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Y3S1 NEURO > Pain > Flashcards

Pain Flashcards

1
Q

what is the definition of 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 are the two types of pain and what are their receptors

A
  • immediate pain which is transmitted through A delta fibres
  • Persisting pain which is transmitted through c fibres
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3
Q

what is a common consequence for diabetic patients in relation to pain

A

diabetic patients can get peripheral neuropathy which means they cannot feel their feet so commonly get problematic ulcers which can cause the foot to become gangrenous

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4
Q

A-alpha nerve fibre

A

motor fibres to muscles and proprioception

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5
Q

A-beta fibres

A

touch and pressure

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6
Q

A-gamma fibres

A

motor fibres to muscle spindles

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7
Q

A-delta fibres

A

temperature and pain

  • myelinated
  • sharp and localised pain
  • fast conduction
  • polymodal
  • not usually visceral
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8
Q

B fibres

A

autonomic nervous system

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9
Q

C fibres

A

temperature and pain

  • unmyelinated
  • dull throbbing pain
  • slow conduction
  • polymodal
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10
Q

what are the 4 factors which summarise the physiology of pain

A
  1. transduction
  2. transmission
  3. modulation
  4. perception
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11
Q

what is transduction

A

conversion of a noxious stimulus (heat, mechanical, chemical) into an action potential in a nociceptor

  • heat more than 45 degrees or less than 15
  • chemical = K+, ATP, Bradykinin, histamine, substance P
  • mechanical
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12
Q

transduction

A

nociceptors are the free nerve endings of A delta and C fibres

they respond to stimuli that will potentially cause damage to the tissue
- primary hyperalgesia (pressing on a bruise)

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13
Q

give examples of substances which activate nociceptors

A
  • potassium
  • protons
  • serotonin
  • bradykinin
  • histamine
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14
Q

give examples of substances which lower the threshold for nociceptors

A
  • prostanoids
  • leukotrienes
  • substance p
  • CGRP
  • Glutamate (MAIN)
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15
Q

No single “pain receptor” but glutamate binds to

A
  • AMPA
  • NMDA (sleeping but important!)
  • G-protein couple receptors
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16
Q

The Neospinothalamic tract

A

which terminates in the ventral posterior lateral nucleus (VPL) is mainly composed of Aδ fibres.

17
Q

The Paliospinothalamic

A

tract which terminates in the dorsomedial (DM) and intra laminar areas is composed of C fibres.

18
Q

Descending Inhibition (3 mechanisms)

A
  1. GABA & Glycinergic interneurones
  2. Descending inhibition PAG-RVM-DH
  3. Endogenous opioids

+ DISTRACTION

19
Q

What is the gate control theory

A

based on the theory of presynaptic inhibition of pain information produced by mechanical stimulation.

basically your nociceptor fibres transmit the pain signals to the dorsal horn but if someone rubs your leg then the mechanoreceptors that deal with this sensation synapse on an inhibitory neurone and therefore cut off this signal before it gets there (presynaptic inhibition which closes the gate to noxious information)

20
Q

Pain perception

A
  • Reticular system elicits an autonomic response

* Limbic system links perception of pain with mood

21
Q

Visceral Pain

A
  • Visceral nociceptors respond to distension or ischaemia
  • Visceral primary afferent will activate multiple second order neurones
  • Pain more diffuse (less well localised)
  • Converge on second order neurones with somatic input
  • Referred pain (convergence)
22
Q

Associated features of pain

A
  • Sweating
  • Pallor
  • Nausea
  • Tachycardia
  • Hypertension
23
Q

step 1 on pain ladder - mild pain

A

simple analgesics

24
Q

step 2 on pain ladder - moderate pain

A

use mild opioid like codeine or tramadol

continue the simple analgesics

25
Q

step 3 on the pain ladder - severe pain

A

use strong opioid such as morphine

continue simple analgesics

26
Q

medications for neuropathic pain

A

amitriptyline and gabapentin

27
Q

Neuropathic Pain

A

A pain arising as a direct consequence of a lesion or a disease affecting the somatosensory system

28
Q

• Allodynia

A

pain response to things that should not elicit pain such as touch

29
Q

causes of neuropathic pain and what can be found on examination

A

Traumatic (phantom limb pain)
Diabetic neuropathy Postherpetic neuralgia Trigeminal neuralgia Post-stroke pain

changes in colour of limb to changes in sensation

30
Q

dysaesthesia

A

unpleasant/abnormal sensation

31
Q

hyperalgesia

A

over reactive pain to something that would normally be painful but is over dramatic

32
Q

neuroglia

A

pain in the anatomical distribution of a nerve or nerves

33
Q

Neuroplasticity behind chronic pain

A
  • Prolonged inflammatory response results in decreased pain threshold in primary afferents
  • Increased production of substance P & CGRP
  • Recruitment of NMDA receptors • Wakes up WDR
  • “wind-up” phenomenon
34
Q

spinal cord changes to neuroplasticity in chronic pain

A

Spinal Cord - changes in gene & receptor expression in DRG & dorsal horn neurons

35
Q

Risk Factors for Chronic Pain

A 
female 
age 
genetics 
low socio-economic status 
occupational 
history of abuse 
compensation

modifable:

  • anxiety and depression
  • surgical approach
  • attitudes
  • communication
36
Q

what is the Budapest criteria

A
  1. Patients must report continuing pain disproportionate to the trauma
  2. Patients must report at least one symptom in three of the four following categories:
    (a) Sensory: hyperalgesia (that is, exaggerated pain to a painful stimulus, such as pinprick) and/or allodynia (that is, pain elicited by a normally non-painful stimulus, such as light touch)
    (b) Vasomotor: skin colour and/or temperature changes/asymmetry
    (c) Sudomotor/oedema: swelling and/or sweating changes or asymmetry
    (d) Motor/trophic: weakness, tremor, dystonia, decreased range of motion and/or trophic changes/asymmetry involving nails, skin and/or hair
  3. Patients must display one sign in two of the categories above
  4. Signs and symptoms must not be better explained by another diagnosis.

Y3S1 NEURO (44 decks)

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