time.

A

Interconnected

34
Q

Anxiety, pain and distress cause __________ by depleting serotonin, dopamine, endogenous opioid and ______________ volumes in the CNS.

A

Depression
Norepinephrine
Mood

35
Q

T/F - Depression itself does not deplete neurochemicals that are used to restore and balance mood.

A

False - Depression itself DOES deplete neurochemicals that are used to restore and balance mood.

36
Q

Since neurochemicals like serotonin and norepinephrine are involved in __________ modulation, it means that their effectiveness in that role is reduced as an intrinsic aspect of depression. This results in the pain and other ________ discomfort symptoms that are part of the clinical presentation of depression.

A

Descending Modulation
Physical

37
Q

The following are manifestations of depression that is ____________ in nature:
- Agitation
- Loss of appetite
- Decreased libido
- Suicidal ideation
- Aggressive behaviour (verbal or physical)
- Irritability

A

Serotonergic

38
Q

The following are manifestations of depression that is _____________ in nature:
- Decreased concentration
- Slowness
- Loss of energy
- Weakness
- Tiredness
- Reduced self-care (hygiene)

A

Noradrenergic

39
Q

_______ effects that reduce or suppress uncomfortable symptoms seem to work in large part by enhancing central modulation.

A

Placebo

40
Q

T/F - The effects of massage therapy have placebo components, especially via the therapeutic relationship and effects of touch on the brain.

A

True

41
Q

Neuron loss or ________ can lower firing rate, adding to the brain’s interpretation difficulties.

A

Scarring

42
Q

____________, edema and chemicals released by damaged tissue can cause intense, irritable firing patterns.

A

Inflammation

43
Q

Abnormal firing patterns can occur anywhere along the pathways that carry transmission to the sensory cortex and often promote proximal ______________ confusion.

A

Proximal Depolarization

44
Q

________, compression and demyelination are additional factors that can cause interpretation challenges and also create transmission pattern __________.

A

Ischemia
Asynchrony

45
Q

T/F - A cluster of demyelinated axons, such as in multiple sclerosis, will transmit faster than same-function neurons that are intact.

A

False - A cluster of demyelinated axons, such as in multiple sclerosis, will transmit MORE SLOWLY than same-function neurons that are intact.

46
Q

When it comes to multiple sclerosis, the information arrives in __________ batches, producing a more baffling interpretation challenge that often results in the assignment of dysfunctional _________ experiences.

A

Disordered
Sensation

47
Q

T/F - Sensation can be activated without a stimulus when there is damage to a first order neuron’s receptor or axon.

A

True

48
Q

A specific symptom caused by peripheral nerve damage occurring mostly with median, sciatic (tibial) and C8/T1 spinal nerve injuries. It reflects damage/irritation to the sympathetic vasomotor neurons within the affected nerve.

A

Complex Regional Pain Syndrome II (CRPS II/Causalgia)

49
Q

The primary symptom of CRPS II is an intense “_______” pain that usually has a “shooting” quality, often accompanied by ________ of the skin.

A

“Burning”
Erythema

50
Q

___________ pain is a common phenomenon when there is irritation or damage in the sensory nervous system.

A

Neuropathic

51
Q

Neuropathic pain due to __________ nerve damage can be caused by:
- Trauma
- Neuralgias
- Shingles (ex. Herpes Zoster)
- Facet joint issues
- Amputation (ex. Phantom Limb)

A

Peripheral

52
Q

Neuropathic pain due to _______ nerve damage can be caused by:
- Transverse myelitis
- Spinal stenosis
- Multiple sclerosis
- CNS infections
- Stroke

A

Central

53
Q

__________, diabetes and chemotherapy can cause systemic damage in both the peripheral and central nervous system.

A

Alcoholism

54
Q

Possible mechanisms of ___________ pain include:
- Sprouting of sympathetic post-ganglionic nerve fibres on first order afferent endings and first order sensory cell bodies
- Lowered threshold for firing of c fibres and a delta fibres
- Proliferation of alpha adranergic receptors on first order sensory afferent endings and first order cell bodies
- Possible ephaptic afferent activation
- Permanent hyperactivation of wide dynamic range neurons

A

Neuropathic Pain

55
Q

Possible mechanisms of ___________ pain include:
- Glutamate excitotoxic cell death of inhibitory neurons
- Inadequacy of central descending serotonin, norepinephrine, opioid peptide pathways to control nociception
- Immobilization by pain decreases gating of nociceptive input, limiting physical therapy to initiate gate
- Sprouting of c fibres in spinal cord
- Extension of interneuron dendrites into additional spinal cord laminae

A

Neuropathic Pain

56
Q

The presentation of neuropathic pain can vary substantially as well, from numb, ________ sensations to “burning” or “electric shock” or “________” to more everyday types of pain.

A

Tingling
“Stabbing”

57
Q

T/F - Neuropathic pain can often be triggered by non-nociceptive stimuli. It may be continuous or more episodic.

A

True

58
Q

T/F - Neuropathic pain is often mild and easy to live with.

A

False - Neuropathic pain is often SEVERE and VERY CHALLENGING to live with.

59
Q

Things like _______, illness, intense emotional states, anxiety and depression can make neuropathic pain _____.

A

Fatigue
Worse

60
Q

There are a range of treatment approaches recommended for addressing ___________ pain, such as:
- Anticonvulsant
- Analgesic/antidepressant medications
- Physiotherapy
- Massage therapy
- Psychotherapy
- Acupuncture
- Relaxation practices

A

Neuropathic Pain

61
Q

Absence of any sensation; the stimulus does not produce any of the expected sensation.

A

Anaesthesia

62
Q

___________ can be induced, for example by using nerve-blocking agent in dental work.

A

Anaesthesia

63
Q

Diminished sensation; the experience matches the nature of the stimulus, but is less strong than expected. Often referred to as numbness.

A

Hypoesthesia

64
Q

Heightened or exaggerated sensation; the experience accurately matches the stimulus, but produces an exaggerated or unexpectedly strong response.

A

Hyperaesthesia

65
Q

Hyperaesthesia can occur because of neuronal irritation or damage, but also for a range of _______________ reasons.

A

Psychoemotional

66
Q

Abnormal sensations, such as “pins and needles” or “bugs crawling on the skin”; the sensation experienced does not correlate with the stimulus.

A

Paraesthesia

67
Q

T/F - There is in fact reliable paraesthesia stimulus because it is a naturally produced sensation.

A

False - There is in fact NO reliable paraesthesia stimulus because it is NOT a naturally produced sensation.

68
Q

____________ can also occur when there is reduced blood flow to a nerve.

A

Paraesthesia

69
Q

When a paraesthesic sensation is painful, such as “hot pokers” or “electric burning”; dramatically strange and painful types of sensory experience.

A

Dysaesthesia

70
Q

Instead of the expected sensation, an innocuous or non-nociceptive stimulus results in pain, typically a “regular” sort of pain experience.

A

Allodynia

71
Q

T/F - Allodynia results in an increased pain threshold.

A

False - Allodynia results in A REDUCED pain threshold.

72
Q

_________ can be caused by local nerve damage/irritation, by problems in the CNS circulatory or appreciation centres and also by poor central modulation.

A

Allodynia

73
Q

The response to a nociceptive stimulus is weak; the sensation is not as strong as predictable because of the stimulus.

A

Hypalgesia

74
Q

Heightened sensitivity to painful stimuli; the person experiences an unexpectedly strong pain intensity as compared to the predicted response to the stimulus; may be accompanied by strong subjective/emotional response.

A

Hyperalgesia (aka. Hyperalgia)

75
Q

T/F - With hyperalgesia, often there is a continuation of the pain after the stimulation has ceased, sometimes for quite an extended period.

A

True

T3 SYSTEMS (27 decks)

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