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MD1 Neuroscience > Pain > Flashcards

Pain Flashcards

1
Q

What is pain?

A

Unpleasant sensory and emotional experience associated with actual/potential tissue damage

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2
Q

What are some physiological stimuli for nociceptive pain?

A

Mechanical
Termal
Chemical injury

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3
Q

What are some clinically relevant stimuli for nociceptive pain?

A 
Abnormal mechanical forces 
- Osteoarthritis
Organ injury
- Angina
- Ischaemic claudication
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4
Q

What is pain proportional to?

A

Strength of stimulus

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5
Q

Describe the nociceptive pathway in general

A 
Nociceptor encodes info
Relayed to spinal cord/brainstem
Travels via ascending pathways
Much of info goes through thalamus
Up to areas of cortex
Converted into pain perception
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6
Q

Is nociception different to somatosensation?

A

No, it’s a subclass

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7
Q

What is the threshold for nociceptors?

A

High threshold

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8
Q

What do nociceptors transduce and encode, in general?

A

Noxious stimuli; eg:

  • Strong mechanical forces damaging tissue
  • Extremes in temperature
  • Chemical stimuli that damage skin like acid
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9
Q

What is a noxious stimulus encoded into by the nociceptor terminal?

A

Electrical signal

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10
Q

What is a noxious stimulus?

A

Stimulus that’s damaging/threatens damage to normal tissues

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11
Q

What are the three steps in transmission of nociception?

A

1) Action potential transfers electrical signal from periphery to spinal cord
2) Spinal cord nociceptive neurons integrate and transfer info to brains/other parts of spinal cord - 2nd neuron
3) Thalamic/brainstem nociceptive neurons integrate and transfer information to cortical and other brain regions

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12
Q

What are the two components of pain perception?

A

Sensory

Emotional

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13
Q

What does the sensory part of pain perception do?

A

Identifies discriminative aspects

  • Location
  • Intensity
  • Quality
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14
Q

What two ganglia contain primary afferent sensory neuron cell bodies?

A

Trigeminal ganglia

Dorsal root ganglia

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15
Q

What nociceptors do the trigeminal ganglia contain?

A

Those projecting to head

  • Migraine
  • Tooth and jaw pain
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16
Q

What nociceptors do the dorsal root ganglia contain?

A

Those projecting to body - most

  • Somatic
  • Visceral
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17
Q

How many axons does a nociceptive fibre have?

A

1 axon with 2 parts

  • Peripheral axon projecting via peripheral nerves to endings in somatic/visceral targets
  • Central axon projecting to dorsal horn of spinal cord
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18
Q

What are the types of nociceptive fibres?

A

C fibre

A delta fibre

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19
Q

Describe C fibres

A

Thin
Unmyelinated
Slow

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20
Q

Describe A delta fibres

A

Thin
Myelinated
Medium-fast

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21
Q

Compared to touch receptors, are nociceptive receptors fast or slow?

A

Slow

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22
Q

Describe the terminal of the peripheral axon of a nociceptive fibre

A

Free nerve endings

Not encapsulated in specialised cell like touch receptors

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23
Q

In which layers of the spinal cord do the central axons of nociceptors terminate?

A

Superficial layers - usually laminae 1 and 3

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24
Q

What is the nociceptive pathway in the spinal cord?

A

Those in dorsal horn project to brain via spinothalamic tract on opposite side of spinal cord

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25
Where is the point of decussation in the nociceptive pathway?
Dorsal horn - via synapse
26
What white matter tract do nociceptors travel up in the spinal cord?
Anterolateral tract
27
Does all nociceptive information go up to the brain?
No, some only goes to spinal cord > forms reflex circuit
28
What happens when a noxious mechanical stimulus is detected by a nociceptor in the knee region?
Elicits complex withdrawal reflex in both legs without any input from brain
29
What happens to nociceptive information when the spinal cord is anaesthetised?
Perception of pain blocked because ascending pathway blocked | Spinal cord reflexes aren't blocked
30
What type of pain do A delta fibres elicit?
Sharp
31
What type of pain do C fibres elicit?
Slow, burning
32
What type of behaviours are A delta fibres more likely to elicit?
Withdrawal reflex
33
What type of behaviours are C fibres more likely to elicit?
Behaviours that remove stimulus
34
Why can you feel a first and second pain?
When both A delta and C fibres are activated, they transmit signals at different speeds, so pain from A delta fibres is felt first, and quickly. Pain from C fibres follows and remains for a longer time
35
What is inflammatory pain?
Pain felt during active inflammation
36
How is inflammatory pain detected?
Properties of nociceptors altered by chemicals released by damaged tissues/immune system in context of disease
37
What is spontaneous pain?
Pain felt when there is no external stimulus/pain with innocuous stimulus
38
Why do we get spontaneous pain?
Sensory amplification
39
Where can amplification happen?
Peripherally | Centrally
40
What are clinically relevant stimuli for peripheral amplification?
Tissue trauma Surgery Joint inflammation; eg: rheumatoid arthritis
41
What is one type transducer protein that's found on nociceptors?
TRPV1
42
What is TRPV1 activated by?
Capsaicin Heat Acid Certain lipids - endogenous equivalents of cannabinoids
43
Where is TRPV1 found?
Most membrane terminals of nociceptors?
44
What type of receptor is TRPV1?
Gated ion channel for Na and Ca
45
Do all nociceptors express the same transducer proteins?
No, different functional classes express different types
46
What type of nociceptors is TRPV1 found on?
Polymodal nociceptors | Heat specialised nociceptors
47
Do all members of the TRP respond to the same stimuli?
No, different members respond to different stimuli
48
Where is TRPA1 found, and to what does it respond?
``` In airways Responds to - Nicotine - Formalin - Others ```
49
What does TRPM8 respond to?
Menthol
50
How does the "inflammatory soup" affect nociceptor activity?
Chemical signals released by tissue damage/disease Detected by different receptors on nociceptor terminals Downstream cell signalling causes sensitisation
51
How does downstream signalling affect nociceptor sensitisation?
Changes properties of terminal and lowers threshold
52
Define hyperalgesia
Increased response to normally painful stimulus
53
Define allodynia
Painful response to normally innocuous stimulus
54
How can allodynia be clinically detected?
Stroke skin softly with paintbrush/cue tip > intensely painful to patient
55
What can central sensitisation result from?
Increased nociceptor activity after peripheral sensitisation
56
Describe secondary hyperalgesia
If you have localised painful stimulus, get localised pain induced by stimulus Over time, hyperalgesia extends into areas that aren't damaged because initial signal activates regions of spinal cord, including across segments Amplifies info coming in from adjacent nociceptive and non-nociceptive afferent fibres
57
What is neuropathic pain?
Nervous system lesion or disease/ marked neuroimmune response causing pain
58
What are examples of a CNS problem causing neuropathic pain?
Stroke Spinal cord injury MS
59
What causes central amplification in neuropathic pain?
Neuroimmune interactions in periphery and CNS
60
What causes peripheral amplification in neuropathic pain?
Nerve trauma Toxic and metabolic neuropathies Herpes zoster AIDS
61
What does it mean for neuropathic pain to be maladaptive and persistent?
Abnormal amplification maintained independent of lesion/disease
62
How can peripheral neuropatic pain occur?
Damage to peripheral nerves > develop inappropriate branches | Pain perception altered
63
How can a cut terminal continue to produce spontaneous electrical activity?
Cell damage > nerve loses input > central part of axon continues to generate electrical activity
64
What are complex regional pain syndromes (CRPS)?
Multifactorial pain disorder - Pain and other clinical abnormalities - Sensory - Motor - Autonomic - Signs and symptoms spread distally glove- or stocking-like in affected limbs - Sudden change for pain after fracture/surgery to persistent burning pain
65
What is the cause of CRPS?
No identifiable pathology
66
What are examples of functional pain syndromes?
CRPS Migraines Myalgia
67
Define acute pain
Lasts for short time Occurs after surgery/trauma/other condition Warning to body to seek help
68
Define sub-acute pain
Progressing to chronic pain Can be prevented Transition phase
69
Define recurrent pain
Occurs on cyclical basis - Migraine - Pelvic pain
70
Define chronic pain
Lasts beyond time expected for healing
71
What area in the brain does pain activate?
No single area | Activates network
72
What roles do the periaqueductal grey and rostral ventral medulla in the brainstem play in pain?
Form chain projecting back down to spinal cord | Modulate pain
73
What are some major classes of centrally acting analgesic drugs?
``` Opioids NSAIDs Anticonvulsants Tricyclic antidepressants (TCAs) Serotonin-noradrenaline reuptake inhibitors (SNRIs) Alpha 2-adrenergic agonists Cannabinoids ```
74
What is an example of an opioid?
Morphine
75
What are two examples of anticonvulsants?
Gabapentin | Pregabalin
76
What is an example of an alpha 2-adrenergic agonist?
Clonidine
77
What is an example of a cannabinoid?
Marijuana
78
How can pain experience be modulated?
Feedback pathway to spinal cord that can inhibit/amplify info brought by nociceptors
79
What effect does fear have on the perception of pain?
Hypoalgesia
80
What cortical areas are involved in the modulation of pain?
Anterior cingulate Prefrontal Insula
81
By giving a person a placebo and telling them that it reduces pain, what effect does this have in the brain?
Produces genuine analgesia via endogenous pain modulation | Placebo analgesia reduced/prevented by opioid antagonists
82
What effect on the brain does it have by giving a patient a nocebo?
Hyperalgesia
83
What are the factors in the psychobiological model of pain perception?
``` A delta and C nociceptive input Injury - Peripheral and central sensitisation Chemical and structure - Neurodegeneration - Metabolic - Maladaptie plasticity Cognitive set - Hypervigilance - Attention - Distraction - Catastrophising Mood - Depression - Catastrophising - Anxiety Context - Pain beliefs - Expectation - Placebo ```

MD1 Neuroscience (55 decks)

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