Neurobiology- Polston Flashcards

1
Q

Pain and pain management is a big part of what you will deal with.

A

In terms of drug prescribing

chronic pain management is all about SLOW pain stuff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mirror therapy

A

-one of the therapies used to deal with phantom limb pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is pain?

A

a sensory experience
-a series of neurochemical events or responses

specifically response to noxious damaging or threatening stimuli

occurs when nociceptive pathways from sensory receptors to the brain are stimulated

  • function of pain is a primitive lower level defensive response that is supposed to keep you alive; when you get to places that may damage your system, we turn on our pain system to take us away from the damaging event; it is an adaptive response
  • like other somatosensory response pain is a perceptual experience and unpleasant experience that is associated with negative emotions and responses to either actual or potential tissue damage.
  • pain is all in the head (you don’t feel the pain if it doesn’t get to the brain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is pain and nociception? Pain and nociception are separable events. Under normal circumstances they go together.

A

Pain is your sensory perception of the pain.

Nociception is the actual damaging event that will trigger neurochemical events.

paraplegia with no perceptional awarements to sensory to your leg; someone has broken your leg with a hammer; no pain because the perception does not reach your brain

nerves that convey pain to your brain are firing even though there is nothing wrong with your leg; its something wrong with your pathway; pain in the absence of nociception

you could have nociception in the absence of pain if the signal doesn’t make it to your brain to be perceived OR you could have pain without nociceptors that have signal coming in for no good reason

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the two main categories of pain? What’s the difference between the two?

A

FAST PAIN

  • happens at the time of the insult (immediate component)
  • very acute, very sharp
  • actual pain from the damage being inflicted
  • happens faster for a number of reason: type of axons that conveys fast pain (Adelta which are lightly myelinated)
  • the first synapse in the pain pathway is in the dorsal horn of the SC the primary sensory afferent synapse in the peripheral???????(11)that synapse uses glutamate (NMDA channel receptors= ionotropic receptors) as the NT
  • time of stimulus to get from periphery to brain is relatively fast
  • easy to localize (you know precisely where the pain is occuring)
  • typically peripheral pain (at the skin or muscle at the periphery)

SLOW PAIN

  • pain after the event
  • about protecting the injured area so you don’t hurt it again
  • C-fibers= unmyelinated (slower to get to the brain)
  • form the -C-fibers and unmyelinated
  • the gift that keeps on giving
  • not well localized (the whole hand is throbbing)
  • occurs in the periphery and mostly deep pain (stomach pain)
  • first synapse in the same region as fast which is the dorsal horn but not uses Substance P neurons; these are neuropeptide which are very slow to make that work through metabotropic receptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SKIN MECHANORECEPTORS

A

-we’re talking about pain and temperature which use the same pathway and free nerve endings (Always together)

  • they can be superficial in layers of the skin
  • they can contain Nociceptor and Thermoreceptors and wrap around Hair follicles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NOCICEPTORS

A

Free nerve endings:
-Widespread in superficial layers of the skin, periosteum/cranium, arterial walls, joints

  • Sparse innervation of most deep tissues
  • No innervation of central neural tissue (in the SC and brain themselves); has interesting connotations (skull, meninges, muscles); why you can anesthetize the pt and cut open their skull with pt awake

it heightens their sensitivity which lowers the threshold for the primary afferent neuron; free nerve endings have a higher threshold for stimulus

you would want a higher threshold for pain conveying than fine touch coneying; it makes sense that pain pathways are high threshold pathway (touching clothes would hurt if the pain neurons were low threshold)

Receptor properties vary
-Adequate stimulus depends on modality (crushing, cutting, etc.)

-Receptive field size varies between different pain modalities. 100 mm for mechanical (sharp have small receptive field because we know exactly where that stimulus is as opposed to burning pain that has large receptive fields)

  • Little to no sensory adaptation (in regards to pain conveying neurons)
  • these are TONIC firing neurons (no adaptation)

The perception of pain is your driving force the escape these damaging events.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Many stimuli that can cause pain.

A

Responsive to multiple stimuli

Mechanical stimuli

  • lack of specialized endings raises threshold (breeches the membrane integrity of the free nerve endings)
  • may be somatic (in muscle) or visceral (Cramps)

Chemical stimuli

  • exogenous and endogenous algesic factors (HCl chemical or even HCl in the stomach)
  • may be somatic or visceral

Thermal stimuli

  • heat : > 43ºC (113ºF)
  • cold: < 15ºC (59ºF)
  • usually somatic (we are thermoregulators and have a distinct region of temp our body will experience)

this is all about damage; if it’s going to hurt you then there will be pain

Itch and Tickle

  • associated with nociceptors (cross talk with itching and pain as with mosquito bite and you put ice on it or put your fingernail in the bite)
  • travel in spinothalamic pathway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

THERMAL RECEPTORS

A

-More cold receptors (cool spots) than warmth receptors.

  • Warmth transmitted by C and Ad fibers
  • Noxious heat transmitted by Ad fibers (finger in the candle)
  • Cool transmitted mainly by Ad fibers

the more noxious the stimulus the faster you need to know about it

  • Slow and incomplete sensory adaptation; we do have adaption to slow cold and hot temp
  • Conveyed through anterolateral (spinothalamic) system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PATHWAYS FOR PAIN AND TEMPERATURE: Pain and temperature sensation from BODY

A

Pain and temperature from the body

First order neurons synapse on second order neurons in the ipsilateral dorsal horn (Laminae I and II), IPSILATERAL

SECOND order neurons CROSS THE MIDLINE (in the anterior commissure) and ascend contralaterally in the spinothalamic tract, to synapse on neurons in the VPL nucleus of the thalamus. (some collateral fiber go to VPI for affective aspects, suffering which is not a strict thalamic nucleus that causes feeling of suffering for slow pain–CHRONIC PAIN)

Third order neurons project from the thalamus to the primary sensory cortex. CONTRALATERAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Primary order neurons of pain, temperature, touch, proprioception

A

ALL located in DRG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PATHWAYS FOR PAIN AND TEMPERATURE: Pain and temperature sensation from the FACE

A

First order neurons from the trigeminal ganglion descend to synapse onto second order neurons in the ipsilateral spinal trigeminal nucleus.

Second order neurons cross the midline and ascend contralaterally in the spinal lemniscus (at the level of the cervical spinal cord) to synapse on third order neurons in the VPM nucleus of the thalamus (VPI for affective aspects)

may experience a toothache when you have suffered damage to the cervical ganglion (remember nociception and pain can be separated)

Third order neurons project from the thalamus to the primary sensory cortex. (is DIFFERENT for fast and slow pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

BROWN-SEQUARD SYNDROME

A

what is brown-sequard syndrome?

Brown-Sequard syndrome (BSS) is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.

-for pain and temperature, second order neurons cross over the midline

Ipsilateral signs
Loss of fine touch, vibration, proprioception

Contralateral signs
Loss of pain and temperature, crude touch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PATHWAYS FOR PAIN AND TEMPERATURE

LISSAUER’S TRACT

A
  • first order neuron comes in and synapses in nucleus cuneatus and nucleus fasciculus
  • each dermatome associated with one spinal nerve and in the fine touch pathway that is the only place that sensation is coming in from; so a lesion that hits that level will knock out fine touch sensation
  • pain pathway is different in that the first order neuron comes in and looks for second order neurons in the ipsilateral SC up or down 1-2 SC levels; however if you have lesion at T2 you may not lose all your pain sensation because they descend or ascend 1-2 levels

Pain and temperature sensation

Lissauer’s tract

Axons from some first order neurons conveying pain and temperature synapse immediately onto second order neurons, but many ascend or descend 1-2 levels in Lissauer’s tract before synapsing

Some pain and temperature sensation is therefore spared when a spinal hemisection is discrete.

Sensory sparing reflects branching of afferent pain fibers (Lissauer’s tract)

Lissauer’s tract is is a stack of input NOT a longitudinal input like dorsal column tract; allows you to receive inputs even if there is damage in the dorsal horn; if you damage the spinal nerve none of those branches will work but if they damage in the dorsal horn you have little branches that may come in above it and allow you to detect pain and temp from that dermatome

blue is fine touch
green is pain and temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PATHWAYS FOR PAIN AND TEMPERATURESPINOTHALAMIC TRACT

FAST PAIN

A

fast pain is a newer system

Fast Pain – Neospinothalamic tract

Neospinothalamic tract contains mainly Ad fibers that contain fast pain.

Fibers are primarily from the most dorsal parts of the SC which Rexed’s laminae I and II (marginal zone and substantia gelatinosa)

Sparse projections (on the way up to the thalamus) to the reticular formation (arousal); to get away from that damaging stimuli real quick!!!

Major projection to VPL of the thalamus

Cortical projections for location and quality of stimulus

you are getting sensory projections to thalamus to the cortex real quick (no branching really cuz again you gotta go real quick); does not sightsee lol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PATHWAYS FOR PAIN AND TEMPERATURESPINOTHALAMIC TRACT

SLOW PAIN

A

slow pain is an older system

Slow Pain – Paleospinothalamic tract

Evolutionarily older pathway

Paleospinothalamic tract contains mainly C fibers that convey slow pain (especially visceral).

Second order neurons are primarily from Rexed’s laminae II and III . Some synapse on interneurons in lamina V.

Ascending tract projects widely to the reticular formation, periaqueductal gray, and limbic system

Projections to VPL and intralaminar thalamus nucleus (which is the suffering nucleus)

Limited role for somatosensory cortex;
does a lot of sightseeing!!!; you are NOT going straight to the thalamus or straight to the cortex; relative particular information about where pain is coming from is useless to you!

amygdala (learning center will get some fibers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PATHWAYS FOR PAIN vs. FINE TOUCH COLLATERAL BRANCHING

A

This reemphasizes the places we would see branches to in a slow pain pathway but not a fast pain pathway and definitely not a fine touch as fine touch is all about the cortex!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where are we perceiving the slow pain?

A

mainly in the thalamus

Collateral branching in the paleospino-
thalamic tract allows subcortical responses
-Arousal centers in the reticular formation
-Emotional responses from the limbic system
-Subcortical pain perception - Thalamus

Evidence for subcortical pain perception

  • Removal of somatic sensory cortex does not prevent slow pain perception (cortex is about quality of pain; thalamus is about perception of the pain??)
  • Stimulation of somatosensory cortex induces mild pain only
  • Cortical awareness relates mostly to perception of the quality of pain
  • Thalamic pain syndrome
19
Q

Deep pain is about slow pain systems.

A

Slow pain – conveyed mainly by C fibers. Few Ad fibers in deep structures

Poorly localized (when you break your arm you don’t feel the pain mapped out to that specific site)

Frequently associated autonomic responses such as with nausea, sweating, changes in blood pressure

Often induces reflex muscle contraction. (but you really want to relax!)

Extended muscle contraction exacerbates deep pain

20
Q

VISCERAL PAIN is associated with internal organs and is SLOW pain.

A

Usually doesn’t convey small discrete stimuli. Requires diffuse stimulation of nociceptors throughout

Due to either mechanical or chemical stimuli (not thermal)

Variety of etiological factors

  • Ischemia: formation of acids, bradykinins, proteolytic enzymes.
  • Chemical stimuli: gastric juices
  • Smooth muscle spasm of hollow viscus (cramps and ischemia)
  • Overdistention of a hollow viscus (stretch and ischemia

Most visceral pain comes from cramping or overextension of a hollow tube. C-fibers are fairly sparse innervated which means that if someone was to hit me with a needle it would hurt as it went through your deep tissues but it would be very unlikely to hit a pain fiber as the needle gets to your stomach. Most things that cause visceral pain are WHOLE organ events, you don’t need detailed innervation.

21
Q

VISCERAL AFFERENT PATHWAYS

A
  1. Visceral reflexes (similar to Spinal reflexes)
    Afferent visceral sensory neurons synapse with second order neurons that send branches to autonomic efferents.
  2. Afferent visceral sensory information (not necessarily about pain but like taste, hunger)
    Afferent visceral sensory neurons synapse with second order neurons that project ipsilaterally to the solitary nucleus, which conveys the information to homeostatic centers in the brain.
  3. Visceral pain (related to cramping or stretching and works through pain pathways)
    Afferent visceral sensory neurons synapse with second order neurons that project contralaterally in the spinothalamic tract. Pain is usually referred to the surface of the body (REFERRED PAIN).
22
Q

PARIETAL vs. VISCERAL PAIN

A

Visceral pain is slow pain.
kidney stones or appendicitis does not seem like slow pain.

Parietal layer is CT that surrounds the abdominal cavity and it has a lot of fast pain fibers.

The organ itself only have C fibers but is surrounded by tissue that has fast pain Ad fibers called the parietal layer.

Parietal pain

  • Somatic innervation of pleura - GSA
  • Travel with spinal nerves
  • Fast pain – mainly Ad fibers
  • Easily localized.
  • Conveyed by neospinothalamic tract

Visceral pain (don’t know which part of your uterus is cramping)

  • Visceral innervation of organs
  • Travel with autonomic fibers
  • Slow achy pain – C fibers only
  • Difficult to localize, REFERRED PAIN (you also feel pain in the somatic part of your body even though the problem is visceral: classic example is heart attack is your left arm pain)
  • Conveyed by paleospinothalamic tract
23
Q

Appendicitis

A

Appendicitis – pain felt at two sites

Visceral pain component

  • originates from appendix
  • travels with sympathetic nerves
  • enters spinal cord at T10
  • pain referred to umbilicus
  • slow achy crampy pain

Parietal

  • originates from abdominal wall
  • travels with lumbar spinal nerves
  • enters spinal cord at L1
  • pain felt in lower right abdomen
  • sharp intense immediate pain
24
Q

REFERRED PAIN

A

Females will feel pain in the jaw in an event before a heart attack (check Mommy out). Men will not.

Predicting the site of visceral injury

Site of referral is consistent for each organ.

Referral of visceral pain confounds localization but assists diagnosis.

Not necessarily close to the adult anatomical location

Pain refers to dermatomes that are associated embryologically

25
Q

Mechanism of referred pain

A

Mechanism of referred pain

Interactions between somatosensory and visceral pain pathways

Dorsal Horn Interaction
Shared synapses onto second order neurons that form the spinothalamic tract

Dorsal Column Interaction
Branching of visceral nociceptive afferents into the DCML pathway

26
Q

NEUROPATHIC PAIN

A

Use the word to know the word: pain that is perceived because of a pathology in the nerves in the nerve pathway

Neuropathic pain is defined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system”

  • Neuropathies from diabetes, cancer, HIV (pain in feet because nerves are damaged!!)
  • Thalamic pain
  • Spinal cord stenosis or injury (vertebral column start to grow inward and compress SC causing pain axons to fire)
  • Herpes zoster infection of dorsal root ganglion (shingles) is chicken pox virus that remains dormant??
  • Causalgia (peripheral nerve damage)
  • Phantom limb pain (When someone has lost a limb and they still feel pain)
  • Often accompanied by hyperalgesia (things hurt more than they should) and allodynia (things that should not even be part of the pain modality would now be painful)
27
Q

Trigeminal Neuralgia (tic douloureux) is an example of neuropathic pain.

A

-a compulsive like firing of the pain fibers in the Trigeminal pain pathway and so anytime anything touches your face it is extremely painful; it is usually triggered by what should be a fine touch stimulus but you’ve got neuropathy of trigeminal pain pathway that makes it respond to these things

Age related (50 and over)

Brief episodes of intense stabbing pain

Usually triggered by ‘fine touch’ mechanical stimulus

Seizure-like hyperactivity of the spinal trigeminal nucleus

Usually results from impingement of a blood vessel compressing trigeminal entry zone

Associated with cluster headaches (primarily in men)

Primary treatment approach is anticonvulsant drugs (carbamazepine)

28
Q

Phantom limb pain is an example of neuropathic pain.

A

if its in your brain you feel the pain

Most common after limb amputation

Mastectomy, tooth extraction, etc.

Central sensory processing without input

Intense acutely, made diminish with time

Central somatosensory reorganization

Prominent cause of chronic pain

“Mirror Therapy”: watch video; have to have your limbs???

“Augmented Reality Therapy”: uses computer and electrodes ?????? watch video

29
Q

THALAMIC PAIN: DEJERINE–ROUSSY SYNDROME

Another form of chronic pain is thalamic pain.

A
  • usually due to a stroke
  • Primary cause is thalamic stroke
  • Initial presentation is contralateral numbness and tingling
  • Recovery of function associated with burning and tingling pain
  • Pain worsens over time, chronic and unrelenting
  • Hyperalgesia, allodynia, dysesthesia

ibuprofen will not work, you need morphine

30
Q

THALAMIC PAINTREATMENT OPTIONS

A
  • lesion the thalamus VPI (Suffering nuclei) not the VPL or else you will lose all sensation
  • Unresponsive to basic analgesic
  • Some success with opiates, anti-depressants, anticonvulsants, alternative approaches (NICAM)

-Intralaminar thalamic lesions
Only for severe, intractable pain
Spare VPM and VPL functions

-Electrical stimulation

Unreliable and short-lived effects of existing treatments.

31
Q

BEFORE SGL next week go through the table of content and browse through the first 50 pages about primary and secondary headaches

HEADACHE (CEPHALALGIA)

A

Most common neurological complaint

No nociceptors in neural tissues.  Pain comes from other tissues of the head.  
		Skin
		Connective tissue
		Muscles (tension headache)
		Bone (blunt trauma headache)
		Sinuses
		Meninges (meningitis)
		Vasculature (aneurism)

Primary vs. secondary headache

32
Q

Primary vs. secondary headache

A

vast majority of the book on blackboard is about secondary headaches

Primary Headache (does not have a cause)

  • Not attributable to pathology;these are HA with no known pathology associated with them
  • Usually mediated by CN V
  • Three main types (migraine, tension, and autonomic cephalagias AKA clustered headache which are said to be the most painful HA AKA suicidal HA)

Secondary Headache (have a cause)

  • Directly attributable to cause (injury, infection, disease)
  • Many different causes
  • Treatment approach must address cause
33
Q

NOCICEPTIVE MECHANISMS

STUDY THIS SLIDE NEED TO KNOW

A

Mechanical pain
-Physical disruption of the nerve ending membrane opens ion channels and depolarizes neuron.

Thermal pain - cold
-CMR1: Cold and Menthol Sensitive Receptor

Thermal pain – hot : TRP Receptors

  • Vanilloid receptors: heat and capsaicin
  • TRPV1: noxious heat (> 43ºC) and capsaicin potentiated by PKC*
  • TRPV2: noxious heat (> 50ºC) only

Chemical pain: TRP Receptors (V1 and others)

  • Exogenous compounds such as capsaicin, acrolein, neurotoxins
  • Endogenous compounds from damaged tissue such as histamine, bradykinins, H+ ions, inflammatory cytokines: *activate PKC
  • Contribute to hyperalgesia from inflammation
34
Q

NOCICEPTIVE MECHANISMS: AXON REFLEX

A
  • has to do what happens at the site of injury after the pain; part of the slow pain system
  • decide to prevent from damaging it further
  • works through first order neuron (substance P neurons since we’re talking about slow pain); it sends branches not only to the dorsal horn but has branches that are releasing substance P locally at the site of the injury (all kinds of cells there that respond to the substance P to make that site hurt more); so there is a positive feedback loop, because those compounds released by those cells further stimulate substance P neurons; more substance P = more compounds

C-Fiber interactions with damaged tissue

Substance P from C-fiber stimulates histamine release from mast cells

Role for C-fiber in initiating inflammatory responses, ATP release, H+

Substance P from C-fibers causes vasodilation

Locally released factors stimulate C-fibers

“Vicious circle” of hyperalgesia

35
Q

NOCICEPTIVE MECHANISMS: PURINERGIC RECEPTORS

A

cut my cell ATP will come out because my cells have purinergic receptors

Present on nociceptive nerve endings

P2X (ionotropic) and P2Y (metabotropic)

Signal pain at nanomolar concentrations of ATP: Adequate stimulus

Activation of P2X (nonselective cation) channels results from release of ATP by metabolically hyperactive and injured tissues.

Activation of P2Y receptors by the released ATP stimulates Gi and Gq proteins for Ca++ channel opening and Ca++ induced Ca++ release.

36
Q

PAIN MODULATION: ALGESIC SENSITIZATION

A

Peripheral sensitization (Axon reflex is a form of sensitization where you become more sensitive; you are doing things like up regulating your ion channels which could make you more sensitive OR changing the threshold for these nerves to fire; that makes them more or less sensitive; the more easily the nerves fire the more easy it is for you to perceive pain in your brain)

  • Response to inflammatory mediators such as cytokines, histamines, serotonin
  • Upregulation of voltage-gated ion channels
  • Increased membrane excitability
  • Mechanical and thermal thresholds reduced with peripheral nerve lesions (neuropathic sensitization)

Central sensitization

  • Activity dependent synaptic facilitation
  • May involve synapses at dorsal horn, thalamus, or cortex
  • Long term potentiation
37
Q

PAIN MODULATION: ALGESIC FACTORS

REVIEW THESE IN DEPTH!!!!

A

Central serotonin helps with pain (analgesic). Peripheral serotonin is algesic. Serotonin at the site of injury will make it more sore.

Factors related to injury

  • Cytokines – IL6, TNFa, TNFb
  • Histamines
  • Bradykinins
  • Prostaglandins
  • Hydrogen ions
  • ATP

Neurotransmitters

  • Serotonin in the periphery
  • Glutamate and substance P in the spinal cord

Irritants

  • Capsaicin
  • Acrolein
  • Allergens/Plant oils
  • Heat

Effects of mood disorders -Low levels of brainstem monoamines

Mood has a big influence on pain thresholds. The example of exam, boyfriend, stepping on pin.

38
Q

Pain Threshold

A

low threshold: easy to activate pain receptors

higher threshold: takes more to activate pain receptors

lots of happiness raises your pain threshold

lots of madness decreases your pain threshold

39
Q

ANALGESIC FACTORSTHE ‘GATE CONTROL’ THEORY

A

suck my thumb????

you will quiet down secondary order neurons in the dorsal column

Melzack and Wall, 1965

Inhibitory neuron to second order pain neurons in substantia gelatinosa (less likely to percieve pain, no pain if it doesn’t get to the brain, but nociception is still there)

Modulated by fine touch primary afferents (reduces the perception of pain in your brain)

“Gates” the efficacy of transmission of pain signal

Possible mechanism for acupuncture

40
Q

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

A
  • performed in physical therapy
  • this only works while you’re doing it
  • you put on tens pack which gives you cutaneous electrical stimulation and you feel the tingling instead of the pain but once you take it off you feel the pain
  • it is believed to work through a similar mechanism that is stimulating the A fibers and is somehow inhibiting the second order pain neurons

your nociception is still there but it is not what is getting to your brain

doesn’t get to the brain you feel no pain; you have distracted your brain with something else

41
Q

PAIN MODULATION

ENDOGENOUS ANALGESIC FACTORS

A

naturally occurring opioids
involves the periaqueductal gray

Stimulation of periaqueductal gray leads to endorphin release (turn on serotonin neurons in Raphe nucleus)

Stimulation of periaqueductal gray facilitates serotonin release

Descending serotonin pathways cause release of enkephalins in the dorsal horn that inhibit pain neurotransmission (quieting the secondary neuron)

Ascending serotonin pathways act positively in mood control centers and raise the pain threshold CENTRALLY. Mood is a great pain modulator. Serotonin gives you two benefits. It mechanically quiets the second order neuron in the dorsal horn to shutdown the pain pathway and it enhances your mood which raises your pain threshold.

Norepinephrine also inhibits pain through both descending and ascending pathways

-we know that if we stimulate the periaqueductal gray (matter around the cerebral aqueduct) you will reduce the perception of pain; it can alleviate pain; neurons in the periaqueductal gray project fibers to the Raphe nucleus (home of serotonin neurons); you turn on serotonin neurons in the Raphe nucleus, some of them go to the brainstem or go down to the SC to quiet second order neurons

42
Q

PAIN MODULATION EXOGENOUS ANALGESIC FACTORS

A

Lidocaine/Novocaine (blockers of voltage gated sodium channels meaning no APs)

  • Short lived, topical use
  • Sodium channel blocker
  • Prevents action potential in nerve

Aspirin (acetylsalicylic acid) and NSAIDS

  • Inhibit prostaglandins
  • Inhibit NO
  • Reduce inflammation (inflammatory agents was part of the list of algesic chemicals that were involved in the axon reflex and gave you hypersensitivity and excited you C fibers causing you pain; inflammation causes pain)

Acetaminophen

  • Similar actions to aspirin
  • Limited anti-inflammatory actions

Opioids

  • Act through endogenous opioid receptors.
  • Central inhibition of pain perception.
  • Highly addictive – last resort
43
Q

PAIN MANAGEMENT

A

Physical therapy

Targeted exercise

Acupuncture

Acupressure

Massage

Meditation

Yoga and Tai Chi

Biofeedback

-these raise your pain threshold

44
Q

PAIN RESEARCH

A

apply for NIH institute for research opportunities

-new drug tramadol which may not be as addictive (could be a breakthrough in pain management)