Lecture 5 PT 2

Question 1

What is central sensitization

Answer 1

Central neurons respond disproportionately to continuing nociceptive input

Question 2

Cellular changes due to central sensitization

__________ spontaneous activity

Excessive response to _______ stimuli

_________ after discharge periods following stoppage of stimuli

Receptive fields of central neurons are ______ than normal

Answer 2

[Excessive] spontaneous activity

Excessive response to [afferent] stimuli

[Lengthened] after discharge periods following stoppage of stimuli

Receptive fields of central neurons are [larger] than normal

Question 3

When both central sensitization and peripheral inputs cause neuropathic pain the treatment must…

Answer 3

Target both areas

Question 4

Antinocieption vs pronociception

Answer 4

Antinociception - Inhibition from top down

Pronocicepton- heightening of stimulus

Question 5

Parasthesia vs neuropathic pain

Answer 5

Parasthesia- Abnormal painless sensation (typically tingling)

Neuropathic pain - Pain arising as a direct result of nerve lesion/disease

Question 6

Central sensitization is characterized by ________

Answer 6

Dysesthesias - Unpleasant abnormal sensation that can occur on its own or with stimulation

Question 7

Allodynia

Answer 7

Pain caused by something that wouldn’t normally cause pain

Note: cross-talk is hypothesized between light touch receptors and Nocioceptors

Question 8

Hyperalgesia

Primary vs secondary

Answer 8

Primary- stimuli that are mildly painful cause excessive sensitivity

Secondary- Pain spreads to uninjured areas close to injury site

Question 9

Spontaneous pain

Answer 9

Pain unrelated to external stimulus

Question 10

Temporal summation

Answer 10

Increased pain due to repeated stimulus or continued presence of stimulus

Note: “wind up occurs due to heightened output at 2nd level neurons within dorsal horn

Question 11

True or false: fibromyalgia is a psychiatric disorder

Answer 11

False

Question 12

Fibromyalgia is what?

Answer 12

widespread pain, abnormal pain processing, or pain without external stimulus

Fibromyalgia patients have significantly less graymatter in medial frontal cortex, mid/posterior cingulate cortex, and insular cortex (Note: these are pain inhibiting areas)

Additionally their stress response areas of brain are shown to amplify pain signals

Question 13

Headache redflags: signs of excessive pressure:

Answer 13

Headache upon waking up

Headache with coughing

Worse when laying down

Vomiting

Question 14

Headache redflags: signs of serious intracranial disease

Answer 14

Progressive worsening

Neck stiffness

Rash/fever

History of CA and HIV

Question 15

Causalgia/ reflexive sympathetic dystrophy are older names for what?

Answer 15

Complex regional pain syndrome

Question 16

Complex regional pain syndrome

Answer 16

Complex regional pain is characterized by pain that is greater than would be expected from the injury that causes it.

-Triggered by abnormal response to trauma and disuse of limb

• Pain and vascular changes/atrophy not related to nerve damage

-Time between trauma and onset highly variable

Question 17

Chronic nonspecific LBP

__% have no specific injury

__% resolve in 6-12 weeks

Answer 17

90%

70%

Question 18

True or false: Complex regional pain syndrome is a psychological diagnosis

Answer 18

False

Question 19

Ectopic Foci

Answer 19

Regions outside of nociceptors that are damaged and generate action potentials that stimulate the nociceptors

Demylinated regions are more likely to have this

this causes neuropathic pain

Question 20

Ephaptic transmission

Answer 20

AKA cross-talk

Demyelination causes action potential from 1 neuron to spread to another

Example: light touch receptor neuron activates nociceptors neuron

-Thought to be the cause for Allodynia

Question 21

The most common site of neuropathic pain is in the _________

Answer 21

Periphery

Question 22

How does the nervous system reorganize due to neuropathic pain?

Answer 22

Synapses form between A-beta fibers and 2nd order neurons replace C fibers so that the A-beta neurons now carry nociceptive signals

-Dorsal horn overly active

-Cerebral cortex shows signs of reorganization

Question 23

In people with a spinal cord injury, 66%, and post-stroke (12%) experience neuropathic pain from the _______ without external stimulation

Answer 23

Thalamus

Question 24

A smaller percentage of people with phantom limb sensation have _________

Answer 24

Phantom limb pain

Question 25

The amount of phantom limb pain is correlated to the amount of….

Answer 25

Cerebral cortex reorganization

Question 26

What are the 3 D’s of chronic pain that a therapist must address

Answer 26

Distress

Disuse

Disability