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PHA333 > pain and analgesia (Abdel) > Flashcards

pain and analgesia (Abdel) Flashcards

1
Q

What casues pain?

A

activation of nociceptors by thermal/mechanical/chemical ot other stimuli

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2
Q

What is pain?

A

unpleasant sensory and emotional experience associated with actual or potential tissue damage

it is a perception

occurs in the brain

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3
Q

types of nociceptive pain

A 
visceral
somatic
referred
radiating
breakthrough
psychogenic
phantom
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4
Q

visceral pain

A

diffuse, difficult to locate

referred to a distant, superficial, structure

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5
Q

somatic pain

A
  1. superficial pain - activation of nociceptors in skin/superficial tissue, shar/burning, well defined
  2. deep somatic pain - activation of nociceptors in ligaments/bones/tendons/muscles, dull, aching, poorly localised
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6
Q

referred pain

A

preceived at a location other than the site of the painful stimulus

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7
Q

radiating pain

A

pain that spreads from the original area outwards to another part of the body

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8
Q

breakthrough pain

A

transitory flare up of pain against a background of otherwise well controlled pain

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9
Q

psychogenic pain

A

result of some underlying psychological disorder

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10
Q

phantom pain

A

pain in a part of the body that has been removed surgically/traumatically

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11
Q

What is neuropathic pain and conditions that experience it?

A
  • after direct injurt to a peripheral nerve
  • characterised by damage/dysfunction of somatosensory pathways in PNS/CNS AND pain/hypersensitivity within denervated zone and its surroundings
  • DM, after traumatic injury, ischaemia, radiation therapy, excessive alcohol consumption, immune system disease, coeliac disease, viral infection
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12
Q

most common cause of neuropathy

A

diabetic neuropathy

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13
Q

types of diabetic neuropathy

A
  1. peripheral/sensory neuropathy - affects mostly nerves of feet/legs
  2. autonomic neuropathy - results from damage to nerves which control involuntary fxns
  3. focal neuropathy - results from injury to periphral nerve at one site
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14
Q

What is neuropathic pain insensitive to?

A

morphine and other opioids

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15
Q

drug classes that can relieve neuropathic pain

A

TCAs (amitriptyline)

anticonvulsants (carbamazepina)

corticosteroids (dexamethasone) - esp cancer pain

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16
Q

NICE recommended drugs effective for neuropathic pain

A

amitriptyline

duloxetine

gabapentin

pregabalin

17
Q

combination Tx for neuropathic pain

A

NOT recommended

18
Q

What is trigeminal neuralgia?

A

neuropathic facial pain condition

pain/loss of sensation in face

disorder of the 5th cranial nerve -> trigeminal nerve

severe paroxysmal, lancinating facial pain

19
Q

trigeminal nerve

A

5th (V) cranial nerve

largest cranial nerve (out of 12)

arises from brainstem

main nerve of sensation for the face

contains sensory fibres for facr

contains motor segment important for chewing/mastication

divides into 3 branches

20
Q

3 branches of the trigemnial nerve

A

V1 opthalmic division - provides sensation to forehead and eye

V2 maxillary division - provides sensation to cheek, upper lip, roof of mouth

V3 mandibular division - sensation to jaw and lower lip

21
Q

trigeminal neuralgia Tx

A

carbamazepina

22
Q

alternative Tx for trigemnial neuralgia

A 
oxcarbazepine
gabapentin
phenytoin
baclofen
amitriptyline
23
Q

What to doif carbamazepine ineffective/c/i in trigeminal neuralgia?

A

get specialist advice

24
Q

What are sensory neurons described as?

A

pseudo-unipolar

-> have a single axon extending from the cell body that forms 2 extensions: dendrites and axon

25
Q

examples of sensory receptors

A

chemoreceptors - snese chemicals

mechanoreceptors - sense touch, pressure, distortion/stretch, (vibrations fromsound waves)

photoreceptors - sense light (retinas)

thermoreceptors - sense temperature

nocioceptors - repsond to a variety of stimuli (heat, pressure, chemicals) and SENSE TISSUE DAMAGE

26
Q

nociceptors

A

detect a wide range of stimuli

chemical/physical stimuli excitate nociceptors by activating a single receptor

excitatory neurons - release glutamate as their primary neurotransmitter

have elevated stimulation threshold

encode the intensity of a stimulus within the noxious range - must not saturat when a stimulus reaches noxious levels

don’t adapt to a persistent stimulus

27
Q

types of nociceptors

A
  1. thermal - activated by noxious heat/cold at various temps
  2. mechanical - respond to intense pressure and incisions that break skin surface
  3. chemical - respond to variety of spices
  4. polymodal - thermal, mechanical and chemical
  5. silent/sleeping - become active when tissue becomes inflamed
28
Q

ascending pain pathway

A

neural projections where sensory info travells from periphery to brain

29
Q

pathways in the ascending pain pathway

A
  1. dorsal column - 1st order neurons, mostly A alpha and A delta fibers
  2. spinothalamic tract - lateral spinothalamic tract (A delta and C fibers) and anterior spinothalamic tract (A beta fibers)
  3. spinocerebellar tract
30
Q

1st, 2nd and 3rd order neurons

A

1st order neurons - signals from periphery t spinal cord or medulla

2nd order - signals from spinal cord/medulla to thalamus

3rd order - signals from thalamus to primary sensory cortex

31
Q

decending pathway

A

modulatd pain sensation

enhances or inhibits the conduction of pain

includes:

  • anterior cingulate
  • insular cortex
  • PAG (periaqueductal gray)
  • nuclei in amygdala
  • PVG of hypothalamus (periventricular gray matter)
  • DLPT (dorsolateral pontine tegmentum)
  • RVM (rostral ventromedial medulla)
32
Q

NTs involved in decending pathway

A 
opiodergic
noradrenergic
serotonergic
cholinergic
GABA-ergic
endocannabinoids
33
Q

What area controls decending inhibitory modulation?

A

PAG - periaqueductal grey

RVM and DLPT

34
Q

What neurons do the RVN and DVLP contain?

A

RVM - 5-HT neurons

DVLP - NA neurons

35
Q

How does the decendng pathway work?

A

spinal cord received input from RVM

5-HT released

  • hyperpolarisation of ascending fibers/dornal horn when interacts with 5-HT 1 R
  • depolarisaiton of GABAergic interneurons, interacts with 5-HT2A, 5-HT3 R

spinal cord receives input from DLPT

AD released

  • hyperpolarisation of porjection neurons/primary afferent fibres, interacts with alpha2A R and apha2B/B Rs
  • depolarisation of dorsal horn/interneurons, interacts with alpha-1A R
36
Q

glutamate and pain

A

associated with acute pain

good/warning pain

37
Q

substance P and pain

A

intense, persistent, chronic pain

ad/damage injury pain

38
Q

prostaglandins and pain

A

potentiate the pain of inflammation by blocking the action of glycine

PHA333 (27 decks)

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