Pain

Question 1

What does capsaicin activate

Answer 1

Polymodal nociceptors; TRPV1

Question 2

What is nociception

Answer 2

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

Question 3

What are nociceptors

Answer 3

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

Question 4

What is nociceptive pain

Answer 4

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

Question 5

What is neuropathic/neurogenic pain

Answer 5

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

Question 6

What is analgesia

Answer 6

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

Question 7

What is anesthesia

Answer 7

Absence of any sensation due to suppression of CNS function

Question 8

What are thefour physiologic processes of noceception

Answer 8

Transduction
Transimission
Modulation
Perception

Question 9

What are four types of nociceptors

Answer 9

Mechanical
Thermal
Chemical
Polymodal

Question 10

What is TRP

Answer 10

Transient receptor potential

Question 11

What is released from lysed cells that can activate nociceptors

Answer 11

ATP

Question 12

What is sensitization

Answer 12

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

Question 13

What is hyperalgesia

Answer 13

Increases perception of pain in response to painful stimuli

Question 14

What is allodynia

Answer 14

Pain evoked by normally non painful stimuli

Question 15

What produces sensitization

Answer 15

Chemical messengers that do not directly activate nociceptors.

Question 16

What are two agents that cause sensitization

Answer 16

Substance P from nerve endings

Prostaglandins from damaged cells.

Question 17

How does a PG work

Answer 17

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

Question 18

What does COX-1 do

Answer 18

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

Question 19

What does COX-1 do with COX-2

Answer 19

Renal electrolyte homeostasis
Renal blood flow maintenance
CARDIOVASCUAR PROTECTION

Question 20

What does COX-2 (inducible) do

Answer 20

Pain
Fever i
Inflammation

Question 21

COX-1 is inhibited by

Answer 21

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

Question 22

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

Answer 22

heart problems

Question 23

What is COX-2 induced by

Answer 23

Hormones
GFs
Inflammatory mediators

Question 24

COX-2 inhibitors

Answer 24

NSAIDs

CELEBREX

Question 25

how doe NSAIDs work

Answer 25

they inhibit the synthesis of PGs involved in sensitization.

Question 26

Nociceptors in the viscera are normally activated by

Answer 26

mechanical stimulation such as: distention contractions

Question 27

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

Answer 27

A-delta | - myelinated, fast and sharp

Question 28

C axons are associated with

Answer 28

Polymodal nociceptors | small, slow conducting

Question 29

Dental nociception is accomplished via

Answer 29

Sub-odontoblastic plexus/ plexus of Raschkow | - sensory afferents of trigeminal nerve and synpathetic branches form superior cervical ganglion

Question 30

Projection neurons travel

Answer 30

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

Question 31

Where are nociceptive input heavily modulated and subject to central sensitization

Answer 31

dorsal horn, both facilitatory and inhibitory. | sensitization by prostaglandins can lead to hyperalgesia and allodynia.

Question 32

Dorsal horn is a major site of action for what drugs

Answer 32

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

Question 33

What does gate control refers to

Answer 33

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

Question 34

How does referred pain occur

Answer 34

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.

Question 35

Modulation is considered the

Answer 35

endogenous pain suppressant neural system

Question 36

What are the endorphins

Answer 36

Endogenous opioid peptides

Question 37

If it is an endorphin, it will contain

Answer 37

Methionine and/or lucine

Question 38

Enkephalin

Answer 38

Miu and delta; 5 amino acids

Question 39

B-endorphin

Answer 39

Agonist to both miu and Delta | 91 amino acids

Question 40

What are dynorphins

Answer 40

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

Question 41

Drugs that enhance _____ and ____ have anti-nociceptive effects

Answer 41

NE | 5HT

Question 42

Opioids act in

Answer 42

PAG | dorsal horn; they inhibit release of pain transmitters

Question 43

What are the features of neuropathic pain

Answer 43

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

Question 44

What are some examples of neuropathic pain

Answer 44

``` phantom limb Diabetes neurophaties Shingles Trigeminal neuralgia/tic douloureux Fibromyalgia ```

Question 45

Neuropathic pain tx

Answer 45

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

Question 46

What are possible mechanisms of neuropathic pain

Answer 46

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

Question 47

How does a placebo work

Answer 47

Endogenous analgesia elicited by suggestion. | Release of endorphins