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Medical Physiology > Exam #6: Sensory Physiology of Pain > Flashcards

Exam #6: Sensory Physiology of Pain Flashcards

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USMLE® Step 1 flashcards
1
Q

Why is chronic pain important?

A
  • 30% US population experiences chronic pain
  • Leading neurological disorder & high cost to society
  • Leading cause of disability & suffering
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2
Q

What is the difference between nociception & pain?

A

Nociception= sensory response to a noxious stimulus

Pain= perception of nociceptive sensory information

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3
Q

What are the two components of pain?

A

1) Sensory-discrimination= perception of external or internal noxious stimuli & the localization to the site of the stimulus
2) Motivation-affective= emotional & sympathetic responses associated with behavior

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4
Q

What brain regions are associated with sensory discrimination?

A

Primary & secondary somatosensory cortices

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5
Q

What brain regions are associated with the motivational-affective component of pain?

A

Frontal cortex
Limbic system
Brainstem

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6
Q

What type of sensory information associated with the sensory-discriminative component of pain?

A

Location
Intensity
Modality (e.g. stab vs. burn)

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7
Q

What type of information is conveyed by the emotional component of pain?

A
  • Negative impact on mood

- Depression associated with chronic pain

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8
Q

What is acute pain? What are the functions of acute pain?

A
  • Body’s warning signal that is critical for survival
  • Pain felt within 0.1 sec of stimulus i.e. VERY FAST
  • Very adaptive i.e. tissue heals and pain abates
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9
Q

What fibers conduct acute pain?

A

A-delta

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10
Q

What is pathologic or chronic pain?

A
  • Pain that begins >1 sec after stimulus and then progressively worsens
  • Can become MALADAPTIVE i.e. persists even if there is no more tissue damage
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11
Q

What fibers conduct pathologic pain?

A

Persistent and SLOW conducting C-fibers

  • small
  • unmyelianted
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12
Q

What are the qualities of acute pain?

A

Sharp
Prickling
Electric
Cutting

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13
Q

What are the qualities of chronic pain?

A

Dull
Throbbing
Aching
Nauseous

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14
Q

What is nocicpetive pain?

A

Physiologic pain that serves as a warning to the body

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15
Q

What is inflammatory pain?

A

Pain that is associated with healing

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16
Q

What is dysfunctional pain?

A

Pain without an underlying lesion or that is disproportionate to tissue injury

  • IBS
  • Fibromyalgia
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17
Q

What is neuropathic pain?

A

Pain from damage to the CNS or PNS that is disproportionate to intensity of nociceptor activation

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18
Q

What is the difference between somatic and visceral pain?

A

Somatic= superficial or deep pain originating from the body

Visceral= pain originating from internal organs

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19
Q

What is the difference between the fibers that mediate somatic and visceral pain?

A 
Somatic= A-delta 
Visceral= C
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20
Q

What are the four general steps from external injury to perception of pain?

A

1) Transduction
2) Transmission
3) Modulation
4) Perception

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21
Q

What is peripheral transduction?

A

Conversion of injury to electrical stimulus

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22
Q

What type of receptors are nociceptors?

A

Free-nerve endings

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23
Q

Where are the soma of nociceptions in the body vs. the face?

A 
Body= DRG 
Face= Trigeminal ganglia
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24
Q

What are the important functional characteristics of nociceptors?

A
  • High threshold

- Slowly adapting

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25
Q

What stimuli can activate nociceptors?

A
  • Mechanical (of high intensity)
  • Thermal
  • Chemical
26
Q

What are the different types of thermal nociceptors?

A 
CMR-1= cold
VRL-1= noxious heat 
VR-1= noxisous heat/ capsaicin
27
Q

What is “inflammatory soup?”

A

Tissue injury resulting in the release of a number of inflammatory mediators

*****These inflammatory mediators stimulate nociceptors & lead to indirect sensitization or LOWERED THRESHOLD

28
Q

What is peripheral sensitization?

A

1) Lowered threshold of activation for nociceptors in response to injury
- Increased sensitivity of neurons directly involved
- Increased sensitivity of a wider area of tissue

2) Activation of silent nocicpetors

29
Q

What NT plays the largest role in peripheral sensitization?

A

Substance P

30
Q

What is allodynia?

A

Pain resulting from non-noxious stimuli

31
Q

What is hyperalgesia?

A

Increased response to a stimulus that is normally painful

32
Q

What is axon reflex?

A

Coupling of sensory system to the SNS in response to inflammatory mediators

33
Q

What is the triple response of Lewis?

A

Redness
Edema
Wheal

34
Q

What is the difference between A-delta & C fibers?

A

A-delta= myelinated–faster

  • localized
  • sharp
  • “first” pain

C= unmyelinated–slower

  • poorly localized/ diffuse
  • polymodal
  • “second” pain
35
Q

What types of fibers are associated with the cutaneous tissue?

A

A-delta & C

36
Q

How do joints and muscles differ from cutaneous tissue in regards to fiber types?

A

2x as many C fibers compared to A-delta

37
Q

What fiber types are present in the viscera?

A

Predominantly C-fibers

38
Q

What happens in the dorsal horn of the spinal cord in the transmission of pain?

A

Synapse from 1st order neuron to dorsal horn 2nd order neuron

39
Q

What tracts carry nociceptive information in the spinal cord?

A

Spinothalamic tracts

40
Q

What lamina are associated with A-delta fibers vs. C?

A 
A-delta= Lamina I 
C= Lamina II & III
41
Q

What are WDRs?

A

Polymodal second order neurons that can respond to noxious stimuli and other stimuli

42
Q

What NT is being release at the synapse between first & second order neurons in the spinal cord? What receptors are on the second order dendrite?

A

Glutamate=

  • NMDA
  • AMPA
43
Q

Recall, what kind of threshold do A-delta & C fibers have?

A

High-threshold

44
Q

What is central sensitization?

A

Amplification of pain signaling in the spinal cord

45
Q

What is secondary hyperalgesia?

A

Prolonged & increased activation of nocicpetors in the periphery & projection pathways in the spinal cord

  • Recruitment of adjacent areas
  • Increased release of NT
46
Q

What NT & receptor type underlies secondary hyperalgesia?

A

Glutamate & NMDA-R

47
Q

What is neuronal plasticity?

A

Modulation of intracellular signaling & changes in gene expression

48
Q

What does neuronal plasticity underlie in respect of pain?

A

Memories of pain & the lasting effects of chronic pain

49
Q

What sensations are carried by the DC/ML?

A

Discriminative Touch

Proprioception

50
Q

What sensations are carried by the AL system?

A

Temp.
Pain
Crude touch

51
Q

What is the neospinothalamic tract?

A
  • Pathway of pain from A-delta fibers

- Lamina I, IV, V

52
Q

What information is carried by the neospinothalamic tract?

A

Sensory-discriminative

53
Q

What is the paleospinothalamic tract?

A
  • Slow type C fibers

- Lamina II, III, V

54
Q

What information is carried by the paleospinothalamic tract?

A

Emotional/ affective

55
Q

What is the function of the spinoreticular tract in pain?

A

Motor response to pain i.e. descending pain control

56
Q

What is the function of the spinomesencephallic tract in pain?

A

Descending pain control, particularly eye movements and regulation of gaze to site of injury via the superior colliculus

57
Q

Where in the brain does the perception of pain occur?

A

Sensory= somatosensory association cortex

Emotional= insular cortex & anterior cingulate cortex

Cognitive= prefrotnal cortex

58
Q

What does the anterior cingulate cortex (ACC) contribute in terms of pain?

A

Attention to pain

*****Conscious activation of the ACC can dampen pain signaling

59
Q

When is the ACC most active?

A

1) Perception of pain
2) Imagining pain
3) Observation of pain in others

60
Q

What is the Gate Control Theory?

A

Generally, this is distraction

- A-beta (mechanoreceptor/ proprioceptor) activation inhibits C-fiber transmission

61
Q

What is descending pain control?

A

Endogenous mechanism in the body to regulate pain

Medical Physiology (74 decks)

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