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neuro exam 3 > neurobiology of pain > Flashcards

neurobiology of pain 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 pain classified by (4)

A
  • underlying etiology
  • anatomic location
  • temporal nature
  • intensity
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3
Q

what is included in underlying etiology

A
  • nociceptive: tissue damage/injury ( incision post op fracture)
  • inflammatory: infection and inflammation
  • Neuropathic: nere damage/injury
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4
Q

what is included in anatomic location

A

somatic visceral

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5
Q

what is the duration of accute and chronic pain

A

acute < 3 month
chronic >= 3 months

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6
Q

what are the different classification of pain intensity

A

Mild:1-4
Moderate 5-7
Severe 8-10

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7
Q

what is nociceptive pain
- examples

A
  • the result of direct tissue injury from a noxious stimulus.
  • Examples include bone fracture, new surgical incision, and acute
    burn injury
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8
Q

what is inflammatory pain
- examples

A

result of released inflammatory mediators that activates nociceptors
* Examples include appendicitis, meningitis, rheumatoid arthritis, inflammatory bowel disease

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9
Q

what is neuropathic pain
-examples

A
  • the result of injury to nerves leading to an alteration in sensory transmission. It can be central or
    peripheral in nature.
  • Examples include diabetic peripheral neuropathic pain, postherpetic neuralgia, chemotherapy induced pain, and ”sciatica
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10
Q

what is acute pain
- examples

A
  • lasting less than three monthss and is a neurophysiological respone to noxious injury
  • resolves with natural healing
    -post-operative pain, fractured bones, appendicitis,
    crush injury to finger
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11
Q

what is chronic pain
- examples

A

is defined as lasting more than 3 months(usually beyond the expected course of an acute
disease or after complete tissue healing).
* Examples include low back pain, most neuropathic pain syndromes,
and chronic pancreatitis.

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12
Q

what is acute on chronic pain
- examples

A

times of acute exacerbations
of a chronic painful syndrome or new acute pain in a person
suffering from a chronic condition.

  • Examples include a sickle cell exacerbation in a patient with sickle
    cell disease or an abscess in a patient with sickle cell disease.
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13
Q

how is pain intensitydetermined

A
  • by pain assesment scores in combination with history and physical exam
  • is subjective
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14
Q

what are pain scales used for

A

Pain Scales are used to assess and quantify the intensity of a patients pain.
Remember that each scale has its’ own scoring range and levels
for mild, moderate or severe pain intensity.

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15
Q

pain is part of ______ ______

A

normal sensation

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16
Q

what is the pain pathway

A
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17
Q

where the cell bodies of pain sensing neurons ( nociceptors)

A
  • in the DRG
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18
Q

Aδ and C DRG neurons are ____

A

nociceotors

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19
Q

what type of neurons are Aδ and C nociceptors

A

They are Pseudounipolar neurons which has one extension
from its cell body and split into two branches.

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20
Q

what do the peripheral and central branches of Aδ and C DRG neurons do

A

Peripheral branches send free nerve endings to end organs
such as skin, muscle, joints, viscera, dura and blood vessels.
* Central branches form dorsal roots entering spinal cord dorsal
horn, synapse on Secondary sensory neurons.

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21
Q

what is the size of Aδ nociceptors, do they have mylintions?
what do they respond to

A
  • Aδ nociceptors are small-medium neurons with thin myelinated
    axons (fibers)
  • Aδ nociceptors respond to mechanical or mechanical/thermal
    stimuli
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22
Q

what is the size of C nociceptors, are they mylinated?
- what do they respond to

A
  • C nociceptors are small neurons with unmyelinated axons
  • C nociceptors respond to mechanical, thermal and chemical stimuli
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23
Q

what dype of pain is the A and C noniceptors

A
  • A: fast and sharp pain - high conduction velocity
  • C: slow, aching pain - slow conduction velocity
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24
Q

both A and C nociceptors send ______ branches which eventually form _____ _____ _____ in end of organs such as ___ ____ ____

A
  • peripheral branches
  • free nerve endings
  • skin, muscle , joints
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25
Q

what are free nerve endings called and why

A

Free Nerve Endings are called “cutaneous nociceptors” since they are
the ones who directly receive external painful (noxious) stimuli.

26
Q

what are the classificatons of of cutaneous nociceptors

A
  • Mechanical Nociceptors: respond to mechanical damage, Aδ
  • Thermal Nociceptors: respond to temperature extremes, Aδ
  • Mechano-thermal Nociceptors: respond to both mechanical and
    temperature stimuli, Aδ
  • Polymodal Nociceptors: respond to mechanical, thermal and
    chemical stimuli, C
27
Q

transduction of pain signals

A
  • Noxious stimuli activated cutaneous nociceptors.
  • Signals are transmitted to cell bodies of nociceptors located in DRG
    to activate nociceptors.
  • Action potentials are produced in nociceptors.
  • Electrical signals are then transmitted through central
    branches to spinal dorsal horn to activate the secondary
    neuron
28
Q

why can cutaneous nociceptors sense pain stimuli

A

special receptors or
ion channels expressing on cutaneous nociceptors respond to
different external stimuli.

29
Q

what are the VR1, CMR1 , ASIC receptors and what do they respond to

A
30
Q

transmission of pain signals

A

-* Electrical signals are transmitted to the secondary order neurons
in spinal cord dorsal horn
* C afferent fibers mainly terminate in superficial gray matter
laminae I-II of the spinal cord
* Aδ afferent fibers terminate in both superficial (I) and
deep (V) laminae.

31
Q

what are the major transmitters involved in pain signal transmission

A
  • EAA: glutamate, aspartate
  • Substance P (neuropeptide)
  • Calcitonin gene related peptide
    (CGRP)
32
Q

pain sensation: reffered pain
how is pain from visceral nociceptors localized
- how it can it be felt as

A
  • poorly localized
  • felt as pain on surface areas
33
Q

how are pain signls carried out to different reigons through the brain

A
  • asceding pathways
34
Q

what are the 2 different ascending pathways

A

Lateral Pathways – Spinothalamic tract (to contralateral lateral
thalamus, then SI and SII cortex) transmits discriminative
information about the location, quality, and intensity of noxious
input.
* Medial Pathways – Spinoamygdalar, spinohypothalamic, medial
spinothalamic, spinoreticular and other spinolimbic tracts. They
activate affective, alerting, motivational, autonomic and escaperesponses to pain (suffering, anxiety, increased attention and
arousal, memory, increased heart rate and blood pressure).

35
Q

which aras of the brain are activated by noxious stimulation

A
  • different cortical and subcortial areas
36
Q

Modulation: inhibition
when are inhabiatory mechanisms activated

A

during transmission of pain
signals to terminate or reduce pain sensation.

37
Q

what do descedning pathways do
- where do they originate

A

Descending pathways inhibit pain activation. The system
originates from cortex, thalamus, midbrain (periaqueductal grey)
and brainstem (rostral ventromedial medulla, dorsolateral pons).
They send axons to spinal dorsal horn and inhibit pain signal
transmission.

38
Q

what are the neurotransmitters of modualtion/inhibition

A

Main neurotransmitters: norepinephrine,
serotonin,
dopamine
endogenous opioids

39
Q

gate control - spinal mechanism

A
40
Q

what is the trigeminal nerve
- what type of fibers does it contain

A
  • the largest cranial nerve, resposible for sensation in the face
  • contain sensory and motor fibers
41
Q

what are the three branches of the trigeminal nerve

A

V1: Ophthalmic branch, sensory
V2: Maxillary branch, sensory
V3: Mandibular branch, sensory and motor

42
Q

where is the trigeminal ganglion located

A
  • depression in the middle cranial fossa
43
Q

what is the importance of the trigmeinal ganglion.

A

contains cellbodies:
1) whose dendrites carry sensations from the face
2) whose axons form the sensory root of the trigeminal nerve

44
Q

how many niclei in the trigeminal nuclei

A
  • 4 ( 3 sensory and 1 motor)
45
Q

what are the general somatic affernt nuclei

A
46
Q

what are the special viceral effernt nuclei ?
- what does it supply

A
47
Q

what is the ascending patheay for orofacial pain

A
  • pain signals from the face are carried to thalmis through the trigeminothalamic tract
  • thalmic projections to sensory cortex corresponding to face area
  • secondary axons from TN project to insula basal ganglia, anterior cingulate cortex, parabrachial area, anygdala,limbic circuitry
48
Q

what is trimenial neuralgia

A
49
Q

what is trigeminal neuralgia charecterized by?
- what nerves does it involve

A
50
Q

nerve innervation of teeth :
what innervates the odontoblastic layer of the pulp
- how do they enter
-what do they further branch into

A

Sensory nerve fibers originating from Superior and Inferior
alveolar nerves innervate the odontoblastic layer of the pulp
cavity
* These nerves enter the tooth through the apical foramen
* They further branch to form sub odontoblastic Nerve Plexus of
Raschkow

51
Q

what do the nerve plexus of Raschkow contact

A

odontobalsts

52
Q

what do the apical extentsions of odontoblasts enter

A

the dentinal tubules

53
Q

what is the hydrodynamic theory

A

the most popular theory to
explain dentine hypersensitivity.

54
Q

what is included in the hydrodynamic theory

A
  • Different types of stimuli ace on exposed dentine
  • Increase fluid flow through the dentinal tubules
  • Activate mechanoreceptors on the pulp nerves
55
Q

Special receptors and ion channels expressed on Odontoblast and
nerve endings also respond to _______ _______

A

external stimuli

56
Q

what are target peripheral nociceptors

A

local anesthetics
anti-inflammatory drugs

57
Q

what is included in local anesthetics

A

– lidocaine, bupivacaine – blocking sodium
channels

58
Q

what is included in anti-inflammatory drugs

A

NSAIDS – inhibiting cyclooxygenase
(Cox1 and Cox2) to reduce inflammatory mediators such as
prostaglandins

59
Q

Target pain transmission centrally by:

A
  • anti depressants
  • opiods
  • anti convulsants
60
Q

examples of antidepressants and what do they do

A

SNRI, SSRI, NRI, TCA – boosting
serotonin and/or norepinephrine levels to activate descending
inhibitory pathway

61
Q

what are examples of opioids and what do they do

A

morphine, oxycodone – activating opioid receptors to
reduce pain transmission (spinal and supra spinal levels)

62
Q

what are examples of anti convulsants and what do tbey do

A

carbamazepine, topiramate, valproic acid,
gabapentinoid – blocking central sodium or calcium channel

neuro exam 3 (10 decks)

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