Nociception Vs. Pain Flashcards by Rachel Frontain

What is Nociception?

Process by which information about a noxious stimulus is conveyed to the brain. It’s a summation of prior cognitive processes that occur before the brain is aware of a painful sensation

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Nociceptor

Nerve receptor preferentially sensitive to nociceptive stimulation or to stimulation that becomes nociceptive if it persists

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Nociceptive

Stimulation of sufficient intensity to activate nociceptors, and even produce a tissue lesion

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-algia

Localized pain without presuming it’s cause

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Antalgic/analgesic

Pertaining to the reduction of pain

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Paresthesia

A spontaneous or provoked unusual sensation (NOT painful)

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Hypoesthesia

A decrease in sensitivity to non-noxious stimulation

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Hypoalgesia

A decrease in pain in response to a typically noxious stimulus

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Anesthesia

Loss of sensation

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Analgesia

Absence of pain following a typically noxious stimulus

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Hyperesthesia

An increase in sensitivity to non-noxious stimulation

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Hyperalgesia

Exaggerated response to typically noxious stimulation

Unusually low nociceptive threshold

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Allodynia

Pain produced by typically non-noxious stimuli

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Characteristics of pain

Universal
Subjective
Context-dependent
Clinically significant - it’s the #1 reason that patients seek chiropractic care

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The paradox of pain

Adaptiveness: the experience of pain is important for survival and serve as warning signs but it’s considered negative

Lack of clear cortical representation: painful stimuli activate several regions of the cortex

Descending pain control mechanisms are present: cognitive and emotional factors can effectively suppress or amplify the experience of pain

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What is “top-down” pain modulation?

The ability to suppress or amplify the experience of pain

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What is pain?

An unpleasant sensory and emotional experience resulting from actual or potential tissue injury (or other stimulus that does not involve the tissue!) and engages the snensory, emotional and cognitive processes of the brain

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What is transient nociceptive pain?

An unpleasant sensation in response to noxious stimuli that does not injure tissue

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Is there tissue damage accompanying transient nociceptive pain?

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Sensations of which pain fibres are recognized with transient nociceptive pain?

First pain (alpha delta fibers) and second pain (C fibers)

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Which type of pain serves as an “early warning sign” that alerts the brain to the presence of a potentially tissue-damaging event?

Transient nociceptive pain

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What will be triggered by transient nociceptive pain?

Behaviours aimed at avoiding potentially tissue-damaging stimuli

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What is acute pain?

Unpleasant sensation in response to tissue injury and/or inflammation

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What is recurrent acute pain?

Pain that returns in periodically in distinct episodes

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Is there CNS plasticity change with acute pain?

Yes, central sensitization occurs

Is there PNS plasticity change with acute pain?

Yes, peripheral sensitization occurs

Is there PNS or CNS plasticity change in nociceptive transient pain?

Neither is present

Describe the physiologic change of the nociceptors in acute pain

Increased excitation or decreased inhibition of nociceptors

What do we know has occurred in the nervous system with chronic pain?

There is injury to the nervous system

What can you see at a physiological level with chronic pain?

Cellular structural changes

Is there change to the PNS plasticity with chronic pain?

Yes the pain afferents are modified

Is there CNS plasticity change with chronic pain?

Yes, rewired networks and circuits

Is chronic pain considered to be protective to our bodies?

No, it is not understood to have a protective role. It persists after the triggering event has RESOLVED

What are the divisions of nociceptive pain?

Somatic Visceral Inflammatory

After what kinds of noxious stimuli does Nociception pain occur?

Mechanical Thermal Chemical

What is inflammatory nociceptive pain associated with?

The process of tissue repair following tissue damage

What are the divisions of neuropathic pain?

Neurogenic pain | Functional pain

What is neuropathic pain a result of?

A nervous system disorder

What are the responses from somatic nociceptive pain?

Superficial or deep pain Nociceptive reflex Autonomic response

What is the mechanism for visceral nociceptive pain?

Distension of viscera

What are the possible responses toward visceral nociceptive pain?

Constant cramping Diffuse pain Autonomic response

What are the possible responses toward inflammatory nociceptive pain?

Spontaneous pain (diffuse) Hyperalgesia Allodynia

What are the mechanisms that cause inflammatory pain?

Tissue lesion and inflammation association

What are the possible responses to neurogenic neuropathic pain?

Spontaneous pain (sharp, ELECTRICAL) Hyperalgesia Allodynia

What are the mechanisms associated with neurogenic pain?

PNS injury | CNS injury

What are the possible responses to functional neuropathic pain?

Spontaneous pain (diffuse, deep) Hyperalgesia Allodynia

What are the mechanisms associated with functional neuropathic pain?

Hyper activation of nociceptive tract inhibition Loss of nociceptive tract inhibition

Why is quantifying pain so important to physicians?

Can diagnosis CAUSE of pain MONITOR the pain Monitor EFFECTIVENESS of treatment

What is the current gold standard for assessment of pain?

Trick question! There is none. Boo.

What are the 2 basic principles that govern the clinical measurement of pain?

1. The patient is the only authority of their pain evaluation 2. Pain should be evaluated in terms of its impact on the person as a WHOLE

What are (5) quantifiable components of the pain experience?

Pain intensity (Wong-Baker faces, LOCQSMATT) Physical capacity (prevent ADLs) Spatial attributes (drawing where it is) Pain quality (describe it in your own words) Psychological component (Beck Depression Inventory)

Can the perception of pain occur without Nociception?

YES!!!!! 😱😱😱😱😱

What does the Biomedical model describe?

The mechanistic model which assumes that each disease process results from a unique underlying pathoanatomical/pathophysiological lesion

Which model ties together a specific disease and its symptoms with the pathoanatomy and pathophysiology?

The biomedical model

Under the biopsychosocial model of pain, would losing employment be a possible cause for increased pain perception?

Yes

What are the goals of the biopsychosocial model of pain?

Explain the multidimensional nature of the pain experience Emphasize the complexity and interdependence of each component which contributes to the experience of pain Provide health professionals with a model of pain that helps them comprehend the different components and thus, find appropriate treatment

What are the 4 distinct neurophysiological events of Nociception?

Transduction Transmission Modulation Perception

Define transduction

Converting noxious stimuli into electrochemical impulses

Define transmission

Transmitting electrochemical impulses along afferents fibers to various nervous system regions

Define modulation

Altering the perception of noxious stimuli by peripheral or central mechanisms

Define perception

The conscious experience of pain created by the interpretation of nociceptive info by higher centres of the CNS

Where are primary cell bodies for neurons carrying noxious info from the body located?

DRG

Where are primary cell bodies of neurons carrying noxious stimuli to the face located?

The trigeminal ganglia

What are the primary nociceptive neurotransmitters utilized with all nociceptive neurons?

Glutamate and Substance P

Are myelinated nociceptors bimodal or polymodal?

They are bimodal

Are unmyelinated nociceptors found in small axons in remak bundles or large axons?

Small axons in remak bundles

Do we have large or small receptive fields for unmyelinated nociceptors?

Large!

What kind of stimuli do unmyelinated nociceptors detect?

Mechanical, thermal and chemical (polymodal)

How can inflammation enhance the perception of pain? (Hint: 2 ways)

Modifying (enhancing) the degree of Nociceptor activation/excitation Decrease the threshold of excitation to cause peripheral sensitization of nociceptors (results in hyperalgesia and allodynia)

What are 2 main causes of peripheral sensitization?

Exposure to inflammatory mediators Repeated application of noxious stimuli