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Pathophys > pain 4d > Flashcards

pain 4d Flashcards

1
Q

pain

A

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

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2
Q

pain is __

A

protective and adaptive
alert for actual or potential threat to physical self

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3
Q

pain is number one reason people___

A

seek medical treatment

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4
Q

Noxious stimulus

A

activates nociceptive stimulus, painful, bothersome

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5
Q

innocuous stimulus

A

non-nociceptive , does not elicit pain, example: gentle touch

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6
Q

algesia

A

sensitivty to pain

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7
Q

analgesia

A

reduced sensitivty to pain

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8
Q

hyperalgesia

A

increased sensitivty to pain

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9
Q

allodynia

A

sensation of pain in the absence of stimulus or pain resulting from normally painless stimuli

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10
Q

Gate control theory

A

pain transmission modulated by impulses synapsing on spinal cord
-cells in substantial gelatinosa fxn as a “gate” that controls transmission of signal to higher centers in the brain

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11
Q

___and___ sense painful stimuli and open gate

A

A delta, C fibers

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12
Q

____FIBERS SENSE INOCUOUS STIMULI CLOSE the GATE

A

A beta

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13
Q

hitting your elbow _____, ______ that same area makes pain subside faster

A

pain: noxious stimuli, rubbing : innocuous stimulus

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14
Q

CNS signals can modify gate

A

ex: depression increases sensitivity to physical pain bc it allows gate to be opened more easily

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15
Q

Neuromatrix theory

A

idea that brain produces patterns of nerve impulses perceived as pain from a variety of inputs: genetics, psychology, cognitive experiences

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16
Q

patterns typically _____in periphery , BUT may also originate independently ______

A

activated by sensory inputs, in the brain without external sensations

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17
Q

neuromatrix takes into account ___ aspect of pain

A

cognitive/emotional

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18
Q

phantom limb pain, chronic pain

A

physical stimulus may be missing but pain is still perceived (neuromatrix theory)

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19
Q

neuromatrix theory is ____to gate theory

A

supplemental

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20
Q

nociceptors

A

free nerve endings throughout the body
-sense chemical, thermal, mechanical stimuli

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21
Q

_____of nociceptors leads to differnces in pain sensitivity

A

uneven distribuation
-why fingertips are more sensitive than back, skin more sensnitve than internal organs

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22
Q

A-delta fibers

A

-lightly mylinated
-transmit sharp , well localized pain
-respond to exteme mechanical and thermal stimulation

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23
Q

C fibers

A

-unmyelinated
-transmit dull, aching, throbbing, burning pain
-respond to mechanical, thermal and chemical stimulation

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24
Q

A-beta fibers

A

mylinated
-transmit touch and vibration
-do not perceive pain BUT play a role in pain modulation

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25
Q

nociceptor activation can be ___ or ___

A

direct, indirect

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26
Q

Direct excitation

A

threshold depolarization
-initiated by heat, radiation, toxins, tissue trauma

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27
Q

indirect excitation

A

tissue injury causes inflammation
-release of inflammatory mediators that cause pain
-prostaglandins, bradykinis, hisamine, leukotrenes

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28
Q

from nociception to pain

A

once nociceptors activated, signal undergoes many steps
-transmission (from periphery to brain)
-perception (awareness of pain)
-modulation (CNS to periphery)

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29
Q

Transmission occurs along a sequence of neurons

A

primary-> secondary-> third

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30
Q

primary- order neurons (periphery)

A

-pain-transmitting sensory neurons, A delta and C
-cell bodies located in gray matter of spinal cord : dorsal root ganglion (DRG)
-synapse on second-order neurons

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31
Q

second-order neurons (think spinal cord)

A

-gray matter of the spinal cord
-second-order neurons are interneurons

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32
Q

excitatory interneurons

A

relay transmission to projection neurons -> thalamus

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33
Q

inhibitory neurons

A

modulate pain transmission

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34
Q

synapse between primary and second-order neurons is _____

A

pain gate

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35
Q

third order neurons (think thalamus)

A

thalamus is major relay center for sensory info
-third-order neurons begin in thalamus
-project to portions of cortex involved in processing and interpreting pain signal

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36
Q

extensive corticol network that handles pain signals is called the

A

“pain matrix”

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37
Q

perception

A

conscious awarness of pain

38
Q

awarness occurs in the ______before it reaches the brain it is considers _______

A

brain, nociception

39
Q

perception is highly subjective: depends on

A

mood, culture, percived gender role, life experinces, past experiences of pain

40
Q

Perception is mediated by

A

somatosensory cortex, prefrontal cortex, limbic system , cerebral cortex

41
Q

Modulation

A

supresses or facilitaes pain
-occurs in spinal cord or brain
most involved interneurons

42
Q

mechanisms of modulation

A

segmental
desceding, diffuse noxious inhibition
expectancy-related corticol activation

43
Q

Segmental inhibition

A

A-beta fibers close the pain gate in SC vis inhibitory interneuron
ex: rubbing an injured area to make it hurt less- decreasing pain sensation

44
Q

Descending modulation

A

signals from cortex/amygdala-> periaqueductal gray (PAG) of midbrains -> spinal cord
-activate inhib. excit. interneurons, depending on NT
(DECR OR INCr pain sensation)

45
Q

Diffuse noxious inhibition

A

pain stimulation in another area counteracts pain of injury (distracts from origin of pain)
-mediated by interneurons in spinal cord
theory behind sucuess of massage/ acupuncture)

46
Q

expectancy related cortical activation

A

cognitive expectations can sig attenuate of intensify pain (thinking abt situation)
ex: expecting something to hurt will increase perception of pain

47
Q

Excitatory NTs involved in pain

A

-glutamate
-AMPA, NMDA receptors
-serotonin

48
Q

Inhibitory NTs involved in pain

A

-GABA (y-aminobutyric acid)
-norepi, serotonin
-endogenous opioids: morphone-like substances that inhibit pain transmission: Endorphins, enkephalins

49
Q

Endogenous opioids

A

3 types of opoid receptors in body:
mu, kappa, delta

50
Q

ligand binding to opioid receptors inhibits release of_____

A

excitatory nts

51
Q

Endorphins (endogenous opioid)

A

-concentrated in hypothalamus and pituitary gland
-strong agonist of u (mu) receptors
-inhibit sensation of pain, relieve stress, produce exhilaration or “high”
-releases during exercise, orgasm, tissue injury

52
Q

Enkephalins

A

-found in brain and adrenal medulla
-agonist at mu and delta receptors
-released in response to stress, pain

53
Q

Neurophysiogically pain type

A

due to tissue damage or NS damage

54
Q

Temporally pain type

A

acute or chronic

55
Q

etiologically pain type

A

cancer pain, postoperative pain

56
Q

regionally pain type

A

abdominal pain, pelvic pain, chest pain

57
Q

Nocicpetive activation of nociceptors

A

somatic, visceral, referred

58
Q

Neuropathic due to injury/lesion of NS

A

central, peripheral

59
Q

Acute pain

A

resolves on its own as injury heals
-self-limiting

60
Q

Chronic pain

A

persistent pain even after tissue damage has healed
-changes in CNS implicated

61
Q

Somatic pain

A

nociceotive pain, due to activation of perpheral nociceptors
-superficial, arises from collective tissue, muscle, bone and skin
-A-delta (sharp), C-fibers (dull)

62
Q

Visceral pain

A

nociceotive pain, due to activation of perpheral nociceptors
-pain in organs and lining of body cavities
aching, gnawing, throbbing, crmaping quality
-poorly localized bc fewer nociceptors in veiscera
-associated w/ nasuea, vomitting, hypotension, restlessness, shock
-can radiate or be referred

63
Q

Referred pain

A

pain felt in an area differnt from its point of origin
-site of referred pain supplied by same spinal nerves as actual site of pain
-skin has more nerve endings, so pain is experienced there instead of at origin

64
Q

Neuropathis pain

A

NOT the result of tissue damage
causes by lesion or injury of the NS

65
Q

sensitization

A

creates pain signals despite lack of stimulus

66
Q

Central neuropathis pain

A

(brain or SC)
Physical trauma to CNS
tumors
MS
Parkinsons

67
Q

Peripheral neuropathis pain

A

(everywhere else)
physical trauma to peripheral nerves
diabetes
alcholism
HIV infection

68
Q

Central and peripheral sensitization trauma to nerves causes:

A

spontaneous activity
abnormal excitability
heightened sensitivity

69
Q

There may be other changes as well

A

decreased pain inhibition pathway (descending modulation)
enlargement of sensory receptive field

70
Q

Central and peripheral sensitization experienced as

A

-hyperalgesia
-allodynia
-incident pain: pain evoked by particular movement
-hyperesthesia: increased sensitivity to touch
-paresthesia: tingling sensation, pins and needles

71
Q

Acute pain

A

protective
alerts individual to immediate threat; mobilizes individual to take action
typically short-lived; last a few seconds to a few days

72
Q

Chronic pain

A

lasts at least 3 months
lasts well beyond expected healing time
seves no physiologic purpose
can be continous or intermittent

73
Q

no one knows :

A

how acute pain develops in chronic
why some people get chronic pain and others dont

74
Q

Neuroimagaing studies show that ____ pain changes that brain

A

chronic

75
Q

possible mechanisms of chronic pain

A

changes in nerve sensitivity
-lower thershold for activaation
-central and peripheral sensitization
spontaneous impulses from regen peripheral nerves
-up-regulation of nociceptive chemokines and their receptors
-loss of pain inhibition in spinal cord
-structural and functional changes in brain processing centers

76
Q

manifestation of chronic pain : central

A

increased excitabilty of neurons in CNS

77
Q

manifestation of chronic pain : peripheral

A

increase excitabilty of neurons in PNS

78
Q

Back pain

A

most common chronic pain condition worldwide
presents a sig personal and economic burdern

79
Q

possible causes of back pain

A

-muscle strains (excertion, poor muscle tone)
-verterbal damage (spondylosis)
-pressure on spinal cord (spinal canal stenosis, herniated discs)

80
Q

Myofascial pain

A

2nd most common chronic pain condition
-associated with injury to muscle or connective tissue (fascia, tendons)
ex: muscle strain, myostis, myalgia, fibromyalgia
-begins sharp, localized due to injury or strain
-over time-> more generalized, deeper aching
example of acute –> to chronic

81
Q

Cancer pain

A

assciated with tumor growth and invasion:
increased pressure from tumor growth, destruction of healthy tissue
-distension (stretching) of organs or tissues
-difficult to treat effectivlty as cancer spreads and pain evolves

82
Q

Cancer tx

A

chemo, radiation
-damge to nerves by anticancer tx leading to sensitization

83
Q

phantom limb pain

A

pain experienced at site of amputation after stump has healed
-80-100% of amutees affected
-more likely pts who had pain before amputation

84
Q

highlights the brains role in pain percepion:

A

phantom limb pain

85
Q

possible causes of phantom lib pain

A

-regen of hyperactivity in injured or cut nerves
-scar tissue or neuroma forming on cut nerves
-alterations in thalamus or cortex
-CNS plasticity in somatosensory cortex

86
Q

treating chronic pain

A

a huge challenge bc
-manifestations of pain can be so varied
-so parents’ response to treatment
-being in constant pain makes ppl sad/hopeless, more sensitve to pain

87
Q

Pain thershold

A

point at which stimulus is perceived as pain
determines by genetic, anatomy

88
Q

pain tolerance

A

-duration of time OR intensity of pain that one can endure before acting on. aresponse (like withdrawal)
-influenced by individuals cultural perception, physical and mentla health, gender, fatigue, mood
-may be incr by warmth, hypnosis, alcohol, pain meds, strong beliefs or faith

89
Q

Congenital insensitivity to pain

A

very rare genetic condition (autosomal recessive)
-mutatation in SCN9A gene
-encodes subunit of sodium channel (Nav1.7) present in sensory nerves
-mutation= absence of Nav1.7 channel, inabilty to transmit nociceptive info to brain

90
Q

TYPES of insensitivty to pain

A

WT: wild type
PE: primary erythermalgia
PEPD: paroxysmal extreme pain disorder
CIP: songential insensitivty to pain

91
Q

congenital insensitivty to pain affected individuals :

A

-can feel differnece btwn sharp and dull, hot and cold
-do not sens epainful stimuli
ex: can tell beverage is hot but not that it is burnign them
results in reduced life expectancy due to accumulation of wounds, burns, bruises, broken bones
-ppl with this used to work in circus shows

Pathophys (11 decks)

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