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Neuroscience > Mod 15 Pain and Nociception > Flashcards

Mod 15 Pain and Nociception Flashcards

1
Q

How is pain vital to human survival?`

A
  • teaches us to avoid potentially harmful situations
  • elicits protective withdrawal reflexes from noxious stimuli
  • encourages to protect and rest injured parts of our body
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2
Q

What is nociception?

A

sensory nervous system’s process of encoding noxious stimuli

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3
Q

What is pain?

A
  • perception (physical discomfort, hurt, or suffering) resulting from actual or potential tissue damage
  • personal experience influenced by biological, psychological, and social factors
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4
Q

What is acute pain?

A
  • result of tissue damage, with well defined onset and pathology
  • protective function
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5
Q

What is chronic pain?

A
  • no protective function and does not always need tissue pathology
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6
Q

What are the two types of acute pain?

A
  • nociceptive
  • neuropathic
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7
Q

What is nociceptive pain?

A

due to actual activation of nociceptors

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8
Q

What is neuropathic pain?

A

neurons have been sensitized to pain, still carry sensation of pain

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9
Q

How is pain unique to each person?

A

several factors (biological, psychological, social) can influence the perception of pain

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10
Q

Is nociceptor activation/firing necessary for pain?

A

not exactly

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11
Q

Is the life expectancy for patients with no pain sensation the same as those with?

A

no, tend to be shorter

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12
Q

What are the characteristics of nociceptors?

A
  • “free” nerve ending
  • A delta fibers (fast): mechanical and thermal
  • C fibers (slow): chemical and polymodal
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13
Q

What is the nociception response?

A

A fibers: first/fast response, sharp and localized
C fibers: throbbing, aching dull pain sensation

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14
Q

What happens if you block A delta fibers?

A

loss of initial fast response of sharp and localized pain

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15
Q

What happens if you block C fibers?

A

loss of dull, poorly localized pain

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16
Q

What is the role of glutamate and neuropeptides?

A

glutamate: fast acting neurotransmitter (fast pain)

neuropeptide: slow acting, can enhance effect of glutamate

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17
Q

What is unique about nociception compared to other senses?

A

only human sense that becomes more sensitive with repeated exposure

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18
Q

What is the neospinothalmic component of the STT?

A
  • a delta fibers
  • mediates fast pain, temperature, and touch
  • localized discriminative nature
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19
Q

What is the paleospinothalmic component of the of the STT?

A
  • c fibers
  • mediates slow pain
  • more enduring, aching, intense pain with an affective nature
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20
Q

Where do primary afferents conveying nociceptive input synapse in the spinal cord?

A

dorsal horn

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21
Q

What do wide, dynamic range neurons respond to?

A

typically respond to nociceptive input but receive non-noxious input as well

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22
Q

What is affect?

A

emotional feeling, tone, or mood attached to a thought elicited by conditions and circumstances of internal and external environments

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23
Q

What is motivation?

A

state of need within us that arouses, maintains, and directs behavior toward a goal

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24
Q

What is acute pain?

A
  • occurs as a result of tissue damage
  • well defined onset
  • protective in nature
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25
Q

What is chronic pain?

A
  • outlasts time expected for tissue healing
  • may occur with or without detectable tissue damage
  • no longer serves a protective function
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26
Q

What are the characteristics of acute pain?

A
  • nociceptive
  • neuropathic
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27
Q

What are the characteristics of chronic pain?

A
  • neuropathic
  • nociplastic
28
Q

How are nociceptive signals modulated?

A
  1. sensitization
    - peripheral (primary hyperalgesia)
    - central ( secondary hyperalgesia)
  2. inhibition
    - gate control
    - descending systems of analgesia
29
Q

What is peripheral sensitization?

A

increased sensitivity of receptors and primary afferents to noxious stimuli

30
Q

What is primary hyperalgesia?

A

exaggerated sensitivity of a nociceptor to noxious stimuli

form of peripheral sensitization

31
Q

What is central sensitization?

A

amplification of neural signaling within the CNS that elicits pain and hypersensitivity

32
Q

What is secondary hyperalgesia?

A

exaggerated sensitivity in areas outside the zone of injury

form of central sensitization

33
Q

What is allodynia?

A

ordinarily painless stimuli are experienced as pain

form of central sensitization

34
Q

What is nociceptive pain?

A

pain that comes from actual or threatened damage to the non-neuronal tissue due to activation of nociceptors

35
Q

What is neuropathic pain?

A

caused by a lesion or disease of the somatosensory nervous system

36
Q

What is nociplastic pain?

A

pain coming from altered nociception despite no clear evidence of actual or threatened tissue damage

cause activation of peripheral nociceptors or evidence disease or lesion of somatosensory system

37
Q

What is the assessment of nociceptive pain?

A
  • clear proportionate mechanical natter to pain
  • pain is localized to area of injury
  • reproduction of pain with movement
38
Q

What is the assessment of neuropathic pain?

A
  • pain described as burning/shooting
  • pain is associated with other neurological symptoms
  • positive neurological findings
  • pain provocation on palpation of relevant neural tissues
39
Q

What is the assessment of nociceptive pain?

A
  • pain is disproportionate to nature and extend of pathology
  • non anatomical
  • maladaptive psychosocial factors
  • absence of signs of tissue injury/pathology
40
Q

What is gate control theory?

A

pain signals can be interrupted in the substantia gelatinosa of spinal cord, acts as a “gate”

41
Q

What is the gate control theory in simple terms?

A

activation of light touch A-beta fibers activate inhibitory interneurons in the spinal cord that shut off the nociceptor fiber transmission

  • when you jam your finger and put pressure on it or hold it, it can make the injury less painful

A beta fibers block second order transmission of A delta and C fibers

42
Q

How do PTs use gate control theory?

A

manual therapy, AROM, PROM, low grade joint mobilization

43
Q

Is gate control theory temporary or permanent inhibition?

A

temporary

44
Q

What is descending analgesia?

A

descending pain modulation system, projections from cortex to spinal cord to modulate pain

initiate release of endorphins: serotonin (raphe nuclei) and norepinephrine (locus coeruleus) to make pain not feel as bad

45
Q

How do you manage pain from the periphery as a PT?

A

touch and massage

grade 1-2 joint mobilization

heat and cold

transcutaneous electrical nerve stimulation

46
Q

What is exercise-induced analgesia?

A

release of beta endorphins from the pituitary and the hypothalamus enables analgesic effects by activating m-opioid receptors

47
Q

What is phantom limb pain?

A

following amputation of limb surgically or accidentally, you feel pain and parathesias in the missing limb

48
Q

How do you treat phantom limb pain?

A

surgical ablation, hypnosis, and rehab

49
Q

What is thalamic syndrome in relation to pain?

A
  • central post stroke pain
  • intractable as pain generation is above major centers of pain modulation
  • severe, burning, spontaneous paroxysmal pain
50
Q

What is important about complex regional pain syndromes?

A
  • post traumatic pain is disproportionate to the severity of the injury and accompanied by allodynia and automatic changes
  • maladaptive plasticity throughout nervous system
  • changes in cortical body representation
51
Q

What happens in central sensitization?

A
  • things that were not seen as painful are now painful (allodynia)
  • things that are slightly painful are now super painful (hyperalgesia)
52
Q

What is graded exercise?

A

physical activity that starts very slowly and gradually increases overtime

53
Q

What is graded exposure?

A

process by which you slowly and progressively expose yourself to some form of stress, in order to make you less sensitive to that form of stress

54
Q

What are the benefits of pain neuroscience education?

A
  • pain ratings
  • disability
  • pain knowledge
  • pain castrophization
  • fear avoidance
55
Q

Who benefits from pain neuroscience education?

A
  • sensitized nervous system
  • long lasting pain
  • high levels of fear or fear avoidance
56
Q

What are the drawbacks of pain neuroscience education?

A
  • not viable intervention for pain and disability
  • provides concerns regarding healthcare costs
  • clinicians need to be trained
  • long term effects not as significant as short term
57
Q

What type of pain can PNE be used with?

A

nociplastic

58
Q

What can use in addition with PNE?

A
  • mobilization and manipulation
  • soft tissue massage
  • muscle and neural mobilization
  • trunk stabilization
  • circuit based aerobic exercise
  • movement exercise
  • dry needling
  • usual PT care
59
Q

What referred pain area is associated with the diaphragm?

A

c3-4

60
Q

What referred pain area is associated with the heart?

A

t1-4

61
Q

What referred pain area is associated with the gallbladder?

A

t7-8

62
Q

What referred pain area is associated with the small intestine?

A

t9-10

63
Q

What area of referred pain is associated with the large intestine?

A

t10 on right

64
Q

What referred pain area is associated with the reproductive organs?

A

t10-12

65
Q

What referred pain area is associated with the kidneys and ureters?

A

L1-2

Neuroscience (15 decks)

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