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Pathophysiology - Midterm > Lecture 8: Neuropathic Pain > Flashcards

Lecture 8: Neuropathic Pain Flashcards

1
Q

What are the 2 types of pain?

A

Nociceptive and neuropathic

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2
Q

What is nociceptive pain?

A

A nociceptor is stimulated by a noxious stimuli through mechanical, thermal, or chemical means, which is associated with inflammation

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3
Q

What is neuropathic pain?

A

Pain initiated by a lesion or dysfunction of the somatosensory system, resulting in abnormal activity of the nociceptive pathway

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4
Q

What causes neuropathic pain?

A

Drug, disease, or injury induced damage to sensory fibres involved in the pain processing loop

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5
Q

What are examples of disease-induced neuropathic pain?

A

MS, diabetes, shingles

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6
Q

What are examples of drug-induced neuropathic pain?

A

Alcohol or cancer medications

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7
Q

What are 10 triggers of neuropathic pain?

A

Alcoholism; amputation; diabetes; drugs; shingles; HIV or AIDS; MS; spinal injury; stroke; tumour

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8
Q

What are the types of pain and temperature nerve fibers?

A

A-delta (small & myelinated) and C (small and unmyelinated)

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9
Q

What type of fibres are pain and temperature nerve fibres?

A

Peripheral AFFERENT fibres

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10
Q

What is the function of pain and temperature nerve fibres?

A

Carry pain impulse from peripheries to spinal cord

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11
Q

What is the type of touch nerve fibres?

A

A-beta (large and myelinated)

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12
Q

Where do nerve fibres enter the spinal cord?

A

Lamina 2

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13
Q

What is different about the pain pathway in people with neuropathic pain?

A
  • Vibrations are shot off from A-beta fibers to laminae 2, causing a greater sense of pain
  • Have over-excitation of dorsal horn neurons
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14
Q

How do nerve fibres relay info to the brain?

A

Through postsynaptic dorsal horn ASCENDING neurons

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15
Q

Once the brain gets a signal from a nerve fibre, what does it respond with?

A

Anti-nociceptive stuff

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16
Q

What is the resting membrane potential of the interior of a cell?

A

-70 mV

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17
Q

How is resting membrane potential achieved?

A

Net electrochemical gradients of Na, K, Cl, and Ca

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18
Q

Why is resting membrane potential closer to Ek?

A

Membrane is more permeable to potassium

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19
Q

How is membrane potential maintained?

A

Na/K pump by pumping out 3 Na and 2 K in for every ATP

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20
Q

How do neurotransmitters cause depolarization and give 2 examples?

A
  • Excitatory neurotransmitters bind to postsynaptic recptors and cause depolarization
  • Glutamate and substance P
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21
Q

How do neurotransmitters cause hyperpolarization and give 2 examples?

A
  • Inhibitory neurotransmitters bind to postsynaptic receptors and cause hyperpolarization
  • GABA and glycine
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22
Q

What causes hyperexcitability?

A
  • Enhancement of excitatory mechanisms

- Loss or reduction in inhibition

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23
Q

What happens when cell permeability increases?

A

Na and Ca increase intracellularly, causing depolarization and action potentials

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24
Q

What is wind-up and when does it occur?

A

Occurs when adjacent neurons produce action potentials in response to ectopic firing, causing the pain signal to increase in strength

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25
Q

What is the receptor for glutamate?

A

AMPA, NMDA

26
Q

What is the receptor for aspartate?

A

AMPA, NMDA

27
Q

What is the receptor for substance P?

A

Neurokinin I

28
Q

What is the receptor for GABA?

A

GABA-A or GABA-B

29
Q

What is the receptor for adrenalin?

A

Adrenergic

30
Q

What is the receptor for noradrenalin?

A

Adrenergic

31
Q

What is the receptor for serotonin?

A

Serotonergic

32
Q

What is the receptor for endogenous opioids?

A

Opioid

33
Q

What is the effect of glutamate?

A

Excitatory (increases pain)

34
Q

What is the effect of aspartate?

A

Excitatory (increases pain)

35
Q

What is the effect of GABA?

A
  • Inhibitory (decreases pain)

- Opens Cl and K channels and closes Ca channels

36
Q

What is the effect of adrenalin?

A

Inhibitory (decreases pain)

37
Q

What is the effect of noradrenalin?

A

Inhibitory (decreases pain)

38
Q

What is the effect of serotonin?

A

Inhibitory (decreases pain)

39
Q

What is the effect of endogenous opioids?

A

Inhibitory (decreases pain)

40
Q

True or false: neuropathic pain symptoms are extremely unpredictable

A

True

41
Q

How can neuropathic pain symptoms vary?

A

Based on severity, intensity, and location

42
Q

What are 8 sensory symptoms of neuropathic pain?

A

Pins and needles; shooting; stabbing; numbness; aching; tingling; jabbing; throbbing

43
Q

What is allodynia?

A

Pain due to stimulus that doesn’t normally provoke pain

44
Q

What is hyperalgesia?

A

Pain response greater than usual to a stimulus that is normally painful

45
Q

What is paraesthesia?

A

Abnormal numbing or prickling of skin

46
Q

What is the pain triad?

A

Involves neuropathic pain, sleep disturbances, and psychological symptoms

47
Q

What are common disorders that occur with neuropathic pain?

A

Insomnia; lack of concentration; depression; fatigue; stress; anxiety

48
Q

Is neuropathic pain easy or difficult to diagnose and why?

A

Difficult because of complexity of condition

49
Q

What is involved in the diagnosis questionnaire for neuropathic pain?

A
  • 10 yes or no questions

- Patient with a score of 4 or more classifies their pain as neuropathic pain

50
Q

What are the 4 points of focus for neuropathic pain treatment?

A

1) Inhibition of first order sensory afferent
2) Synaptic inhibition between first order sensory afferent and dorsal root ganglion
3) Synaptic inhibition between dorsal root ganglion and dorsal horn interneurons
4) Synaptic inhibition between dorsal horn interneurons and ascending tract

51
Q

How can action potentials be regulated?

A
  • Decreasing excitation (Na channel blockers, inhibiting Ca channels, or blocking excitatory receptors)
  • Increasing inhibition (GABA agonists or inhibition of serotonin and noradrenalin reuptake)
52
Q

What are the functions of antiepileptics?

A
  • Decrease influx of Na and Ca
  • Enhance inhibitory effects like GABA
  • Decrease glutamate concentration and/or block NMDA receptors
53
Q

What is an example of an antiepileptic?

A

Gabapentin

54
Q

What are the functions of tri-cyclic antidepressants?

A
  • Block reuptake of noradrenalin and serotonin

- Block Na and Ca channels and NMDA receptors

55
Q

What is an example of a tri-cyclic antidepressant?

A

Amitriptyline

56
Q

What is the function of selective serotonin reuptake inhibitor antidepressants?

A

Inhibit serotonin reuptake without affecting noradrenaline

57
Q

What is an example of a selective serotonin reuptake inhibitor antidepressant?

A

Sertraline

58
Q

What is the function of topical anti-neuralgic agents?

A

Exact mechanism unclear, but it is thought that they desensitize afferent neurons by depleting release of substance P

59
Q

What are 2 examples of topical anti-neuralgic agents?

A

Capsaicin ointment or lidocaine

60
Q

True or false: it is possible to completely treat a patient with neuropathic pain

A

False, it is only possible to relief the pain to a more manageable level

Pathophysiology - Midterm (11 decks)

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