End- Lecture 7

Question 1

What do affective components refer to?

Answer 1

Affective components refer to the emotional components and they are about the subjective experience.

Question 2

KNOW THE DIAGRAM ON LECTURE 7 PG 3

Question 3

is it easy for a person to subjectively differentiate between the sensitive and affective experience of pain?

Answer 3

NO

Question 4

What is the most up to date way of understanding pain?

Answer 4

2 main components of the personal experience is the noxious sensory input and the affect component which is emotional motivational. 2 other sub components which are social cultural, and conceptual judgement

Question 5

What does the sensory aspect of pain come from?

Answer 5

noxious imput

Question 6

Where do ascending nociceptive signals come from? How are they distributed? Where?

Answer 6

• they enter through the spinal cord
• are distributed through 3 different pathways
• one to the thalamus, (the other two are through the amygdala and the cerebellum)

Question 7

What does the PAG control? What is it involved with?Explain the process of ascending nociceptive signals travelling from the brain stem and reaching the PAG.

Answer 7

PAG controls the release of endogenous opiods and is involved in pain perception. See how the arrows mostly go up from the brainstem towards the cortx. The cortex is basically the tissue that covers the brain. It is called ascending nociceptive signals cause they go up from periphery of body or organs towards the brain. As the pathways ascend from the sensors, they all converge onto the brain stem but then out of the brain stem they start diverging towards 3 different directions. We will focus on one of these (the one that goes through the thalamus which is the place that most sensory perceptions go through on their way to the cortx incl visceral and somatic.

Question 8

Do descending nocicpetive signals exist? What do they do?

Answer 8

They’re ascending because there are also descending signals that modulate how much pain we experience.

Question 9

What is the process of interoception as in what pathway does it take? What does regions of the brain does it include?

Answer 9

includes nociception

The thalamus sends projections to the:
– Posterior Insula

– Anterior Cingulate Cortex (ACC)

– Somatosensory Cortex

Question 10

What is the insula? What is it involved with? Where is it in the brain? What is the difference between green and white matter?

Answer 10

it is involved with interoception.

The insula is a kind of cortex but it is a latin word for island. It is like an island cortex inside the white matter of the brain. Why is it an island? the green lines on the diagram are actually white matter connections. Gray matter is the body of the neuron and the generation of chemicals, DNA, and organelles etc happen there. This is where the electrical impulse will be generated. BUT in order for the neuron to connect to other neurons it uses the white matter (axon) like a cable to send it to other neurons. The axons look white because of the myelin sheath which is why they are called white matter. The green thing on the diagram is an axon that goes to the cortex.

Question 11

KNOW THE DIAGRAM ON LECTURE 7 PG 5

Question 12

What are the 3 branches of the thalamic pathway? What is the original process that leads to the thalamus?

Answer 12

Within the thalamic pathway we have a 3 pronged fork which goes to 3 different regions of the cortex. The ACC which has many recpetors for endogenous opiods, the other is the insula and the third is the somatosensory cortex

The main process that brought the signal to the thalamus is ascending nociceptive signals.

Question 13

What components of pain does empathy involve?

Answer 13

the affective but not the sensory components of pain.

Question 14

how was the study about the brain regions of empathy set up?

Answer 14

• Scanned women, while their partners (men) sat right next to the scanner bed on which women lied
• The women could see their partner’s right arm through a mirror
• Pain was delivered through electrodes attached to the right hand (the right hand was either the woman’s or her partner’s)

Question 15

What are the 2 brain areas that are activated only during first hand pain experience?

Answer 15

-Primary somatosensory cortex (S1 or SI) left.

• Secondary Somatosensory cortex (S2 or SII) located in the posterior insula (left)

Question 16

how did the study on empathy find the areas of the brain related to the first person experience of pain? how does this relate to the thalamus?

Answer 16

First person experience of pain is when the person in the machine received the pain. What they could see was that the primary somatosensory cortex, one of the regions the thalamus sends nociceptive inputs to was being activated in the first hand experience of pain.

Then, the secondary somatosensory cortex in the posterior insula was also activated. That activity was only there when people themselves had the noxious sensory input.

Question 17

What are the 2 shared networks observed when pain was applied to the self and to the partner? Are these involved in other things as well?

Answer 17

the anterior cingulate cortex and the bilateral anterior insula. These activations are there whether we are sensing the pain or observing people in pain. The ACC is involved in placebo effects as a note.

Question 18

What do we mean by bilateral anterior insula?

Answer 18

bilateral means both sides, so both the right and the left interior insula are getting activated.

Question 19

When looking at brain scans, where is the gray image coming from and where are the highligthed areas coming from?

Answer 19

The grey images come from the MRI but the color comes from the FMRI which is overlaid later.

Question 20

Where is the ACC in the brain?

Answer 20

then the one in the middle is the ACC.

Question 21

What are the parts of the brain activated by empathy but not by first hand experience? Why do we believe that these activations happened in the specific study?

Answer 21

But there were a whole bunch of other parts of the brain activated through empathy. The reason why these activations are happening in the brain is because this is not a random person, there is a relationship of caring, when we see someone we care about receiving pain experiences, empathy is a form of simulating our own experience that we know from the past.

Question 22

Why is the cortical region activated during the experience of empathy?

Answer 22

What happens is when you imagine something, you are having an active experience which is why the cortical regions are activated . BUT whats happening here is not like cognitive imagining, it is a visceral kind of imagining. You are not hearing someones words and imagining, you are watching and are imagining.

Question 23

What do the sensory components in the brain tend to be? What is the difference between the posterior and anterior part of the insula?

Answer 23

The sensory components tend to be the primary sensory cortex, and the posterior insula. In this case there is a difference between the posterior and interor part of the insula (post is more sensory, interior is more affect)

Question 24

Why is it important to understand the neurological differences between first hand pain and empathy?

Answer 24

because pain is largely influenced by things other than sensations. If we understand the extent to which our experience of pain is influenced by emotions events etc.

Question 25

Are there large individual differences how pain is experienced?

Answer 25

yes .

Question 26

Explain the connection between affective, sensory, nociception, and pain.

Answer 26

Pain is more affective and nociception is the sensory almost by definition. Noci and sensory are pretty much equivalent, but experience and affective componetns, affective components are only part of the experience.

Question 27

Explain the neural correlates of interindividual differences in the subjective experience of pain study. (3 summary points, 1 explanation paragrpah)

Answer 27

• thermal stimulation of the skin of the right lower leg (alternated 30 sec of 49°C and 30 sec of 35°C)
• there were big individual differences in pain experience
• separated subjects into
  HIGH-sensitivity group (reported high pain ratings) LOW-sensitivity group (reported low pain raitings)

In this study they induced pain by applying heat to the body, heat reaches a point where pain receptors are triggered because there is a potential of getting burned with it. In this case they detected some big individual differences in terms of the pain experience. high sensitivity reported high ratings after the stimulation. Everyone recieved the same temperature n the experiment condition and the control condition experienced warm but not as hot.

Question 28

What are the differences in brain activation between people who have High sensitivity to pain and people who have low sensitivity to pain? Where was there no difference? how does this relate to the regions associated with the personal experience of pain? Do the individual differences in pain map exactly onto the empathy regions?

Answer 28

Big individual differences at Anterior Cingulate Cortex (ACC) and Primary Somatosensory Cortex (SI) activation. The SI and the ACC are much more active in people with high senstivity to pain and the lower regions were more common. When you compare the 2 groups, the high sensitivity to pain people were more so activiating the primary sensory cortex and the anterior cingulate cortex. So these ones that were more involved in the personal experience.

Both the sensory and affective components of pain are involved in individual differences. The important part is that you have one affective region that is different and the sensory component as well.

No significant differences at the level of thalamus, midbrain and other deep subcortical structures. The insula did not show as a big difference. There was little difference because these areas mainly carry the sensory aspects which is less related to the individual experience. The individual differences in pain don’t map exactly on the empathy regions either.

Question 29

KNOW THE DIAGRAM ON LECTURE 7 slide 12

Question 30

At what biological level do the most prominent individual differences in pain experience occur?

A. In the distribution of visceral and somatic nociceptors in the body
B. During afferent pain signal processing in the spinal cord
C. At midbrain structures like the periaqueductal gray
D. At cortical regions of the brain

Answer 30

D. At cortical regions of the brain

Question 31

Is there a difference between the baby skull and the adult skull? When do they become the same? What is a big visual difference? What do people often associate with this difference?

Answer 31

There’s a big difference between the babies skull and the grown up skull. The big difference is that babies don’t have the same skull as even a 5 year old child. One thing you can see here is the elongation of the head. Sometimes people even look at that picture and think that must hurt but what we don’t take into account is that this is part of the structure of the babies skull

Question 32

KNOW THE DIAGRAMS ON LECTURE 7 PAGE 17

Question 33

What are the plates in baby skulls likened to? Why? When is the skull like this? When does it change? is it painful?

Answer 33

Baby skulls have 4 plates which are not fused together, they are almost like tectonic plates. You have these plates that sometimes can move and the do move during the birth proces which is why after birth the babies skulls can eb quite elongated. We don’t have to remeber these terms. These plates eventually fuse until we end up with one dome shaped skull. Even after birth babies still have these unfused plates and the overlap can happen in order ot mold the head and make it able to pass through the pelvis (not necessarily painful)

Question 34

What is the reason for molding during labour? What allows shaping to happen? When does the shape of the head return to normal?

Answer 34

lets the baby fit more easily through the pelvis

allowed by the softness of the bones and their

loose connections at the sutures
within a few days after birth, the shape of the
head returns to normal

Question 35

How can you tell where a baby’s skull is overlapping? Is the mom’s pelvis a rigid object?

Answer 35

the ridge in the skull in the last picture is where the overlap of the skull is. The mom’s pelvis is also not a rigid object becuase our pelvis is pieces of bones connected to ligaments.

Question 36

What is a benefit of having a relatively slow labour when it comes to molding? What is molding? What does it help with? How does molding relate to why babies often have hats on after birth?

Answer 36

Technical term is molding. A benefit of having a relatively slow labour is that the molding can take place a little more gradually or more so. Milding refers to the different plates of the babies skull becoming overlapping. It lets the baby fit more easily through the pelvis. This is allowed through the softness of the bones. They are not floating completely free, they are connected to ligaments which are stretchy. The molding happens during labour and later unmolds itself. A lot of the things during the birth process seem unnatural because we don’t often see it which is why newborn babies often have hats on.

Question 37

What is the scientific method for inferring sensation in a baby? What are 4 examples of these things that are beleived to be linked to sensations of pain?

Answer 37

behaviour

crying (changes in pitch, temporal patterning, and harmonic structure also reflect the degree of pain and urgency)

• facial expressions (brows bulge, crease, and furrow; lips purse, the mouth opens wide, the tongue is taut, and the chin quivers)
• body movement (jerking, pulling back, swinging arms, push away with arms and legs)
• physiological stress response (variations in respiration, extreme heart rate elevation and instability, chemical blood changes)

Question 38

Does molding happen during C-sections?

Answer 38

Unless there is an emergency c section, the molding won’t happen. Stage 2 is when the baby starts descending which usually occurs before an emergency c section

Question 39

How is molding important for the baby’s respiratory health? how does this relate to conditions that baby’s delivered by C-section often have?

Answer 39

The effort of the head molding produces cortisol in the baby which is important for the lungs to mature and be able to breath after the birth. The squeezing or molding process is an advantage which you don’t get from a scheduled c section. Which is one of the reasons c section babies can have more respiratory issues like asthma

Question 40

KNOW THE DIAGRAM ON LECTURE 7 PAGE 21

Question 41

Name the sensory component to pain, the affective components, and the behavioural components

Answer 41

sensory = noxious sensory input

affective = emotional motivational, social cultural, conceptual judgmental

behavioural = emotional reaction avoidance approach (from emotional motivational), the decision making judgment selective report (from conceptual judgmental), and the social behaviour role performance (from social cultural)

Question 42

What are the three main components of understanding pain? What type of experience do they relate to?

Answer 42

noxious sensory input (sensory experience/personal experience)

emotional motivational (affective experience/personal experience)

emotional reaction avoidance/approach (observable behaviour)

Question 43

For most of the 20th century what did people believe about babies and pain? What helped people determine this? What was concluded? What did people think about the development of pain?

Answer 43

For most of the 20th century, it was believed that newborns were somehow not yet sensitive to pain

Experiments with painful stimulation on newborns (e.g., McGraw, 1941 - pin prick)
* found little reaction to stimulation at day 1, but increased reactions by day 12
* concluded that:
- newborns had limited sensitivity to pain
- the first week to ten days was a period of “hypoesthesia” (abnormally weak sense of pain, heat, cold, or touch)

They believed it took time to develop like walking etc.

Question 44

What was the common medical view of pain in babies for most of the 20th century? What did they interpret as reactions to pain, what did they think it represented, what did they think about the brain’s capacity for pain?

Relevant quote?

Answer 44

Newborn reactions to painful stimuli
(facial grimaces, cries, leg withdrawal, defensive gestures with arms)
* represented “a local reflex” (Most of our understanding of this comes from a reflex arc They thought the pain didn’t get to the brain because the brain wasn’t mature yet so their reactions are just reactions)
* had no mental or emotional importance
* the brain at birth is highly immature because it is still largely unmyelinated
“Even when there is sensitivity it is reasonable to assume that neural mediation does not extend above the level of the thalamus.”

Question 45

what was a key thing done in the 60s and 70s to newborn babies? Why?

Answer 45

One key thing done in the 60s and 70s was being held by the feet and being slapped on the bum to make them cry because if the baby cries, the lungs are working and the baby survived the birth.

Question 46

What was an important factor that was overlooked in the studies that had determined that babies didn’t feel pain?

Answer 46

All the mothers in newborn pain studies had received anesthetic drugs during labor and delivery. AKA The pin prick tests were done under the influence of the anesthetic drug being given to the mum

Question 47

What is the current consensus on babies experience of pain? Why might this be?

Answer 47

“Compared with older children and adults, neonates are more sensitive to pain and vulnerable to its long-term effects.”

When babies are born, the bodies of the nuerons are almost all there but there is a lot of brain growth that happens later that comes primarily from white matter. One of the implications to pain is that if you have neurons that are myelinated, the pain will be conducted more slowly and throughout more areas. This might mean that they feel more pain

Question 48

What are 2 main routine interventions done to babies within an hour of being born?

Answer 48

vitamine K injections and enthromyocin ointment

Question 49

What is the rational for the adminsitration of vitamin k injections after birth? Do the babies natural get vitamin K? Why is it delivered in the form of an injection?

Answer 49

rationale for administration: to prevent bleeding in the baby
*vitamin K serves as a coagulant (helps blood clotting) (In general, the big concern is that if the birth coudl be traumatic to the baby, it is important to give them things to stop possible intenral bleeding. )

• babies seem to be born with low levels of vitamin K
• shown to reduce bleeding (e.g., during circumcision)
• some vitamin K comes from the placenta, but is thought to be not enough
• oral administration also possible and effective, but concerns about compliance

Question 50

Can parents chose not to have their children get vitamin K?

Answer 50

The injection illicited a lot of crying from the baby. If the parents decide they don’t want these procedures, they have to jump through a lot of hoops and its very difficult

Question 51

What are the possible harms of erythomyocin ointment? What is it? What is the rationale for administration? When was it mandated?

Answer 51

• could irritate the eye and blurs baby’s vision
• rationale for administration: to prevent any infections that the baby might get while passing through the birth canal. It is an antibiotic ointment
• rationale and procedure itself outdated
• administration of antibiotic eye ointment was mandated by law in BC until 2018

Question 52

Why did the baby cry a lot after getting enthromyocin ointment wiped off?

Answer 52

The baby cried a lot especially when it is wiped off because it may spread it more throughout the eyes and into the tissue.

Question 53

What is not taken into account when looking at the rational for enthromyocin oitnment intervention?

Answer 53

The reason she is giving this rational to us is because what is never taken into account in the rational is the behaviour and the potential experience in this case.