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Neuro > Pain > Flashcards

Pain Flashcards

1
Q

What is the definition of pain

A

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

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2
Q

what is the classification of acute pain

A

short term, less than 12 weeks duration

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3
Q

what is the classification of chronic pain

A

continuous long term pain, more than 12 weeks duration OR pain tat persists after the time that healing would have been theought to have occurred after trauma/ surgery

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4
Q

what are the divisions of chronic pain

A

cancer pain and chronic non-cancer pain

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5
Q

what are the 3 parts of coping with chronic pain

A

Pacing, Planning, Prioritising

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6
Q

what is a flare up (in terms of pain)

A

increase in patient’s usual pain; not a new pain sensation

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7
Q

what is the definition of nociceptive pain

A

pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors
- used in conjunction with a normally functioning somato-sensory system

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8
Q

what is the definition of neuropathic pain

A

pain arising as a direct consequence of a lesion or disease of the somato-sensory system

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9
Q

what does allodynia mean

A

pain due to stimulus that does not normally provoke pain

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10
Q

what does dysesthesia mean

A

an unpleasant abnormal sensation, whether spontaneous or evoked

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11
Q

what does hyperalgesia mean

A

increased pain from a stimulus that normally provokes pain

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12
Q

what does hypoalgesia mean

A

diminished pain in response to normally painful stimulus

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13
Q

what does hypoesthesia mean

A

dimisinished sensitivity to stimulation, excluding special senses

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14
Q

describe the path of 1st order/ primary afferent neurones of the pain response

A

enter spinal cord through spinal nerve or brainstem through CN V, ipsilateral to peripheral receptor
Remain ipsilateral and synapse with 2nd order neurones in the CNS

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15
Q

describe the path of 2nd order neurones in the pain responses

A

cell body located in spinal cord/ brainstem

axons decussate to other side of CNS and ascend to thalamus where it terminates

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16
Q

describe the path of 3rd order neurones in the pain response

A

cell body located in thalamus

axon projects to somatosensory cortex in post central gyrus of parietal lobe

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17
Q

what are nociceptors

A

sensory neurones found in any area of body that can sense pain either externally or internally

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18
Q

where are the cell bodies of nociceptors

A

dorsal root ganglion (body) or trigeminal ganglion (face/ head/ neck)

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19
Q

what can cause hyperalgesia

A

presence of tissue damage/ bradykinin/ prostaglandin E2 can reduce nociceptive AP threshold so increase sensitivity to stimuli

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20
Q

what is the modality of nociceptors generally

A

poly-modal; thermal/ chemical/ mechanical

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21
Q

what are the 2 type of afferent fibres associated with the pain response

A

alpha delta fibres and c fibres

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22
Q

describe alpha delta fibres

A

thinly myelinated
carry touch, pressure, temperature, FAST pain information
small diameter; 1-5 microns
medium conduction speed; 5-40m/s

23
Q

describe c fibres

A

unmyelinated
carry SLOW pain, temperature, touch, pressure, itch, postganglionic autonomic fibres information
smallest diameter - 0.2-1.5 micrometers
slowest conduction speed; 0.5-2m/s

24
Q

what sort of neurones are a delta and c fibres

A

1st order

nociceptors

25
Q

where do 1st order neurons synapse with 2nd order neurones in the pain pathway

A

substantia gelatinosa in grey matter of dorsal horn of spinal cord

26
Q

describe a delta terminals

A

release glutamate as neurotransmitter

- fast acting

27
Q

describe c fibre terminals

A

release glutamate and substance P as neurotransmitter

- slow acting, involved in mediation of dull aching pain

28
Q

what does the spinothalamic tract carry

A

pain, temperature, crude touch from body

29
Q

where does the spinothalamic tract enter the spinal cord

A

Lissauer’s fasciculus

30
Q

what does the trigemino-thalamic tract carry

A

pain, temperature, crude touch from face/ head/ neck

31
Q

where does the trigemino-thalamic tract receive contributions from

A

CN 5, 7, 10, 12

32
Q

what does the lateral spinothalamic tract carry

A

pain and temperature

33
Q

what does the anterior spinothalamic tract carry

A

crude touch

34
Q

where do the spinothalamic/ trigemino-thalamic tracts terminate

A

ventral posterior lateral nucleus of thalamus

35
Q

what tracts are involved in the pain response

A

spinothalamic and trigemino-thalamic

36
Q

describe dorsal root ganglion

A

on dorsal root
composed of cell bodies of nerve fibres that are sensory - afferent
pseudo-unipolar neurons
1st order neurons

37
Q

what are the functions of the nuclei in the thalamus

A

relay and association

38
Q

what is the role of the insula

A

where degree of pain is judged - contributes to subjective aspect of pain perception

39
Q

where is the insula

A

within brain via sylvian fissure

40
Q

where is the cingulate gyrus

A

medial aspect of cerebral hemispheres

41
Q

what is the role of the cingulate gyrus

A

linked with limbic system; involved in emotional response to pain and associated with emotion forming/ processing learning and memory

42
Q

what the periaqueductal grey

A

grey matter around aqueduct in the midbrain

43
Q

where does the periaqueductal grey receive input from

A

somatosensory cortex (Brodmann 1,2,3)

44
Q

what pathway is the periaqueductal grey involved in

A

descending pain pathway

45
Q

when is the periaqueductal grey activated and why

A

activated in situations of high stress and contributes to modulation of afferent noxious transmission
has high concentration of opioid receptors and endogenous opioids

46
Q

where does the periaqueductal grey project to

A

dorsal horn

47
Q

what happens when the periaqueductal grey is activated

A

opioid receptors are activated leading to reduction in pre-synaptic neuronal sensitivity so reducing substance P release so reducing pain sensation
- less impulses travel up 1st/2nd/3rd order neurons to somatosensory cortex so less pain felt

48
Q

what do opioids do

A

bind to opioid receptors in periaqueductal grey so reducing pre-synaptic neuronal sensitivity
-result in profound analgesia

49
Q

what is the definition of analgesia

A

selective suppression of pain without effects on consciousness/ other sensation

50
Q

what is the definition of anaesthesia

A

uniform suppression of pain

- sometimes consciousness is lost e.g. general anaesthetic

51
Q

what is the Melzack-Wall Pain Gate theory

A

states that non-painful input closes the gate to painful input
- preventing pain sensation from travelling to the somatosensory cortex to be perceived and thus felt

52
Q

what are some treatments for pain

A

analgesics
acupuncture
exercise
hypnotherapy

53
Q

what is substance P

A

Peptide neurotransmitter involved in pain transmission
-also a vasodilator
remains bound to receptors for longer time so transmits long lasting pain

Neuro (11 decks)

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