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Pathophysiology Spring 2016 - exam 2 > Pain > Flashcards

Pain Flashcards

1
Q

Recovering from surgery or with acute medical conditions

A

Acute pain

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2
Q

Any abnormal sensation described as unpleasant by the patient

A

Dysesthesia

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3
Q

Exaggerated PAIN response from a normally painful stimulus; usually includes aspects of summation with repeated stimulus of constant intensity & aftersensation

A

Hyperalgesia

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4
Q

Abnormally painful & exaggerated reaction to a PAINFUL stimulus; related to hyperalgesia

A

Hyperpathia

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5
Q

Exaggerated perception of TOUCH stimulus

A

Hyperesthesia (hypesthesia)

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6
Q

Abnormal perception of PAIN from a normally NON- PAINFUL mechanical or thermal stimulus; usually has elements of delay in perception

A

Allodynia

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7
Q

Decreased sensitivity & raised threshold to painful stimuli Can be Genetic & may require less narcotics

A

Hypoalgesia (hypalgesia)

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8
Q

Reduced perception of all sensation, mainly touch

A

Anesthesia

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9
Q

Loss of perception of vibration

A

Pallanesthesia

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10
Q

Reduced perception of pain stimulus

A

Analgesia

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11
Q

Mainly spontaneous abnormal sensation that is not unpleasant/painful; usually described as “pins & needles”

A

Paresthesia

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12
Q

Burning pain in the distribution of one or more peripheral nerves I.e. phantom limb pain

A

Causalgia

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13
Q

Anesthesia vs. Analgesia

A

Anesthesia is keeping them asleep - patient does not PERCEIVE pain and touch Analgesia is taking way the pain response

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14
Q

where does pain start?

A

nociceptors

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15
Q

sensation felt as noxious (painful)

A

protopathic

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16
Q

sensation felt as non noxious- (high touch, temperature discrimination, light touch)

A

Epicritic

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17
Q

Precise location

A

Aδ Fibers

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18
Q

fast - 0.1 sec after stimulus

A

Aδ Fibers

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19
Q

thinly myelinated

A

Aδ Fibers

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20
Q

Felt on surface of body

A

Aδ Fibers

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21
Q

Slow- 1 sec after stimulus

A

C fibers

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22
Q

felt deeper in tissue and surface tissue

A

C Fibers

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23
Q

slow, burning, aching, throbbing

A

C Fibers

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24
Q

Chronic pain

A

C fibers

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25
Q

sharp, pricking, electric pain

A

Aδ Fibers

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26
Q

Precision in location, know exactly where it is

A

Aδ Fibers

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27
Q

Unmyelinated

A

C Fibers

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28
Q

fast and slow fibers reach threshold to a stimulus

A

Thermal and mechanical nociceptors

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29
Q

Slow pain only

A

Chemical nociceptors

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30
Q

significantly contribute to nociception and neuronal SENSITIZATION durring peripheral inflammation and nerve injury

A

Chemical nociceptors

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31
Q

5 substances Chemical nociceptors release

A

Acetylcholine, Bradykinin Saubstance P, Prostaglandins and Proteolytic enzymes

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32
Q
  1. Noxious stimuli causes cell damage and release of sensitizing chemicals (Prostaglandins, Substance P, Bradykinin, Serotonin and histamine) 2. Substances activate nociceptors and lead to the generation of an ACTION POTENTIAL
A

Transduction

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33
Q

Transmission includes the propagation of impulses from the site of injury to the __________ and __________ with projections to the ____________, _____________ and _____________ cortices.

A

Dorsal horn of the spinal cord Thalamus cingulate, insular and somatosensory

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34
Q

Process of altering pain transmission using BOTH inhibitory and excitatory mechanisms

A

Modulation

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35
Q

Three places modulation can take place

A

Peripherally at the site Dorsal horn of the spinal cord Brain stem

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36
Q

when transduction, transmission, and modulation interact with the psychology of the patient

A

Perception of pain

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37
Q

This is thought to be mediated through the thalamus

A

Perception of pain

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38
Q

What is the relay center for nociception

A

Dorsal horn of spinal cord

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39
Q

Name the four types of neurons in the dorsal horn

A

Primary afferent Intrinsic (Interneuron) Projection Neurons Descending neurons

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40
Q

extend caudally from several reions of the brain

terminate in the dorsal horn

have improtant role in modulating nociceptive information

A

Descending neurons

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41
Q

project rostrally into white matter to reach various parts of the brain

A

Projection neurons- may be synonomous with 2nd order neurons

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42
Q

Substania Gelitinosa

Superficial Dorsal Horn

Where C fibers synaps on 2nd order neurons

LOTS of interneurons

A

Lamina II

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43
Q

Two functional groups of interneurons

A
  1. Inhibatory- GABA or Glycine
  2. Excitiatory - glutamanergic cells
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44
Q

Impotrant in the integration and modulation of incoming nociceptive information

A

Inerneurons

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45
Q

Descending__________ neurons project from the brain througout the dorsal horn.

From the pontene neuron(locus Cerueus) __________ is released onto interneuorns

From the Raphe Nuclei ___________ is released onto interneurons.

The interneurons then release _____________ on the opiate receptors which increase ___________ conductance. They are our bodies natural ________.

A

Monoaminiergic

Norepinepherine

Serotonin

Enkephalins

Potassium

Opioids

46
Q

1st order neurons enter the spinal cord via the dorsal root ganglion and can synapse in three places

A
  1. Interneuons
  2. Sympathetic neurons
  3. ventral horn (motor) neurons
47
Q

Modulate the pain at the level of the dorsal horn by releaseing NE which is an antialgesic/algesic

Cause a response to the pain by integration of incoming nociceptive stuimuli

A

1st order neurons synapsing on Sympathetic neurons in the dorsal horn of the spinal cord

48
Q

Where information is coming in and has the ability to transtfer it to SNS neurons to get a response

Can modulate pain from th acsending and descending tracts

in the spinal column in the gray matter between 1st and 2nd order neurons

A

Interneurons in the dorsal horn of the Spinal Cord

49
Q

Interneurons synapsing on motor neurons in the ventral horn of the spinal cord

A

Causes muscle spasms

50
Q

2nd order neurons start in the gray matter of the ___________ dorsal horn

A

ipsilateral

51
Q

Pain will usually synapse in the __________ dorsal horn then cross over to the _________ and travel to the thalamus via the __________ tract.

A

gray matter of the ipsilateral

WHITE MATTER

Spinothalamic tract

52
Q

Another name for spinothalamic tract

A

Anterolateral tract

53
Q

what percentage of 2nd order neurons cross the midline and form the spinothalamic tract?

A

90%

54
Q

Spinal thalamic tract is the major pain pathway to the thalamus, ___________, ______________, and ___________.

It lies _____________ in the white matter of the spinal cord

A

reticular formation

nucleus raphe magnus

periaquaductal gray

anterolaterally

55
Q

Feels the sensation

A

1st order neuron

56
Q

responsible for the perception and localization of pain

A

3rd order neuron

57
Q

located in the thalamus and send fibers to somatosensory areas I and II

A

Third order neurons

58
Q

location of somatosensory areas one and two

A

parietal cortex

superior wall of the sylvan fissure

59
Q

there is no perception of pain until…

A

it arrives at the somatosensory cortex via the third order neurons

60
Q

Pathway that couses insomnia r/t pain infomation being sent to the reticular activating system (RAS)

A

Spinoreticular tract

61
Q

Responsible for chronic pain patients needing sleep aids

A

Spinoreticular tract

62
Q

Activates anti-nociceptive decending pathway to the spinal cord that calms the pain at the level of the spinal cord

A

Spinomesencephalic tract

63
Q

The same as activating our intrinsic opoid system

A

Spinomesencephalic tract

64
Q
A
65
Q

Evoke emotional behavior by activating the hypothalamus where the stress reponse is located

Causes chronic pain patients to have physiologic psychological changes

A

Spinohypothalamic Tract

Spinotelencephalic Tract

66
Q

Chronic pain causes personality changes, communicates with the amygdala, when chronic pain goes away, personality back to normal

A

Spinotelencephalic Tract

67
Q

What fibers are inhibatory on the STT nuron in the dorsal horn of the spinal cord?

A

A- Beta

68
Q

What fibers are excitatory on the STT nuron in the dorsal horn of the spinal cord?

A

A- Delta

69
Q

How are the laminal divided in the dorsal horn of the spinal cord

A

they are from lamina I- VIII

they start with 1 on the outside and progressively go to 8 on the inside

70
Q

The neospinothalamic tract is most clely associated with

A

the location and perception of pain

71
Q

the paleospinothalamic tract is most closely associated with

A

the initiation of unplesant aspects of pain as well as the autonomic response

72
Q

Pathway of fast pain________________

  1. ___ fibers pass through the DRG to lamina___and __________ in the dorsal horn
  2. synapse with __________ or _______________.
  3. 2nd order neurons _____ to white matter and __________
  4. some of the 2nd order neurons will terminate on ______________, MOST travel to ____________ of thalamus and synapse with 3rd order neurons
  5. 3rd order neurons go to the ___________ where pain can be

__________ and __________.

A

Neospinothalamic Tract

  1. Aδ fibers pass through the DRG to lamina I and V (lamina marginalis) in the dorsal horn
  2. synapse with interneurons or 2nd order neurons
  3. 2nd order neurons cross to white matter and join the STT
  4. some of the 2nd order neurons will terminate on reticular fomation (sleep centers), MOST travel to ventobasal Complex (VBC) of thalamus and synapse with 3rd order neurons
  5. 3rd order neurons go to the somatosensory cortex where pain can be perceived and located
73
Q

Pathway of slow pain_____________

  1. __ fibers pass through the DRG to lamina _________________ in the dorsal horn
  2. ________ has lots of internurons that connect with_________. most of the 2nd order neurons go up ________ crossing. Very few _______ and join the STT
  3. 2nd order neurons terminate widely in the ________, 1/10th of their fibers stop in the ________ the rest stop in the ________, ________ and tectum of the midbrain ______________.
  4. There are ______________ but the 2nd can communicate with other parts of the brain,
  5. This system is responsible for the unpleasant aspects of pain, the _____, _____ pain and the __________ response to pain.
A

Paleospinothalamic tract

  1. C fibers pass through the DRG to lamina II and III (II = substantia gelatinosa) in the dorsal horn
  2. Lamina II has lots of internurons that connect with lamina IV-VII. most of the 2nd order neurons go up without crossing. Very few cross and join the STT
  3. 2nd order neurons terminate widely in the brainstem, 1/10th of their fibers stop in the thalamus, the rest stop in the medulla, pons and tectum of the midbrain periaquaductal grey.
  4. There are NO 3rd order neurons but the 2nd can communicate with other parts of the brain,
  5. This system is responsible for the unpleasant aspects of pain, the slow, dull pain and the autonomic response to pain
74
Q

lamina V

A

lamina marginalis

75
Q

lamina II

A

substantia geitinosa

76
Q

Fibers from the ________________ tract teminate alot lower, in the reticular area of the _________ this is the reason for their autonomic response and processing of ___________________ pain

Fibers from the _____________ tract terminate in the _______ and thus they are able to _________ and __________ pain.

A

Fibers from the Paleospinothalamic tract teminate alot lower, in the reticular area of the brainstem this is the reason for their autonomic response and processing of slow, dull (chemical and heat) pain

Fibers from the Neospinothalamic tract terminate in the cortex and thus they are able to perceive and locate pain.

77
Q

Fast pain can be localized easily if A-delta fibers are stimulated together with ____________

A

tactile receptors

78
Q

Slow pain of C-fibers is __________ visceral and slow pain

A

Poorly localized

79
Q

What are the three areas that mediate the brain analgesia system

A
  1. Periaquaductal grey matter in the midbrain
  2. nucleaus raphae magnus in the medulla
  3. nocioception inhibitory interneurons within the dorsal horn of the spinal cord
80
Q

Epicenter of analgeisa

prominent role in descending pain modulation

plays a role in defensive behavior-such as protecting an injury

sends fibers from brain to spinal cord

to the sides of the cerebral aquaduct in th midbrain

A

Periaquaductal Grey

81
Q

pain modulator in the midbrain

A

periaquaductal gray

82
Q

pain modulator in the medulla

A

nucleus raphe magnus

83
Q

pain modulator using serotonin

A

Nucleus Raphe Magnus

84
Q

Afferently stimulated from axons in the spinal cord and cerebellum

It gets the signals crossing the cerebellum and the spinal cord

Sends projections to the dorsal horn of the spinal cord to directly inhibit pain using serotonin

A

Nucleus Raphe Magnus

85
Q

neurotransmitters directly involved in endogenous pain supression system

A

enkephalins and seorotonin

86
Q

releases serotonin to stimulate interneuron to release enkephalin tonto theopiate receptors

A

Nucleus Raphe Magnus

87
Q

releases NE onto interneuron that releases enkephalins onto opiate receptor - these then send messages to the periphery to modulate pain locally

A

Pontene neuron (locus ceruleus)

88
Q

what is the role of the descending pathway?

A

Pain modulation - they will let us know if we need to fo to the emergency room if they cannot moculate pain enough via the opoid receptors.

89
Q

three naturally occuring opioids

A

endorphins

enkephalins

dinorphins

90
Q

Excitatory neurotransmitter released by the pain fiber isn the substantia gelatinosa of the spinal cord

Cause neurogenic inflammation

Released slower- over a few minutes

Involved in slow chornic pain

A

Substance P

91
Q

acts on mast cells releasing histmaine- produce smooth muscle contraction and mucous secretion

A

Substance P

92
Q

Excitatory Neurotransmitter that acts instantly

lasts only a few milliseconsds

associated with fast pain

immediate release when hammer hits hand

A

gutamate

93
Q

Neuropeptide released by sensory neurons that causes neurogenic inflammation

releases slowly

It is a protien involved in pain modulation

Potent Vasodialator

A

CGRP

94
Q

where does pain modulation occur

A

peripherally at nociceptors

in the spinal cord

supraspinal

95
Q

pre synaptic receptor on a 2nd order neuron blocekd by a magnesium ion

A

NMDA receptor

96
Q

Under normal conditions neuron isnt depolarized long enough to allow this receptor to pass Ca++ ions

A

NMDA receptor

97
Q

persistant pain causes glutamate to build up in the synaptic cleft and the 2nd order neuron is depolarized long enough for this receptor to open

A

NMDA receptor opens because the magnesium pore blocker is knocked off

98
Q

in acute pain, this is cleared fast enough from the synaptic cleft and 2nd order neuron is not depolarized long enough to knock magnesium from the NMDA receptor

A

Gultamate

99
Q

this receptor being activated is associated with chronic pain

A

NMDA receptor

100
Q

substance p activates

A

NK1 n (neurokinin-1)

101
Q

EAA (excitatory amino acids) like glutamate immediatly activate ____________ receptors causing a transient depolarization of the _____________. The ___________receptor is never activated in ____________ pain becuse the neuron is not depolarized long enough to dislodge the _________.

A

AMPA

2nd order neuron

NMDA

Acute pain

Mg++

102
Q
  1. In response to intense or prolonged barrages of incoming nocioceptive infomation neurons become ________ and over respond to incoming pain signals.
  2. This barrage from ________ depolarizes the 2nd order neuron long enough to allow ______ ions to exit the _______ receptors.
  3. This resuts in an i________ which in turn activates ____________ which converts ________ to _______.
  4. Because NO is a gas it rapidly difuses out of the neurons

and acts ______________.

A
  1. sensitized
  2. gluamante, Mg++, NMDA
  3. influx of Ca++ ions, nitric oxide synthase eNOS, L-Argenine, NO.
  4. pre and postsynaptically.
103
Q

When AMPA receptor are anctivated and Nitric oxide acts presynaptically what does it do?

A

Causes an exagerated release of substance P and Excitory Amino Acids (ie Glutamate)

104
Q

When AMPA receptor are anctivated and Nitric oxide acts postsynaptically what does it do?

A

Causes neurons to become hyperexcitable

Ask

105
Q

increased NO levels also cause _________ to be released intracellularly leading to increased ___________.

A

cGMP

excitation/ sensitization

106
Q

How does morphine work

A

stops excitation by binding to the mu receptors and increasing potassium conductace which will hyperpolarize the cell

107
Q

________________ Response to Pain

increased ________ hormones

Decreased _________ metabolism, insulin, testosterone

hyperglycemia then leads to increased ________ which leads to an increase in __________

A

Neuroendocrine

catobolic

anabolic

ACTH

108
Q

Coronary artery constrictionion is caused at

A

high catchecholamine levels

109
Q

release of this may incduce coronary vasospasm

A

serotonin

110
Q
A

Pathophysiology Spring 2016 - exam 2 (1 decks)

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