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Human Systems and Anatomy > Pain > Flashcards

Pain Flashcards

1
Q

what can pain be defined as

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or descriebed in terms of such damage

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2
Q

what is normal pain

A

this is the pain we feel on a day to day basis that is elicited when intense noxious stimuli that threatens to damage normal tissue occurs

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3
Q

why is normal pain an induced pain

A

only occurs when there is threatened damage to normal tissue

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4
Q

why do we feel normal pain

A

it has an adaptive biologically useful role becuase it protects us from being harmed - gives us warning of potential damage to our tissues

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5
Q

what characterised normal pain

A

high threshold with limited duration

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6
Q

what type of pain is normal pain

A

acute nociceptive pain

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7
Q

what are the sensory afferents involved in acute nociceptive pain

A

a delta and c fibres

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8
Q

which fibres mediate the perception of all pain

A

a delta and c fibres

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9
Q

explain this

A

there are different spikes of activity corresponding to different classes of axons as they conduct action potentials

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10
Q

which axon is responsible for the sensation of dull and aching pain

A

c fibre

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11
Q

which axon is responsible for the sensation of sharp and stabbing pain

A

a delta fibres

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12
Q

what is the first pain

A

sharp and stabbing

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13
Q

what is the second pain

A

dull and aching

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14
Q

describe the receptive end of nociceptors

A

unspecialised free nerve endings that give way to a delta and c fibres

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15
Q

describe nociceptor endings

A

free nerve endings with a high threshold of activation

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16
Q

what does it mean to say that nociceptor endings have a high threshold of activation

A

it is hard to recruit them but once they are recruited it is clear they have been activated (bruh that is so silly why did i transcribe it like that)

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17
Q

what type of pain is associated with a delta fibres

A

noxious mechanical and thermal pain

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18
Q

what kind of pain is associated with c fibres

A

polymodal

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19
Q

what does polymodal mean

A

responds to various types of stimuli

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20
Q

what kind of receptor proteins are found on nociceptor endings

A

several types, allowing them to respond to different noxious stimuli

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21
Q

what does it mean to say that nociceptor endings display sensitisation

A

it means once we have felt a pain in that region of skin, that region will remain sensitive to pain because the nerve endings there are activated

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22
Q

which neuron is in the periphery during the sensory pathway

A

primary sensory neuron

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23
Q

which neuron is the spinal cord and brain stem during the sensory pathway

A

the second sensory neuron

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24
Q

which neuron is in the thalamus in the sensory pathway

A

tertiary sensory neuron

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25
Q

what is the name of the sensory pathway for somatic nociception

A

spinothalamic pathway

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26
Q

what is the official name for pain

A

somatic nociception

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27
Q

what stimuli results in the spinothalamic pathway being activated

A

pain
temperature
crude touch

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28
Q

relay the full spino thalamic pathway to me

A
  • free nerve endings transduce noxious stimuli
  • depolarise nerve endings
  • conduct an action potential to the spinal cord
  • via a delta or c fibres
  • into outer layer of the dorsal spinal cord
  • synapse with second order sensory neurons
  • axons cross over to opposite side of the spinal cord and project up via the anterolateral funiculus
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29
Q

where are the axons of second order neurons found as they relay information up the spinal cord to the thalamus

A

in the anterolateral funiculus - a well defined region of white matter

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30
Q

where is the antero funiculus

A
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31
Q

as the second order neuron ascends the spinal cord, it gives off branches. where, and how many?

A

2 at the medulla
2 at the pons
2 at the midbrain
2 at the thalamus

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32
Q

why do the second order sensory neurons give off branches as they ascend

A

to activate neuronal populations in the pons and medulla to aid with the perception of pain

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33
Q

what is the spino thalamic tract

A

a sensory tract that carries nociceptive, temperature, crude touch and pressure from our skin to the somatosensory area of the thalamus.
the lateral spinothalamic tract carries pain and temperature.
the anterior spinothalamic tract carries sensory input about crude touch

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34
Q

where in the spinal cord do the primary afferents synapse with the secondary afferents

A

substantia gelatinosa, located in the grey matter of the spinal cord

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35
Q

describe the route of the second order sensory neurons

A

they enter the anterolateral portion of the spinal cord and enter the brainstem as the spinal lemniscus

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36
Q

what makes us itch

A

pruritogens

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37
Q

describe the nociceptive afferents in the tooth

A

similar to the spino thalamic pathwawy, the free nerve endings are found extended in dentine and will send their axons via the trigeminal nerve into the ventral trigeminothalamic pathway to the somatosensory cortex in the appropriate somatotopically defined regions

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38
Q

summarise the ventral trigeminothalamic pathway

A
  • information is projected along the trigeminal primary afferent into the spinal nucleus of the spinal cord
  • synapses with second order neuron
  • crosses midline and projects to the thalamus
  • synapse with third order neuron
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39
Q

what are the receptors of the pain pathway

A

nociceptors free nerve endings

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40
Q

what is the axon class of the pain pathway

A

a delta and c fibres

41
Q

what are the central nervous system relay cells in the pain pathway

A

spinal dorsal horn and the spinal trigeminal nucleus

42
Q

what is the central nervous system pathway for pain pathways

A

spinothalamic for body and ventral trigeminothalamic for face

43
Q

which area in the forebrain is involved in pain pathways

A

primary sensory cortex and subcortical areas

44
Q

where are the target neurons found in the pain pathway

A

dorsal horn or the spinal trigeminal nucleus

45
Q

why is pain a good thing

A

it is a prominent symptom and is good for diagnosis usually

46
Q

what does pain attribute for diagnosis

A
  • location
  • quality
  • intensity
  • duration
  • relieving events
47
Q

what does the location of pain aid for in diagnosis

A

it identifies the certain spinal cord regions involved via the use of a dermatome map
it can also locate which branch of the trigeminal nerve is being stimulated depending on where in the face the pain is being felt.

48
Q

which branches of the trigeminal nerve are sensory

A

opthalmic and maxillary branch

49
Q

which branch of the trigeminal nerve is both sensory and motor

A

mandibular branch

50
Q

why can location of pain be misleading

A

due to referred pain

51
Q

what is referred pain

A

this is when pain is perceived in one part of the body but the pathology is elsewhere

52
Q

why is referred pain believed to occur

A

due to sites being of common embryological origin

53
Q

how does referrred pain come about

A

pain tenders to refer from an internal organ to a superficial area like the skin

54
Q

why does pain referral happen

A

convergence of inputs in the central nervous system

55
Q

where is pain felt when the heart is pathological

A

the left arm and shoulder

56
Q

where is pain felt when the oesophagus is pathological

A

sternum and left shoulder

57
Q

where is pain from the ureter felt

A

around the pelvic region

58
Q

is pain the same for everyone

A

no, everyone has different thresholds for pain

59
Q

what are some factors for pain perception

A

genetic
molecular
cellular
anatomical
physiological
psychological
social

60
Q

what is SCN9A

A

this is the gene that encodes that alpha subunit of voltage gated sodium channel Nav1.7

61
Q

which type of sodium channel is associated with nociceptive afferents

A

Nav1.7

62
Q

what does mutation in SCN9A result in

A

loss of NAv1.7 function, leading to an inability to experience pain
the sensory and motor tests of the patients with this mutation remain normal

63
Q

what are the three main factors that can impact how noxious stimulus is perceived

A

psychological
situational
emotional

64
Q

what are the psychological factors that lead to a change in perception of what noxious stimulus was applied

A

sex
age
cognitive level
previous pains
family
culture

65
Q

what are emotional factors that can affect how we perceive pain

A

fear
anger
frustration

66
Q

what are situational factors that can impact how we perceive pain

A

expectation
control
relevance

67
Q

describe the gate control theory of pain

A

this is the idea that when we feel pain if we shake our hands or rub the pain then it will dissipate

68
Q

why does rubbing or shaking a wound dissipate the pain

A

rubbing the injury stimulates beta fibres, and these axons project into the spinal cord.
they birfurcate to send the principle branch to the dorsal column nuclei, where they activate the dorsal column pathway to allow perception of the rubbing stimulus
another branch will activate circuits in the dorsal spinal cord that activates a population of inhibitory interneurons which inhibit the second order pain projecting neurons.
inhibiting these neurons blocks transduction which loses the perception of pain.
information is relayed into the spinal cord, and rubbbing engages the inhibiting interneurons to inhibit the perception of pain

69
Q

what do the collateral branches of the second order neuron function to do

A

they engage a series of neurons that send information back down the spinal cord to influence the perception of pain in the spinal cord itself

70
Q

why are there collateral sstems in the descending projections of the spinal cord

A

they modulate the perception of pain so we try to dampen it down

71
Q

what is the supraspinal loop

A

this is when there is direct inhibition of projection neurons and activation of enkephalin containing interneurons that reduce the activity in nociceptive circuits

72
Q

describe the events in the supra spinal loop

A

activity can be dampened down in the dorsal horn.
release of seratonin and noradrenaline in stressful situations can lead to inhibited second order projections which reduces the activity of nociceptor circuits in the region

73
Q

what is the 5HT projection

A

this is seratogenic

74
Q

what is the NA projection

A

noradrenaline

75
Q

where do 5HT and NA come from

A

the PAG and the medullary raphe nuclei

76
Q

what is PAG

A

periaqueductal gray matter

77
Q

where is the PAG found

A

in the pons

78
Q

where is the medullary raphe nuclei

A

the medulla

79
Q

why do we have a supra spinal loop

A

to allow us to continue a situation where we are injured if there is danger or high levels of excitement - we do not notice the pain we are in nearly as much

80
Q

what are the cardinal signs of inflamation

A

heat
redness
swelling
pain
loss of function

81
Q

what is the triple response reactiona

A

this is when we scratch ourselves, and there is a red reaction, a wheal and a flare

82
Q

what is the red reaction

A

the redness directly where the injury occurred

83
Q

what is the wheal

A

this is the white border that occurs around the injury

84
Q

what is the flare

A

this is the red concentration encasing a wound on the surface

85
Q

what is the triple response a result of

A

mild mechanical trauma

86
Q

what is dermatographia

A

people with strong triple responses that can have prominent reactions to scratches that last a long time

87
Q

what are the chemicals released at the sight of mechanical trauma

A

potassium ions and prostaglandings
brady kinin
5-HT

88
Q

what is released from damaged tissue after mild mechanical trauma

A

potassium ions and prostaglandins

89
Q

what is released from plasma when a capillary is ruptured due to mild mechanical trauma

A

bradykinin

90
Q

what is released from platelets when there is mild mechanical trauma

A

5-HT

91
Q

what is the purpose of the release of potassium ions, bradykinin, prostaglandins from a trauma

A

they activate receptive endings to notify that there was tissue damage, which leads to depolarisation and generation of an action potential that is conducted centrally to engage in the spino thalamic pathway

92
Q

what are some substances that arrive to the site of infection

A

peptides from other free nerve endings like CGRP and substance P, which mediate the triple respone
there is also mast cells activated to release histamine to further activate receptive endings

93
Q

what causes the production of a wheal

A

substance P can cause plasma exctravasation through the release of bradykinin which is important for wheal generation

94
Q

why does a flare develop in the triple response

A

CGRP causes vasodilation and this happens peripherally which is why the flare develops

95
Q

what are relieving factors for the triple response

A

restriction of blood pressure
apply cold water to vasconstrict
take antihistamine to reduce mast cell degranulation and reduce triple response

96
Q

which substance produces the wheal

A

bradykinin

97
Q

what are the roles of substance P

A

plasma extravasation
oedema
release of bradykinin

98
Q

what are the roles of CGRP

A

dilation of blood vessels to produce the flare

99
Q

which drug can minimise the effect of mast cell degranulation

A

antihistamines

Human Systems and Anatomy (57 decks)

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