Module 5 - Pain Flashcards
Second pain (also known as slow pain) occurs via activation of which nerve fibre type?
- A β fibres
- A γ fibres
- A δ fibres
- A α fibres
- C fibres
C fibres
What is the term given to pain arising in response to a normally innocuous stimulus?
- Neuropathic pain
- Allodynia
- Hyperalgesia
- Sensitization
- Hysterical pain
Allodynia
What is the anatomical location of the secondary somatosensory cortex?
- Precentral gyrus
- Ventral posterior thalamic nucleus
- Sylvian fissure
- Thalamus
- Postcentral gyrus
Sylvian fissure
Which of the following is a recognised physiological effect of nociceptive pain?
- Decreased ACTH
- Decreased aldosterone
- Decreased coagulation activity
- Increased insulin
- Protein catabolism
Protein catabolism
For which agent/modality is there level 1 evidence of pre-emptive analgesic activity?
- Regional analgesia
- NMDA receptor antagonists
- Opioid agonists
- Centrally-acting alpha-2-agonists
- Epidural analgesia
Epidural analgesia
Activation of Aδ fibres is responsible for first pain sensation via the release of what neurotransmitter?
- Glutamate
- GABA
- Substance P
- Glycine
- Noradrenaline
Glutamate
What is the term given to an exaggerated response to a noxious stimulus?
- Hyperalgesia
- Allodynia
- Hysterical pain
- Neuropathic pain
- Sensitization
Hyperalgesia
There are many distinct differences between superficial and visceral pain. Which of the following is a characteristic of superficial pain?
- Radiating pain
- Rapid, sharp pain
- Associated with autonomic symptoms
- Radiating pain
- Poorly localised
Rapid, sharp pain
What medications would be considered first line therapy for neuropathic pain?
- Codeine
- Antidepressants
- Injection of corticosteroid
- Topical lignocaine
- Morphine
Antidepressants
Which of the following is a recognised physiological effect of nociceptive pain?
- Increased insulin
- Protein catabolism
- Decreased ACTH
- Decreased aldosterone
- Decreased coagulation activity
Protein catabolism
Which central pain modulatory system has been demonstrated to contribute to the mechanism of psychological pain management strategies including relaxation and distraction?
- Modified gate control theory system
- Modified gate control theory system
- Pontine noradrenergic system
- Periaqueductal grey-rostral ventrolateral medullary system
- Diffuse inhibitory noxious control system
Periaqueductal grey-rostral ventrolateral medullary system
With regard to the modulation of pain, what is the phenomenon of “wind-up”?
- Release of substance P from afferent terminals that sensitizes adjacent free nerve endings
- Increased micturition and defaecation
- Quicker withdrawal reflexes
- Sequential discharge of AB fibres to produce mediated pain
- Repetitive firing of C fibres that produces a progressive increase in the number of action potentials in dorsal horn neurones
Repetitive firing of C fibres that produces a progressive increase in the number of action potentials in dorsal horn neurones
Which property is unique to a nociceptor?
- Do not respond to stimuli in the innocuous range
- Capable of sensitisation
- Unmyelinated axons
- Respond to stimuli only in the noxious range
- Unimodal receptors
Capable of sensitisation
What is the function of the neospinothalamic (lateral spinothalamic) tract?
- It produces the autonomic stimulation associated with pain
- It projects to the medial thalamus
- It conveys the location and intensity of pain
- It produces the unpleasant affective component of pain
- It projects mostly to the reticular system and increases arousal
It conveys the location and intensity of pain
With regard to modulation of pain, on what does the modified gate-control theory depend?
- Distraction posed by the need to pass urine
- Alpha-2 receptor blockade
- Activation of encephalin interneurons
- Downgrading of the autonomic nervous system response to pain
- Activation of large diameter A fibres in the area of pain
Activation of large diameter A fibres in the area of pain
Sensory receptors can be thought of as transducers that convert various forms of energy into action potentials in sensory nerves.
Match the type of receptor to the following description:
- Cutaneous receptors for touch and pressure
- Found in the rods and cones of the retina
- Detect sensations of warmth and cold
- Cutaneous receptors for touch and pressure - Mechanoreceptors
- Found in the rods and cones of the retina - Photoreceptor
- Detect sensations of warmth and cold - Thermoreceptor
There is a wide variety of neurotransmitters released by nociceptors at their synapse with secondary afferent nociceptive neurons. What are the most common neurotransmitters?
Glutamate, Substance P, and CGRP
PAG-RVM factors increasing pain
- Attention toward pain
- Anxiety
- Infection
PAG-RVM factors decreasing pain
- Distraction or threatening situation
- Hunger
- Urgency or micturition
Peripheral sensitisation
Tissue damage or inflammation release substances
Activate receptors on nociceptor
Secondary messengers lead to phosphorylation
Also increased transcription and translation leading to increased number of receptors
Central sensitisation
Repetetive intense sustained noxious stimuli
Phosphorylation dependend changes of secondary order neuron
Increased transcription of receptors and channels leads to increased excitation and decreased inhibition
Clinical manifestations of central sensitisation
- Spontaneous pain
- Allodynia
- Secondary hyperalgesia
- Tertiary hyperalgesia
- Temporal summation
- Aftersensations
