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HD&T > Pain > Flashcards

Pain Flashcards

1
Q

What does capsaicin activate

A

Polymodal nociceptors; TRPV1

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2
Q

What is nociception

A

The physiological process by chick information on actual/potential tissue damage is conveyed to the CNS

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3
Q

What are nociceptors

A

Specialized ion channels on sensory nerve endings that respond to noxious stimuli

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4
Q

What is nociceptive pain

A

pain resulting from activation of nociceptors as a result of actual or potential tissue damage and processing by the CNS

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5
Q

What is neuropathic/neurogenic pain

A

abnormal sensory processing which does not signal actual or potential tissue damage
does not promote healing or repair.
May be considered a disease.

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6
Q

What is analgesia

A

Selective reduction of pain perception, w/o affecting other sensory modalities

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7
Q

What is anesthesia

A

Absence of any sensation due to suppression of CNS function

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8
Q

What are thefour physiologic processes of noceception

A

Transduction
Transimission
Modulation
Perception

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9
Q

What are four types of nociceptors

A

Mechanical
Thermal
Chemical
Polymodal

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10
Q

What is TRP

A

Transient receptor potential

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11
Q

What is released from lysed cells that can activate nociceptors

A

ATP

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12
Q

What is sensitization

A

Increased sensitivity and response to stimuli in and near the inured area

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13
Q

What is hyperalgesia

A

Increases perception of pain in response to painful stimuli

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14
Q

What is allodynia

A

Pain evoked by normally non painful stimuli

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15
Q

What produces sensitization

A

Chemical messengers that do not directly activate nociceptors.

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16
Q

What are two agents that cause sensitization

A

Substance P from nerve endings

Prostaglandins from damaged cells.

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17
Q

How does a PG work

A

PG receptor stimulation results in activation of specific Na- channels making the nociceptive nerve ending more excitable

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18
Q

What does COX-1 do

A 
I is constitutive, it generate PGs for physiologic reg go 
GO cytoprotection
Platelet aggreagation
Renal electrolyte homeostasis 
Renal blood flow maintenance
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19
Q

What does COX-1 do with COX-2

A

Renal electrolyte homeostasis
Renal blood flow maintenance
CARDIOVASCUAR PROTECTION

20
Q

What does COX-2 (inducible) do

A

Pain
Fever i
Inflammation

21
Q

COX-1 is inhibited by

A

NSAIDs
Which is the basis for the basis of the adverse effects of NSAIDs such as aspirin and Ibuprofen.
Bleeding
Stomach irritation.

22
Q

People that use COX-2 inhibitors are at risk of developing

A

heart problems

23
Q

What is COX-2 induced by

A

Hormones
GFs
Inflammatory mediators

24
Q

COX-2 inhibitors

A

NSAIDs

CELEBREX

25
Q

how doe NSAIDs work

A

they inhibit the synthesis of PGs involved in sensitization.

26
Q

Nociceptors in the viscera are normally activated by

A

mechanical stimulation such as:
distention
contractions

27
Q

Nociceptive transmission of pain to the spinal cord is carried by —- axons

A

A-delta

- myelinated, fast and sharp

28
Q

C axons are associated with

A

Polymodal nociceptors

small, slow conducting

29
Q

Dental nociception is accomplished via

A

Sub-odontoblastic plexus/ plexus of Raschkow

- sensory afferents of trigeminal nerve and synpathetic branches form superior cervical ganglion

30
Q

Projection neurons travel

A

Across midline
ascend in spinothalamic tract.
Thalamus as major somatosensory relay

31
Q

Where are nociceptive input heavily modulated and subject to central sensitization

A

dorsal horn, both facilitatory and inhibitory.

sensitization by prostaglandins can lead to hyperalgesia and allodynia.

32
Q

Dorsal horn is a major site of action for what drugs

A

NSAIDs; anti-nociceptive action inhibit the synthesis of PGs.
Opioids

33
Q

What does gate control refers to

A

Inhibition of pain by touch due to convergence of inputs from A ß and A delta and C fibers

34
Q

How does referred pain occur

A

Visceral afferent noceceptors converge on the same pain-projection neurons as the afferents from the somatic structures in which the pain is perceived. Pain can’t distinguish origin.

35
Q

Modulation is considered the

A

endogenous pain suppressant neural system

36
Q

What are the endorphins

A

Endogenous opioid peptides

37
Q

If it is an endorphin, it will contain

A

Methionine and/or lucine

38
Q

Enkephalin

A

Miu and delta; 5 amino acids

39
Q

B-endorphin

A

Agonist to both miu and Delta

91 amino acids

40
Q

What are dynorphins

A

A and B, primarily Kappa
Kappa; antagonistic to miu and delta receptors
block opioid reward/addictive properties.
disphoria properties

41
Q

Drugs that enhance _____ and ____ have anti-nociceptive effects

A

NE

5HT

42
Q

Opioids act in

A

PAG

dorsal horn; they inhibit release of pain transmitters

43
Q

What are the features of neuropathic pain

A 
Continuous; burning or aching 
Periodic; Lancing or electric
Occurs w/o activation of nociceptors 
Hyperalgesia and allodynia common/dramatic
Can be innitiated by triggers
44
Q

What are some examples of neuropathic pain

A 
phantom limb 
Diabetes neurophaties
Shingles
Trigeminal neuralgia/tic douloureux
Fibromyalgia
45
Q

Neuropathic pain tx

A 
No response to NSAIDs 
Antidepressants; Cymbalta
Anticonvulsants; Lyrica, gabapentin
Corticosteroids; work on 5HT and NE systems 
Avoid triggers
46
Q

What are possible mechanisms of neuropathic pain

A

Persistent peripheral sensitization
Spontaneous firing of damaged nociceptive nerves
Prolonged input from hyper excitable fibers
Decreased activity of endogenous pain suppressant neural system.

47
Q

How does a placebo work

A

Endogenous analgesia elicited by suggestion.

Release of endorphins

HD&T (19 decks)

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