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Head and Face Pain > Head and Face Pain Neuroanatomy > Flashcards

Head and Face Pain Neuroanatomy Flashcards

1
Q

What systems are involved with the neurological processing of pain?

A
  1. Ascending sensory
  2. Descending modulatory
  3. Multiple cortical structure activations
  4. Interneuronal modulation within the spinal cord
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2
Q

Crude Touch, Pain, and Temperature from the body are found in which system?

A

The anterolateral system or Spinothalamic Tract

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3
Q

What type of neuron are Primary Sensory Neurons?

A

Pseudounipolar

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4
Q

Where are the cell bodies of the primary sensory neurons from the body located?

A

The dorsal root ganglia

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5
Q

Where do primary sensory pain neurons from the body synapse on secondary order neurons?

A

Lamina II in the dorsal horn of the spinal cord grey matter

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6
Q

Where do secondary sensory pain neurons from the body travel?

A

From the posterior horn of the spinal cord, it ascends and descends 1-2 segments in Lissaur’s tract, then decussates through the anterior white commissure, and ascends to the VPL of the thalamus via the spinothalamic tract.

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7
Q

Where do tertiary sensory pain neurons from the body travel?

A

From the VPL of the thalamus through the posterior limb of the internal capsule to the primary somatosensory cortex.

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8
Q

Where are the cell bodies of the primary sensory neurons from the face located?

A

The Trigeminal Ganglion, The Semilunar Ganglion, The Gasserian Ganglion

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9
Q

Where do primary sensory pain neurons from the face synapse on secondary order neurons?

A

Lamina II of the Spinal Trigeminal Nucleus

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10
Q

Where do secondary sensory pain neurons from the face travel?

A

From Lamina II within the Spinal Trigeminal Nucleus, then ascends via the dorsal trigeminothalamic tract or decussates then ascends via the ventral trigeminothalamic tract (ventral trigeminal lemniscus) to the VPM nucleus of the thalamus.

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11
Q

Where do tertiary sensory pain neurons from the face travel?

A

From the VPM through the posterior limb of the internal capsule to the primary somatosensory cortex.

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12
Q

Which cortical structures are activated by pain stimuli?

A

Amygdala, cingulate gyrus, insula, frontal, occipital, and temporal lobes

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13
Q

What role for the amygdala play when activated by pain stimuli?

A

Fear and anxiety

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14
Q

What role for the cingulate gyrus play when activated by pain stimuli?

A

emotionality, executive function, and direct autonomic control

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15
Q

What role for the insula play when activated by pain stimuli?

A

confluence of all sensory modalities and interoception

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16
Q

What role for the frontal, occipital, and temporal lobes play when activated by pain stimuli?

A

TBD

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17
Q

What is Central Pain?

A

Pain that occurs without the activation of peripheral nociceptors.

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18
Q

What is Central Neuropathic Pain?

A

Pain caused by the altered function of the CNS, without specific activation of peripheral mechanisms.

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19
Q

Where is Central Neuropathic Pain most often located?

A
  1. Spinal Cord
  2. Brainstem
  3. Cortex
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20
Q

What structure plays the largest role in suprasegmental modulation of pain?

A

The Periaqueductal Gray

21
Q

Input to the PAG are received through which tract?

A

75% of all pain afferents fire into the PAG via the spinomesencephalic tract

22
Q

Which structures does the PAG receive input from?

A

The frontal lobes, the hypothalamus, amygdala, PMRF, insult, and Locus Ceruleus

23
Q

Where does the PAG relay information to?

A

The Rostral Ventral Medulla (RVM) and the Dorsal Lateral Pons (DLP)

24
Q

What is the RVM?

A

The site of the Nucleus Raphe Magnus.

25
Q

Which neurotransmitter system is the Nucleus Raphe Magnus involved with?

A

5HT

26
Q

Under normal conditions, the RVM is inhibitory to which structures?

A

The WDRN’s and Pain.

27
Q

What is the DLP?

A

The site of the Locus Ceruleus.

28
Q

Which neurotransmitter system is the Locus Ceruleus involved with?

A

NE/E

29
Q

Under normal conditions the DLP is inhibitory to which structures?

A

Descending fibers inhibit WDRN amplification in the dorsal horn at Laminae I & II

30
Q

Which structures are associated with the frontal modulation of pain?

A
  1. Cortical - PMRF
  2. Frontal - Limbic
  3. Frontal - Basal Ganglia
31
Q

How is the PMRF associated with the frontal modulation of pain?

A

Inhibition of pain and IML

32
Q

How is the Limbic system associated with the frontal modulation of pain?

A

Increased limbic output activates the IML through the posterior hypothalamus, frontal inhibition is required to reduce this response

33
Q

How is the Basal Ganglia associated with the frontal modulation of pain?

A

The BG - Limbic systems are involved with a loop allowing for decreased IML activation.

34
Q

What is sensitization?

A

The up regulation of any number of components within the processing of pain, it can occur peripherally and centrally.

35
Q

What is Peripheral Sensitization?

A

A decrease in the firing of large diameter afferents, and an increase in the firing of small diameter afferents.

36
Q

A release of which factors can decrease the high threshold nociceptors

A
  1. Plasma catecholamines (NE/E)
  2. Inflammatory cytokines
  3. IL-#
  4. Cox-#
  5. NO
  6. TNF-a
37
Q

What are the effects of nociceptive stimulation of sympathetic activity?

A

Increased IML increases the adrenal system to up regulate plasma catecholamines, increasing sensitization.

38
Q

What is central sensitization due to?

A

Loss of inhibition supra segmentally and segmentally onto the WDRN’s in the spinal cord.

39
Q

What is Cortical Remapping?

A

Reorganization of central pain pathways, also considered a form of central sensitization

40
Q

What is cortical remapping classically seen in?

A
  1. Phantom Limb Pain
  2. Low Back Pain Syndromes
  3. Carpal Tunnel Syndrome
41
Q

What is Synaptic Remodeling?

A

Chronic firing of C-fibers cause release of neural growth factors in Lamina II. Synaptogenesis attracts A-Fibers to move from Laminae III & V to Lamina II.

42
Q

What does Synaptic Remodeling result in?

A

Pain produced by activation of LDA.

43
Q

What is a possible treatment of Synaptic Remodeling?

A

Immobilization

44
Q

How is inflammation associated with pain?

A

Inflammation begins with an environmental trigger resulting in a biochemical signal.

45
Q

What is the major pathway for the amplification of inflammation?

A

NF-kappaB

46
Q

What is NF-kappaB?

A

It is a nuclear transcription factor that promotes gene activation encoded for inflammatory mediators.

47
Q

What can trigger the NF-kappaB cascade?

A

Environmental triggers

48
Q

What are the 5 ways pain ascends in the Spinothalamic Tract?

A
  1. Spinothalamic to the VPL
  2. Spinoreticular to the reticular fm
  3. Spinomesencephalic to the PAG (70%)
  4. Cervicothalamic
  5. Spinohypothalamic
49
Q

Where does the PAG relay Anterolateral inputs to?

A

The ascending reticular activating system (ARAS)

Head and Face Pain (8 decks)

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