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Clinical symposium > pain > Flashcards

pain Flashcards

1
Q

define pain

A

the feeling or perception of irritating, sore, stinging, aching, throbbing, miserable, or unbearable sensations arising from a part of the body.

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2
Q

define noiception

A

is the sensory process that provides the signals that trigger pain

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3
Q

where abouts are noiceptors found

A

the periphery as simple free nerve endings.

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4
Q

Tissue damage and inflammation triggers release of which substances.

A

prostaglandins, bradykinin and histamine.

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5
Q

do nocioceptors have myelin

A

No myelin, terminates naked.

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6
Q

what is the function of prostaglandins, bradykinin and histamine

A

sensitise peripheral nocioceptors and induce hyperalgesia.

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7
Q

what happens when nocioceptors are sensitised due to inflammatory mediators, where do they send signals

A

spinal cord

blood vessels- to mast cells in order to enhance inflammation.

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8
Q

what is the neurotransmitter that causes mast cells to release histamine

A

substance P

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9
Q

what inflammatory mediator triggers chemonoiceptors

A

bradkyinin

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10
Q

what 2 types of fibres transduce the stimulated noicoceptive fibres

A

unmyelinated C fibres and thinly myelinated Ad fibres.

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11
Q

what are the 3 modalities of noicoception

A

mechanical

chemical thermal

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12
Q

what type of receptor increases the number of action potential with increased amount of heat.

A

noiceptors- tells you how hot something is

thermoreceptor- just tells you if something is hot.

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13
Q

large diameter and slow condition are which receptors

A

pain and temperature

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14
Q

small diameter and fast conduction are which receptors

A

proprioception and discriminative touch.

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15
Q

what type of fibres carry the first pain associated with injury

A

Fat Ad fibres

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16
Q

what are the characteristics of the first pain associated with injury

A 
Sharp or prickling
Easily localised
Occurs rapidly
Short duration
Mechanical or thermal nociceptors
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17
Q

what type of fibre carry the second pain associated with injury

A

C fibres

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18
Q

what are the characteristics of the second pain associated with injury

A 
dull ache, burning
poorly localised
slow onset
persistent
polymodal noiceptors.
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19
Q

where are the cell bodies of noicoceptors

A

dorsal root ganglion

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20
Q

how is the signal transducer from the dorsal route horn.

A

Nociceptive fibres have their cell bodies within the dorsal root ganglion.
Afferent terminals enter the dorsal horn and travel up/down a short distance within the Zone of Lissauer.
Afferent terminals synapse onto neurones within the superficial laminae of the dorsal horn.
Principle areas innervated by nociceptor afferents are lamina I and lamina II (substantia gelatinosa).
Nocicecptive fibres – first order neurons

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21
Q

in which laminae of the DRG do nocioceptors synapse

A

first and second.

22
Q

what is the zone of lissauer

A

where afferents travel up a few segments in the spinal cord before synapsing

23
Q

how does referred pain occur

A

cross talk- viscera and the skin enter spinal cord through common routes and target overlapping populations of spinal neurons.
so internal stimuli can cause referred pain at the affected dermatome level in the body.

24
Q

where is angina pain referred

A

upper chest wall and left arm

25
Q

where is appendicitis referred

A

abdominal wall

26
Q

where is ureteric pain referred

A

lower abdomen

27
Q

is the spinothalamic pathway contra/ipsilateral

A

contralateral- crosses at the level of entry.

28
Q

what is the function of the ascending pathways

A

• Processes afferent inputs from peripheral mechano-, thermal and polymodal nociceptors.

29
Q

what are the 3 components of the ascending pathways

A

lateral-spinothalamic tract
spinoreticulothalamic tract (paleospinothalamic)
anterio-spnothalamic

30
Q

what pathway carries pain and temperature

A

spinothalamic

31
Q

what pathway carries proprioception and 2 point touch

A

dorsal column pathway

32
Q

A unilateral lesion in the spinal cord will produce what effect

A

produce sensory loss of touch, pressure, vibration and proprioception on same side below level of lesion and pain an temperature loss on opposite side of the lesion.

33
Q

what type of sensory information does the trigemionathamic tract carry

A

sensory information from the face and head.

34
Q

what is the name of the structure where the primary and secondary neurone of the trigeminothalamic tract synapses

A

pars caudalis.

35
Q

where do dorsal column and spinothalamc tract project in the thalamus

A

VPL

36
Q

where does the trigeminothalamic tract project in the thalamus

A

VPM

37
Q

is the trigeminothalamic tract contralateral or ipsilateral

A

contralateral

38
Q

define phantom pain

A

Pain and touch sensations with no sensory inputs

39
Q

what is the most likely cause of phantom pain

A

cortical re-organization in the ‘virtual’ body maps of thalamus and cortex, e.g. foot taken over by leg.

40
Q

do we have endogenous opiates

A

yes

41
Q

what is the function of opioids

A

relieve pain by acting pre and post synaptically.

42
Q

give 2 examples of endocannabinoids

A

anadamide and 2-arachidonyly-glycerol

43
Q

what receptors do anadamide and 2-arachidonyly-glycerol work on

A

CB1, and CB2

44
Q

what is the function of endogenous ligands

A

Inhibits behavioural responses to acute noxious stimuli, limits hyperalgesia and neuropathic pain.

45
Q

define hyperalgesia

A

A reduced threshold for pain
An increased intensity of painful stimuli
Spontaneous pain.

46
Q

are interneureones stimulatory or inhibitory

A

inhibitory

47
Q

how can you control your own pain.

A

Descending ‘endogenous analgesic’ pathways from periaqueductal grey and reticular formation decrease transmitter release from primary afferent terminals by an interaction with opioid receptors.

Binding of opiates, decreases neurotransmitter release, and decreases AP up spinothalmic pathway, so you can control your own pain.

48
Q

define innocuous stimulus

A

not harmful

49
Q

what afferents carry painful stimuli

A

c-afferents

50
Q

what afferents carry non painful stimuli

A

AB-afferents

Clinical symposium (20 decks)

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