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PHYSL 372 > Lecture 7 - Pain Part 1 > Flashcards

Lecture 7 - Pain Part 1 Flashcards

1
Q

what is pain?

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

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2
Q

what is nociception?

A

physiological processing of tissue damaging information (ex: stubbing your toe and knowing you stubbed your toe)

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3
Q

pain is a protective mechanism to prevent:

A

tissue injury and permit recovery from injury

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4
Q

heightened pain; often a more robust response to something that already hurts

A

hyperalgesia

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5
Q

pain arising from gentle touch (painful response to a stimulus that would not normally be painful)

A

allodynia

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6
Q

in the somatosensory component, specific pain pathways allow:

A

the localization, intensity, and quality of pain

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7
Q

the affective component of pain allows for:

A
  • production of negative emotion
  • arousal
  • initiation of stress responses
  • interruption of ongoing procedures
  • learning
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8
Q

stress, anxiety, and anticipation can:

A

make pain worse

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9
Q

what is first pain?

A

the initial response to tissue damage sensed by free nerve endings and transmitted by sensory A-delta fibres (feels like a ‘pricking’ pain)

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10
Q

what is second pain?

A

an ongoing pain response caused by the release of bradykinin, histamine, acid metabolites, and prostaglandins at the site of lesion, and transmitted by C-fibres (feels like a ‘burning’ pain)

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11
Q

musculoskeletal and other ‘mild’ pain have two main phases:

A
  • first pain
  • second pain
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12
Q

what is deep pain?

A

a deep aching pain, felt as deep to the body surface, and poorly localized (highly diffuse)

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13
Q

how is deep pain treated?

A

with opioids

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14
Q

how is deep pain initiated?

A

by major trauma (post-operative pain, injury, or childbirth)

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15
Q

both deep pain and mild pain have been referred to as ‘good pain’ because:

A

it prevents overuse of damaged tissue and allows healing to occur

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16
Q

pain resulting from nerve injury or infections (there is some change in the nervous system)

A

neuropathic pain

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17
Q

list five examples of neuropathic pain:

A
  • phantom limb pain
  • trigeminal neuralgia
  • diabetic neuropathy
  • post herpetic neuralgia (shingles caused by herpes Zoster)
  • HIV-AIDS neuropathy
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18
Q

true or false: neuropathic pain responds poorly to opioids

A

true

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19
Q

how do you treat neuropathic pain?

A

antidepressants, cannabanoids, or anticonvulsants (like pregabalin or gabapentin)

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20
Q

why does shingles appear in a striped pattern?

A

it runs along the dermatomes

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21
Q

why do we treat neuropathic pain with antidepressants?

A

adds inhibition to the pain pathways

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22
Q

why do we treat neuropathic pain with anticonvulsants?

A

the physiology of epilepsy is similar to pain

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23
Q

why is neuropathic pain known as ‘bad pain’?

A

there is no obvious biological function

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24
Q

type of pain characterized by allodynia, hyperalgesia, causalgia, and spontaneous pain

A

neuropathic pain

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25
Q

type of pain that has a slow onset, outlasts the original injury, and is stimulus independent

A

neuropathic pain

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26
Q

primary sensory neurons reside in the:

A

dorsal root ganglia (DRG)

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27
Q

innervates the target tissue (ie: skin) and sends projections into the spinal cord

A

primary sensory neurons

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28
Q

different subtypes of sensory neurons mediate:

A

different sensations

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29
Q

what type of neurons are primary sensory neurons?

A

pseudo-unipolar neurons

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30
Q
  • myelinated and rapidly conducting
  • carry innocuous information
  • convey touch, pressure, muscle afferent information (important for movement, balance, and proprioception)
    these are all characteristics of:
A

Aa and Ab fibres

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31
Q

are Aa and Ab fibres responsible for pain sensation?

A

no

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32
Q

ion channels that open with mechanical force (mechanosensors)

A

Piezo 2 channels

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33
Q
  • thinly myelinated
  • carry first pain
  • slow conduction velocity (<40 m/s)
  • high threshold mechanoreceptors
    these are all characteristics of:
A

A-delta fibres (nociceptors)

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34
Q

A-delta fibers terminated primarily in:

A

spinal lamina I, lamina II, lamina V

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35
Q
  • unmyelinated
  • carry second pain
  • very slow conduction velocity (0.2-1 m/s)
    these are all characteristics of:
A

C fibres (nociceptors)

36
Q

C fibres terminate primarily in:

A

spinal laminae I and II (marginal zone and substantia gelatinosa)

37
Q

peptidergic C fibres are:

A

high-threshold mechanoreceptors and polymodal nociceptors, and mechanical cold nociceptors

38
Q

isolectin B4 positive (IB4+) C fibers are:

A

low-threshold mechanoreceptors (gentle mechanical stimulation)

39
Q

peptidergic C fibers express:

A

sensory neuropeptides

40
Q

what is the main neurotransmitter for Ab fibers?

41
Q

what are the main neurotransmitters for A-delta fibers?

A

glutamate, substance P, and CGRP

42
Q

thermoreceptors on A-delta fibers

A

TRPV1 and TRPM8

43
Q

nociceptor specific sodium channels on A-delta fibers

A

Nav1.8/1.9 and Nav1.7

44
Q

growth factor (NGF) dependent channels on A-delta fibers

45
Q

people who don’t feel pain don’t express these channels

46
Q

what are the main neurotransmitters for peptidergic C fibers?

A

glutamate, substance P, and CGRP

47
Q

what are the main neurotransmitters for non-peptidergic C fibers?

48
Q

in the dorsal horn, pain fibers project to:

A

lamina II (substantia gelatinosa), lamina I (marginal zone), and lamina V

49
Q

in the dorsal horn, pain fibers make connections with:

A
  • lamina I projection neurons
  • local circuit interneurons
  • dendrites of wide dynamic range neurons (lamina IV and V)
50
Q

lamina I projection neurons project to the:

A

brainstem, parabrachial nucleus, hypothalamus, and thalamus

51
Q

local circuit neurons are involved in:

A

local withdrawal and autonomic reflexes

52
Q

pain exits the spinal cord in either ____ or ____ projection fibers

A

lamina I, lamina V

53
Q

all types of primary afferent (sensory) fibres release:

54
Q

glutamate acts on:

A

excitatory NMDA and AMPA receptors

55
Q

some pain fibers release ____ and ____ which generates ____

A

substance P, CGRP, slow excitation of dorsal horn cells

56
Q

signal transmission in the dorsal horn is modulated by:

A

GABA/glycine interneurons

57
Q

some inhibitory neurons release:

A

enkephalin and endorphin (endogenous opioids)

58
Q

descending NA/5-HT inputs from the rostroventral medulla, locus coereleus and raphe nuclei modulates:

A

spinal processing of pain

59
Q

type of neurotransmitter that has mixed excitatory/inhibitory effects

A

5-HT (serotonin)

60
Q

type of neurotransmitter that has predominantly inhibitory effects

A

NA (noradrenaline)

61
Q

descending pathways from the rostroventral medulla (RVM) release:

A

endogenous opioids

62
Q

most axons of lamina I and lamina V projection neurons cross midline and:

A

ascend in anteriolateral quadrent of spinal cord

63
Q

what are the five main pathways that pain takes from the spinal cord to the brain?

A

1) spinothalamic tract
2) spinoreticular tract
3) spinomesencephalic tract (spinoparabrachial tract)
4) cervicothalamic tract
5) spinohypothalamic tract

64
Q

a phylogenetically old tract which projects to the intralaminar thalamic neurons

A

spinothalamic tract (medial division)

65
Q

type of pain tract which is responsible for the affective and alerting aspects of pain, and is associated with slow (second) pain

A

spinothalamic tract (medial division)

66
Q

the medial division of the spinothalamic tract lacks:

A

somatotopic organization (there is pain in an area but it’s not very specific because the input from the dorsal cells have large receptive fields)

67
Q

the medial division of the spinothalamic tract projects widely to the:

A

association and prefrontal cortex

68
Q

known as the “gateway to the cortex”

69
Q

a phylogenetically recent tract which projects to the ventroposteriolateral (VPL) nucleus of the thalamus

A

spinothalamic tract (lateral division)

70
Q

the lateral division of the spinothalamic tract is somatotopically organized, which allows for:

A

localization and discrimination of pain

71
Q

what percent of ventroposteriolateral (VPL) neurons are nociceptive?

72
Q

the lateral division of the spinothalamic tract projects to the:

A

somatic sensory cortex and parietal lobe

73
Q

tract associated with fast, first pain

A

spinothalamic tract (lateral division)

74
Q

type of pain tract which lacks topographical organization and projects to the reticular neurons in the brain stem

A

spinoreticular tract

75
Q

what kind of receptive field do reticular neurons have?

A

a wide receptor field

76
Q

the spinoreticular tract is associated with:

A

general aspects of pain perception (ie: alerts onset of pain)

77
Q

neurons in the reticular formation project to the:

A

thalamus (reticulothalamic tract)

78
Q

the spinomesencephalic (or spinoparabrachial) tract projects to:

A

1) midbrain periaqueductal gray matter (PAG)
2) hypothalamus (lateral parabrachial area), nucleus of the solitary tract, and amygdala

79
Q

responsible for interaction between ascending pain signals and descending analgesic information from ‘emotional centres’ such as the amygdala

A

the midbrain periaqueductal gray matter (PAG)

80
Q

responsible for autonomic, affective, and neuroendocrine responses to pain

A

hypothalamus, nucleus of solitary tract, and amygdala

81
Q

the amygdala adds ____ to sensory information

82
Q

what are the four main cortical structures involved in pain?

A
  • anterior cingulate cortex
  • prefrontal cortex
  • insular cortex
  • somatosensory cortex
83
Q

the anterior cingulate cortex, prefrontal cortex, insular cortex, and somatosensory cortex are all a part of the:

A

pain matrix

84
Q

part of the pain matrix responsible for attention

A

anterior cingulate cortex

85
Q

part of the pain matrix responsible for evaluative, higher cognitive functions

A

prefrontal cortex

86
Q

part of the pain matrix that acts as a hub for putting “value” on a sensation

A

insular cortex

PHYSL 372 (18 decks)

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