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Neuro > Pain > Flashcards

Pain Flashcards

1
Q

Pain

A

An unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage

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2
Q

Purpose of immediate pain

A

Warns of imminent tissue damage —>withdraw from the source of injury

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3
Q

Purpose of persisting pain

A

Encourages us to immobilise the injured area, giving damaged tissue the best chance to heal

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4
Q

Nociception

A

Describes the neural processes involved in producing the sensation of pain

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5
Q

Nociceptive pathways

A

Transduction in the periphery, through transmission to the dorsal horn of the spinal cord, then on to the brain

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6
Q

Acute pain

A

Pain <12 weeks duration

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7
Q

Chronic pain

A

Continuous pain lasting >12 weeks
Pain that persists beyond Tissue healing time

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8
Q

2 types of chronic pain

A

Non-cancer
Cancer

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9
Q

Nociceptive pain

A

Pain that arises from actual or threatened damage to non-neural tissue and is due to activation of nociceptors

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10
Q

Neuropathic pain

A

Pain caused by a lesion or diseases of the somatosensory nervous system

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11
Q

Nociplastic pain

A

Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors, or evidence for disease or lesion of the somatosensory system causing pain

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12
Q

Examples of neuropathic pain

A

Trigeminal Neuralgia
Glossopharyngeal Neuralgia
Post Herpetic Neuralgia
Painful Diabetic Neuropathy
Complex Regional Pain Syndrome
Phantom limb pain
Pain due to spinal cord damage / stroke / brachial plexus avulsions

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13
Q

Allodynia

A

Pain due to a stimulus that does not normally provoke pain

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14
Q

Dyesthesia

A

An unpleasant abnormal sensation, whether spontaneous or evoked

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15
Q

Hyperalgesia

A

Increased pain from a stimulus that normally provokes pain

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16
Q

Hypoalgesia

A

Dismissed pain in response to a normally painful stimulus

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17
Q

Pain pathways

A

Peripheral receptor
1st order neurons
2nd order neuron
3rd order neuron

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18
Q

1st order neuron

A

From the periphery to ipsilateral spinal cord

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19
Q

2nd order neuron

A

Crosses to the contralateral cord and ascends to the thalamus, the system’s integrative ‘relay section’

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20
Q

3rd order neuron

A

From thalamus to midbrain and higher cortical centres

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21
Q

Nociceptors

A

Transduction
Physical stimulus —> Action potential
Most are poly-modal (thermal/chemical/mechanical)

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22
Q

Primary Afferent neurones

A

Nociceptors are the free nerve endings of primary afferent neurons
AΔ fibres
C fibres
found in any area of the body that can sense pain either externally or internally

External: skin / cornea / mucosa
Internal: viscera / joints / muscles / connective tissue

The cell bodies of these neurons reside in either
Dorsal root ganglion (body)
Trigeminal ganglion (face / head / neck)

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23
Q

Cell bodies of primary Afferent neurones are found in either

A

Dorsal root ganglion (body)
Trigeminal ganglion (face/head/neck)

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24
Q

Dorsal root ganglion

A

Present on the dorsal root (sensory)
Composed of cell bodies of nerve fibres that are sensory (afferent)
First order neurons
Pseudo-unipolar neurons
Can be the source of pain pathology
Trigeminal ganglion is the equivalent for the face / head

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25
Q

A-Alpha nerve fibre carries what kind of information

A

Proprioception

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26
Q

A-beta nerve fibre carries what kind of information

A

Touch

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27
Q

A-delta nerve fibre carries what kind of information

A

Pain (mechanical and thermal)

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28
Q

C nerve fibre carries what kind of information

A

Pain (mechanical, thermal and chemical)

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29
Q

Which nerve fibres are myelinated

A

A-Alpha
A-beta
A-delta

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30
Q

Which nerve fibre is unmyelinated

A

C

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31
Q

A-Alpha nerve fibre diameter

A

13-20 um

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32
Q

A-beta nerve fibre diameter

A

6-12 um

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33
Q

A-delta nerve fibre diameter

A

1-5 um

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34
Q

C nerve fibre diameter

A

0.2-1.5 um

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35
Q

A-Alpha nerve conduction speed m/s

A

80-120

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36
Q

A-beta nerve conduction speed m/s

A

35-90

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37
Q

A-delta nerve conduction speed m/s

A

5-40

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38
Q

C nerve conduction speed m/s

A

0.5-2

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39
Q

Dorsal horn

A

On the posterior aspect of the SC the grey matter forms two horns called the dorsal horns. (the ones at the front are called the ventral horns)
Contains distal nerve endings from primary afferents, cell bodies of second order neurones as well as a complex network of other nerves such as excitatory and inhibitory interneurons (and projection neurones) that transmit somatosensory info from the SC to the brain

40
Q

2 dimensions of pain experience

A
  1. Sensory/discriminative- allowing us to locate tissue damage
  2. Affective/aversive- ‘unpleasant’ and ‘emotional’ in the IASP definition
    his is reflected in the anatomy of the different components of the pain pathway:
    The affective component travels centrally along ancient spinal cord pathways to ‘old brain’ centres in the midbrain
    The discriminative part of the sensation is carried along newer tracts to the evolutionary modern sensory cortex
41
Q

Polymodal nociceptors

A

A-delta and C - respond to a variety of stimuli, mechanical, thermal and chemical.

42
Q

A-delta nociceptors

A

thought to mediate the initial, ‘fast’ pain on injury, e.g. on touching a red-hot surface. This ‘fast pain’ initiates the protective withdrawal reflex.

43
Q

C nociceptors

A

responsible for the dull, throbbing pain that accompanies inflammation following injury. This ‘slow pain’ promotes immobilization of the injured body part, which can encourage healing

44
Q

Visceral nociceptors

A

similar to Aδ and C nociceptors found in the periphery. The main difference being that they respond to distension and ischaemia rather than cutting and thermal damage. Visceral pain signals are carried by Aδ and C fibres, which travel with autonomic efferents

45
Q

Activation thresholds

A

Activation thresholds for mechanical and thermal stimulation are high compared to mechanoreceptors and thermoreceptors. In other words, it is extremes of pressure and temperature that activate nociceptors.

46
Q

How do A-delta afferents synapse

A

Aδ primary afferents synapse directly withsecondary afferentsthat will eventually carry the pain signal to the thalamus.

47
Q

How do C fibre afferents synapse

A

C fibres do not synapse directly with secondary afferents, but connect instead withinterneuronsthat carry the signal on to secondary afferents in laminae I or V. These interneurons are important in modulation of the pain signal

48
Q

Visceral input

A

differs in that fewer primary afferents activate a larger number of second order neurons, resulting in poorer localisation of pain. Visceral afferents also converge with somatic inputs, which may account for the phenomenon of referred pain

49
Q

Spinothalamic tract

A

Sensory pathway that carries pain, temperature and crude touch information from the body
2nd order neurons
Originate in the spinal cord (substantia gelatinosa and nucleus proprius)
Axons decussate at / few levels above the site of entry / spinal segment
Cross the midline in the anterior commissure
Then form the anterolateral tract
lateral STT (pain & temperature) and
anterior STT (crude touch)

Terminate in the thalamus
(ventral posterior lateral nucleus)

Some axons terminate in the reticular
formation and midbrain

50
Q

Where does the Spinothalamic tract originate

A

Spinal cord- Substantia gelatinosa and nucleus proprius

51
Q

Where do fibres of the Spinothalamic tract terminate

A

Thalamus (ventral posterior lateral nucleus)

52
Q

Lateral Spinothalamic tract

A

Pain and temperature

53
Q

Anterior Spinothalamic tract

A

Crude touch

54
Q

Where do axons of the Spinothalamic tract decussate

A

at / few levels above the site of entry / spinal segment

55
Q

Ventral Spinothalamic tract

A

Light touch

56
Q

Dorsal columns

A

Fine touch
Proprioception
Vibration

57
Q

Medial Spinothalamic tract

A

ascends deeper in the cord, sending collaterals to the reticular activating system, periaqueductal grey and hypothalamus, before terminating in the medial nucleus. It serves the general arousal and aversive component of the pain experience.

58
Q

Lateral Spinothalamic tract

A

originates from secondary afferents in laminae I and V of the dorsal horn, and runs superficially in the anterolateral white matter cord, ascending directly to the lateral thalamus. As the name suggests, it is the newer of the two spinothalamic tracts and carries the sensory, discriminative part of the pain signal

59
Q

Thalamus

A

Midline, paired symmetrical structure in the brain
Approx 6 X 3 cms long
All sensations (except olfactory) relay / pass through
Multiple nuclei
VPL
Medial group
Reciprocal connections to all parts of the cortex

60
Q

Thalamic nuclei

A

The main thalamic nuclei involved in pain processing are:
Lateral ventral posterolateral (VPL) nuclei
Medial midline group of nuclei
The thalamic nuclei contain cell bodies of third order neurons, the projections of which make up the final part of the nociceptive pathway.

61
Q

Lateral Thalamic nuclei

A

Sensory component

62
Q

Medial Thalamic nuclei

A

Emotional component

63
Q

Sensory cortex

A

Broadmann area 3, 1, 2

Every area on the body is represented in a spatial fashion Sensory homonculus

64
Q

Insula

A

where the degree of pain (experienced or imagined) is judged
Contributes to the subjective aspect of pain perception
Plays a role in perception, motor control, self awareness and interpersonal experience
May also play a part in addiction

65
Q

Amygdala

A

plays a key role in learned emotional responses (fear, anxiety, depression)

important brain center for the emotional-affective dimension of pain and for pain modulation

hyperactivity in the central nucleus of the amygdala accounts for pain-related emotional responses and anxiety-like behavior

66
Q

Cingulate cortex

A

Located on the medial aspect of the cerebral hemispheres

Intricately linked with the limbic system which is associated with emotion formation and processing, learning and memory

Maintains reciprocal connections with other pain processing areas

Has recently been shown to be one of the areas activated by acupuncture

67
Q

Where is the peri-aqueductal gray

A

In brainstem

68
Q

Peri-aqueductal gray

A

Grey matter located around the cerebral aqueduct
Receives input from cortical and sub-cortical areas
Projects onto neurons in the dorsal horn
Modulate afferent noxious transmission
Neurons bear opioid receptors
Pathways also include noradrenergic and serotonergic neurones
Stimulus of the PAG can result in profound analgesia

69
Q

Pain treatment

A

Stimulate descending inhibitory pathway
Gate control
Pharmacotherapy

70
Q

Gate control theory

A

concept that onwards transmission of a nociceptive signal depends on the balance between inhibitory and excitatory inputs at points of integration along the path from transduction to perception.

71
Q

Pain management

A

MDT approach
Biological target
Physio therapy / occupational therapy
Psychology

72
Q

Drugs commonly used in pain medicine

A

NSAID’S
Paracetamol
Opioids
LA’s

⍺2 agonists
NMDA receptor antagonists
TCA’s
gabapentinoids
SNRI’s

73
Q

Opioids use

A

Treat acute pain

74
Q

Problems with long term use of opioids

A

Tolerance (challenge in acute pain settings)
Immunosuppression
Deranged HPAxis
Opioid Induced Hyperalgesia (OIH)

75
Q

Causes of cancer pain

A
  1. Pain associated with direct tumor (tumor infiltration, bone metastases)
  2. Pain associated with cancer therapy (chemo, surgery or radiation)
  3. Pain unrelated to cancer (RA, OA, headache or herpes zoster)
76
Q

Anterior cingulate cortex

A

number of functions, including attention and response selection.
Activation studies suggest the ACC plays an important role in processing information related to the unpleasantness of pain

77
Q

Rexed divisions

A

1952 Rexed subdivided the grey matter of the spinal cord into 10 laminae. Lamina 1–> 5/6 correspond to the dorsal horn
Some of these rexed laminae have special names e.g. lamina II (2) is called substantia gelatinosa

78
Q

Total pain

A

Bio-psych-social model +spirtual
Used for palliative care

79
Q

Overview of first order neurons

A

Enters the spinal cord through a spinal nerve or the brainstem through the trigeminal nerve
Enters ipsilateral to the peripheral receptor
Remains ipsilateral and synapses with a second order neuron

80
Q

Overview of second order neuron

A

Cell body located in the spinal cord/brainstem
It decussates and ascends to the thalamus

81
Q

Overview of third order neurons

A

Cell body located within thalamus
Axons project to the somatosensory cortex

82
Q

What reduces the Nociceptive action potential threshold- hyperalgesia

A

Bradykinin
Prostaglandin E2

83
Q

What do the terminals of alpha-delta fibres release

A

Glutamate

84
Q

What do the terminals of C fibres release

A

Glutamate
Substance P

85
Q

Substance P

A

Peptide neurotransmitter and vasodilator
Remains bound to receptors for a longer time- causing long-lasting pain

86
Q

Which channels respond to hot stimuli

A

TRP channel

87
Q

Which channels respond to cold stimuli

A

TRPM8 channels

88
Q

Mechanical UMN

A

Respond to excess pressure or mechanical deformation
Respond to incisions that break the skin
Have polymodal characteristics

89
Q

Chemical UMN

A

Respond to noxious chemicals
TRP channels modulate the response
Eg capsaicin —> taste spicy foods

90
Q

Sleeping UMN

A

Silent type
Only activate if injury has occurred
Response comes with onset of inflammation to the surrounding tissue

91
Q

Polymodal UMN

A

Respond to thermal, mechanical and chemical stimuli
Majority found in skin

92
Q

Analgesia

A

Selective suppression of pain without effects on consciousness

93
Q

Anaesthesia

A

Uniform suppression of pain - no pain felt at all, can cause loss of consciousness

94
Q

Melzack-Wall pain gate

A

States that non-painful inputs closes the ‘gate’ to painful inputs, thereby preventing pain sensation from being perceived and felt

95
Q

A 21 year old student volunteers to take part in a research study investigating the neuropsychology of pain. Awareness of pain is associated with activity in which region of the brain?

A

Prefrontal cortex

Neuro (22 decks)

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