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Neuromotor Function 1 > Lecture 13: Neural Basis of Pain > Flashcards

Lecture 13: Neural Basis of Pain Flashcards

1
Q

What is pain?

A

Unpleasant sensory and emotional perception associated with actual or potential tissue damage (protective function)

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2
Q

Identify the following in relation to pain:

1) Receptors:
2) Conducting Fibers:
3) Primary pathway:
4) Cortical Areas
5) Areas associated in the dorsal horn of the spinal cord

A

1) Nociceptors
2) A delta and C fibers
3) Spinothalamic (+ parallel pathways)
4) primary somatosensory, cingulate gyrus and insular cortex
5) Lamina I (marginal layer), II (substantia gelatinosa), V

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3
Q

What area in the spinal cord may be a location for referred pain mix ups?

A

Lamina V

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4
Q

_____ pain involves activation of nociceptors, while ____ pain is direct injury to nerves.

A

1) Nociceptive

2) Neuropathic

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5
Q

Shingles is an example of what kind of pain? (nociceptive/neuropathic)

A

Neuropathic

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6
Q

T/F The brain is capable of experiencing nociceptive pain.

A

False. There are no nociceptors in the brain.

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7
Q

Nociceptors that respond to thermal, mechanical and chemical stimuli are referred to as _____ receptors.

A

Polymodal

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8
Q

____ respond to strong pressure, _____ respond to burning heat/extreme cold, and ______ respond to histamine and bradykinin.

A

1) Mechanical receptors
2) Thermal receptors
3) Chemical nociceptors

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9
Q

In response to a hand being put near a hot flame, describe what receptors become active and how their activity changes as the temperature changes.

A

Thermoreceptors become active first, with the magnitude of the afferent response (APs/second) increasing until a certain point (ie. 42 degrees). Thermoreceptor activity plateaus, marking the starting point of activation for nociceptors. Nociceptor activity continues to increase with increasing temperature.

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10
Q

Match the following letters and numbers.

1) First, fast (sharp) pain
2) Second, slow (delayed, dull) pain

A) C fibers
B) A delta fibers

A

1) First fast pain - A delta

3) Second, slow pain - C fibers

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11
Q

List 3 differences between A delta and C fibers noxious stimulation mediation.

A

1) A delta project to Lamina I primarily (few to II and III) while C fibers project to lamina II and III
2) A delta fibers use glutamate for transmission while C fibers use substance P.
3) A delta fibers are involved in the first, fast, sharp pain sensation registered while C fibers are involved in second, longer lasting pain.
4) A delta fibers do not have extensive interconnections in SC while C fibers make lots of interconnections.

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12
Q

What fiber is likely involved in referred pain (A delta or C fiber)?

A

C fibers

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13
Q

Do ascending pain pathways cross? If so, where?

A

Fibers cross in the spinal cord via the anterior grey commissure and ascend in the anterolateral columns.

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14
Q

Identify the 3 areas where the spinothalamic pathway sends information to after reaching the thalamic nuclei. What is the function of each region (in relation to pain)?

A

1) Primary somatosensory cortex + association cortex for sensory discriminative aspects of pain
2) Frontal lobe and limbic system for pain interpretation, emotional and memory aspects of pain
3) Hypothalamus for autonomic response to pain

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15
Q

What are the 2 discriminative aspects of pain?

A

Location and intensity

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16
Q

What parallel pain pathway projects to the reticular formation in the midbrain?

A

Spinoreticular Tract

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17
Q

To what thalamic nuclei does the spinoreticular tract project to? What function does this nucleus serve?

A

Intralaminar nuclei - diffuse projections to entire cortex for arousal

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18
Q

Location, timing and intensity are _____ aspects of pain.

A

Discriminative

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19
Q

Meaning the person ascribes to pain, beliefs of pain from culture and past experience, and focusing exclusively on pain are _______ aspects of pain.

A

Cognitive-evaluative

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20
Q

Unpleasant feelings, increased arousal, fear, anxiety, avoidance behaviours and fight/flight reactions are _____ aspects of pain.

A

Motivational-affective

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21
Q

Perceiving gentle stroking on sun-burned skin as painful is known as ____.

A

Allodynia

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22
Q

______ is an excessive response to noxious stimuli in the tissues surrounding the damaged area.

A

Secondary hyperalgesia

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23
Q

Hyperalgesia is an excessive response to ______ stimuli.

A

noxious

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24
Q

______ hyperalgesia is an excessive response to noxious stimuli in the area of damaged tissue.

A

Primary

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25
Q

A possible mechanism for allodynia and hyperalgesia is ______.

A

sensitization

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26
Q

Describe how sensitization occurs at two levels.

A

Peripheral: nociceptive receptor may become hypersensitive and increase their firing rate in the presence of ongoing stimuli.

Central sensitization: facilitation of sensory transmission to the dorsal horn “windup”

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27
Q

When non-pain peripheral receptors CEASE TO FIRE with continuous stimulation, this is known as ______.

A

Adaptation

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28
Q

T/F: Adaptation can be taught.

A

False

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29
Q

______ is BEHAVIOURAL mechanisms that cause us to not react to stimuli.

A

Habituation

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30
Q

T/F. Habituation can be taught.

A

True

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31
Q

What are 3 mechanisms for nociceptor hypersensitivity?

A

1) Repeated noxious stimuli cause peripheral nociceptors to become more sensitive to painful stimulus (hyperalgesia)
2) Sensitizing chemicals induce response in previously non-responding nociceptors by reducing threshold of nociceptors to noxious stimuli and 3) directly stimulating nociceptors

32
Q

What is the sensitizing chemical involved in nociceptor hypersensitivity?

A

Bradykinin

33
Q

What sensitizing chemicals are involved in making other receptors sensitive to stimuli following repeated noxious stimulation?

A

prostaglandins and substance P

34
Q

Explain the two mechanisms of hyperalgesia by way of central sensitization.

A

1) Intense or prolonged NT release by A delta and C fibers facilitation of nociceptive neurons in the dorsal horn (facilitates opening of postsynaptic ion channels – easier to depolarize dorsal horn neurons)
2. Increased intracellular Ca2+ presynpatically promotes production of nitric oxide. Nitric oxide promotes exaggerated release of substance P –> causes dorsal horn neurons to become hyperexcitable.

35
Q

Describe the mechanism of allodynia by way of central sensitization.

A

Incoming non-noxious stimuli facilitate pain carrying dorsal horn neurons via excitatory INTERNEURONS.

36
Q

What does low intensity noxious or other stimuli do in patients with chronic pain?

A

Generates high levels of nociceptive input to the brain, evoking abnormal pain perceptions

37
Q

You are analyzing the neurological images of a patient with FM. What areas of the brain would you expect there to be an increase in cerebral blood flow?

A

Thalamus and basal ganglia

38
Q

T/F. When the pain source is removed, a patient experiencing sensitization will no longer feel pain.

A

False. Sensitization may lose its direct relationship with the pain source and persist long after the source is eliminated.

39
Q

A patient presents with widespread bilateral pain, fatigue and cognitive difficulties. What conditions may they have?

A

Fibromyalgia

40
Q

A patient presents with prolonged, severe burning pain in their left foot. Upon inspection, you notice the foot is a different colour then the rest of the patient’s body. The foot is also swollen, and elicits painful responses by the patient when touched. What condition does this person have?

A

Complex regional pain syndrome

41
Q

What is pain modulation?

A

An ongoing and transient correction of pain perception

42
Q

What did Melzack and Wall hypothesize about the gate control theory of pain.

A

Melzack and Wall hypothesized that information from first order low threshold large fiber mechanical afferents and first order nociceptive afferents normally converge on the dorsal horn of the spinal cord. The gating system in the CNS opens and closes to let pain messages through to the brain or to block them.

43
Q

Where is the site of the “gate” in the spinal cord.

A

Substantia gelatinosa

44
Q

Input from _____ and ____ fibers stimulates _____ or _____ cells and inhibits inhibitory neurons in the substantia gelatinosa. This opens the gate and allows pain transmission to higher centres.

A

1) A delta
2) C fibers
4) transmission
5) projection

45
Q

Input from ____ fibers carrying information from mechanoreceptors stimulates _____ cells and closes the gate, _____ _____ transmission.

A

1) A beta
2) Inhibitory
3) Blocking
4) Pain

46
Q

What is the learned response to acute pain?

A

Create stimulation in the large diameter fibers, which arise from non-nociceptive mechanoreceptors.

47
Q

When you hit your hand and shake it, this stimulates ____ fibers. The net effect of this action is to ______.

A

1) A beta fibers

2) reduce transmission of pain

48
Q

What is the revised version of the gate control theory, as proposed by Melzack and Wall in 1983?

A

Cognitive Behavioural or Biopsychosocial models

49
Q

What does the biopyschosocial model propose?

A

BPS Model proposes that biological, psychological (thoughts, emotions, behaviours, social factors) play a significant role in human functioning in the context of disease or illness.

50
Q

What did the biopsychosocial model lead to, in terms of treatment?

A

Widespread acceptance of interdisciplinary pain management programs

51
Q

Where are PAG cells located?

A

Periaqueductal grey region of the midbrain

52
Q

In regards to descending regulation of pain: PAG neurons project to ______ in the medulla, by way of the neurotransmitter _____. Neurons then project down to _____ in the dorsal horn of the spinal cord, releasing the NT _____. Dorsal horn interneurons release _____ for two way action: ______ of incoming A delta and C fibers and posynaptic inhibition of _____ in the dorsal horn.

A

1) Nucleus raphe magnus
2) enkephalin
3) interneurons
4) serotonin
5) enkephalin
6) presynaptic inhibition
7) nociceptive neurons

53
Q

What are the two ways in which there can be descending regulation of pain?

A

1) PAG cells

2) Endogenous Opioids

54
Q

What are the two endogenous morphine-like opioids produced by the brain?

A

1) Endorphin

2) Enkephalin

55
Q

In what 3 areas are opioids and their pain receptors concentrated?

A

1) Periaqueductal gray matter
2) Rostral ventral medulla
3) Dorsal horn of the spinal cord

56
Q

How do opioids modulate pain?

A

By inhibiting the release of substance P

57
Q

T/F: Remapping (cortical reorganization) occurs after loss of a body part, in which there is a shift and potential extension of the representation of the painful area in the primary somatosensory cortex and adjacent cortical regions.

A

True

58
Q

A patient who recently had his leg amputated reports constant burning, piercing and throbbing in the distal portion of his amputated limb. What condition may this patient have?

A

Phantom limb pain

59
Q

What is the mechanism behind visceral pain?

A

Axons carrying nociceptive information from the viscera enter the spinal cord at the same segments as cutaneous receptors. This causes mixing of information.

60
Q

Nociceptive activation in the liver may be experienced on the neck. This is known as _______.

A

Referred Pain

nociceptive activation is perceived as a cutaneous sensation

61
Q

By what 3 mechanisms can be visceral pain be explained? Ezplain each briefly.

A

1) Embryological Development - pain referred to area where organ was located in fetal development.
2) Multisegmental Innervation - ANS provides multiple levels of innervation of viscera. Visceral pain my be referred to areas supplied by corresponding spinal nerves.
3) Shared Neural pathways

62
Q

T/F: Visceral pain is highly localized, specific and referred.

A

False.

Poorly localized, diffuse and referred.

63
Q

Explain how impairment in the diaphragm can produce pain in the shoulder.

A

Pain may be referred through shared neural pathways. The phrenic nerve (C3-C5) innervates the diaphragm and the pericardium. Impairment of these structures can produce pain in any of the areas supplied by C3-C5 (e.g. shoulder).

64
Q

T/F: Pain may be referred to areas where the organ was located during the first three years of life.

A

False.

Organ was located during fetal development.

65
Q

Central pain syndrome is caused by injury or disease of the _____.

A

Central nervous system

66
Q

T/F: Central pain syndrome can be associated with damage to the hypothalamus. (ie. hypothalamic pain syndrome)

A

False.

Thalamus (ie. thalamic pain syndrome)

67
Q

Name 4 conditions that may be associated with central pain syndrome.

A

1) Stroke
2) Spinal cord injury
3) MS
4) Neoplasm

68
Q

A patient describes a steady pain that feels like prickling, squeezing, burning sensations. He indicates that the pain comes on with movement, vibration and temperature changes. What condition may this patient have?

A

Central pain syndrome

69
Q

_____ measures cognitive and affective influences on pain sensitivity.

A

Pain Catastrophizing Scale

70
Q

What are the 3 subscales of the pain catastrophizing scale.

A

1) Helplessness
2) Magnification
3) Rumination

71
Q

A patient reports that they anticipate their pain will produce highly negative consequences. On what subscale of the pain catastrophizing scale would you expect to see high results?

A

Magnification

72
Q

A patient reports they have difficulty distracting themself from pain. Where would this be reflected in the pain catastrophizing scale?

A

Rumination

73
Q

A patient has difficulty coping with pain. Where would this be reflected in the pain catastrophizing scale?

A

Helplessness

74
Q

What is a simple tool used to measure pain?

A

Visual analog scale

75
Q

T/F: Visual analog scale can be used to measure severity and improvement of pain reliably in children over the age of 3.

A

False.

Over the age of 5.

Neuromotor Function 1 (21 decks)

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