Lecture 24 - Introduction to Pain Flashcards
Outline the various types of pain
- Nociceptive
• Triggered by brief injury
• Results in brief pain
• Nociceptors carry message to CNS where ‘pain’ is generated - Inflammatory
• Mediators in inflamed tissue activate nociceptors
• Results in persisting pain - Neuropathic
• Abnormal circuits in the CNS
• Can be triggered by non-noxious stimuli, e.g. feather
Give the IASP definition of ‘Pain’
“an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage…”
What is nociception?
Neural encoding and processing of noxious (painful) stimuli
What are nociceptors?
Free nerve endings in tissue (skin, bone) that are activated by noxious stimuli
List ways that nociceptors can become activated
- Mechanical stimuli
- Thermal stimuli
• Heat
• Cold
3. Chemical stimuli • H+ • ATP • Prostaglandin • Bradykinin • Caspaicin • Histamine
Describe nociception following tissue injury
1. Tissue injury results in release of: • Bradykinin • Prostaglandin (through inflammation and activation of COX2) • ATP • Acid
- These chemical activate receptors on nociceptors in damaged tissue
- Activated nociceptors release:
• Substance P
• CGRP - Substance P causes mast cell degranulation, releasing histamine, as well as increased vascular permeability (along with CGRP), resulting in tissue oedema
- Nociceptor conducts message to dorsal horn of spinal cord, where ‘pain’ experience is generated
How can prostaglandin synthesis be pharmacologically targeted?
NSAIDs, such as aspirin and ibuprofen
What is the effect of CGRP?
Where does it come from?
Released by activated nociceptors
Results in increased vascular permeability → tissue oedema
Define the following terms:
• Hyperalgesia
• Allodynia
Hyperalgesia:
• Increased sensation of pain to a stimulus of a given noxious intensity
• i.e. Less intense stimuli can result in pain that would normally be elicited by a very intense stimulus
e.g. pain of showering when sunburnt
Allodynia:
• Pathological response to non-noxious stimuli
• e.g. excruciating pain upon light touch
When does pain hypersensitivity occur?
Describe the mechanism
This occurs after tissue injury
Early inflammation:
• Amplification of chemical mediators that activate nocicpetors
Long terms changes:
• Transcription of ‘pain’ receptors, ion channels and neurotransmitters
• This is driven by cytokines and GFs
Define dermatome
Area of skin supplied by a given spinal nerve
Describe the axonal transport of somatic pain signals from the tissue to the CNS
- Nociceptor activated in tissue
- Action potential travels up axon
• Cell body in dorsal root ganglion - Synapse on neuron in dorsal horn of spinal cord
- Pain pathway projects to:
• Superior colliculus
• Periacqueductal grey (PAG) - Further projections to many areas in the brain
• Dopaminergic system
• Cardiovascular centre
etc.
Outline the different neuron types
Aα - motor and proprioception, heavily myelinated
Aβ - touch and pressure
Aγ - motor to muscle
Aδ - pain, temp., touch
B - preganglionic autonomic
C - pain, reflex, postganglionic autonomic
Which neurons detect pain?
Differentiate between them
Aδ:
• Sharp, prickling, acute pain
C:
• Slow, aching, throbbing, burning pain
Describe what happens to the sensation of pain in the spinal cord
- Modulation of the signal being transmitted by nociceptors
- Dampening aspects
- Interneurons, afferents etc. are interconnected
- Primary nociceptor neuron release glutamate
- Glutamate moves across synaptic cleft and acts on receptor on the post-synaptic neuron:
• NMDA
• AMPA
Attenuation of pain:
• Other neurons inhibit nociceptor neurons in the spinal cord - ‘gate control theory’
• Descending signals form the brain can inhibit nociception in the spinal cord (think about the soldiers tuning out the pain)
Describe Gate Control Theory
a. Interneurons in the spinal cord can release endorphins, which inhibit the neurons that are conducting the ‘pain’ signals
b. Furthermore, vibration stimuli detected by Aβ neurons, can inhibit ‘nociceptor’ neurons in the spinal cord and activate the inhibitory interneurons, thus attenuating pain
Nociceptors, on the other hand, activate neurons in the spinal cord that synapse with the pain centres
What effect do endorphins have on nociception?
Endorphins inhibit pain
Compare the neurotransmitters release by excitatory and inhibitory neurons
Excitatory:
• Glutamate
• Aspartate
Inhibitory:
• GABA
Which receptors does glutamate act on on the post-synaptic neuron?
Compare them
AMPA:
• Low activation threshold
NMDA:
• High activation threshold
Describe the NMDA receptor
Transmembrane pore plugged with Mg2+ in inactive state
Protracted nociceptor results in the displacement of the Mg2+
The receptor is now resistant to opioids
→ “Wind-up”
Describe the effects of opioids
Where do they predominantly act?
Pre-synaptically:
• Decrease neurotransmitter release
Post-synaptically:
• Hyperpolarisation of post synaptic neuron
Predominantly act in the spinal cord
What type of receptor is the opioid receptor?
GPCR