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Clinical Neuro > Pain and Central Sensitisation > Flashcards

Pain and Central Sensitisation Flashcards

1
Q

What does pain mean?

A
  • Danger signal to protect ourselves
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2
Q

What is meant by maladaptive pain?

A
  • Where the initial stimulus for the pain is no longer present but pain still persists
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3
Q

What are two examples of maladaptive pain?

A
  • Fibromyalgia

- Osteoarthritis

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4
Q

What is inflammatory pain a result of?

A
  • ## Break in the skin, damage to the joints or gastric erosion in joints leading to release of inflammatory mediators
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5
Q

What do damaged tissue and inflammatory cells release?

A
  • Release chemical mediators creating an inflammatory soup
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6
Q

What are some examples of chemicals released?

A

-Histamine
-Serotonin
-Prostaglandins
-ATP
Hydrogen ions
-Nerve growth factor

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7
Q

What do the chemicals do when they have been released?

A
  • bind to their respective receptors
  • activating neural ascending pathways
  • sending signal through the dorsal route ganglion, up the neural ascending pathways to the brain
  • Pain stimulus activated in brain
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8
Q

What are two examples of pain treatment options?

A
  • Cox2 inhibitors

- Opioids

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9
Q

What are Nociceptors?

A

-Pain receptors

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10
Q

What happens during a painful stimulus?

A
  • Painful stimulus activates nociceptor
  • Primary sensory neuron enters spinal cord and diverges
  • One collateral activates ascending pathway for sensation and postural adjustment
  • Withdrawal reflex pulls foot away from painful stimulus
  • Crossed extensor reflex supports body as weight shifts away from painful stimulus
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11
Q

What is neuropathic pain?

A
  • neuropathic pain is pain that is a result of ongoing activation of the central nervous system
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12
Q

What are some examples of causes of neuropathic pain?

A
  • Surgery
  • Chemotherapy
  • Disease process
  • Neurotoxicity
  • Trauma
  • Nerve compression
  • Genetic predisposition
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13
Q

What is common with people who have OA?

A
  • Have radiographic changes in 80% of people aged above 75
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14
Q

What are the environmental risks that could lead to OA?

A
  • Obesity
  • Biomechanics (previous injury such as torn acl)
  • Meniscectomy ( surgery of the knee )
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15
Q

What are the genetic factors for OA?

A
  • More common with females

- Family History

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16
Q

What psychological factors for OA?

A
  • Depression

- Anxiety

17
Q

What are examples of sociocultural factors that cause OA related pain?

A
  • Being overweight
  • Social class
  • Unemployment
18
Q

What is joint pathology?

A
  • Extent of damage to a joint
19
Q

What is synovitis?

A
  • inflammation of nerves and blood supply near a joint.
20
Q

What is injurious load in the context of OA pain?

A
  • placing increased load onto joints without sufficient protection
21
Q

How does OA-related knee pain differ?

A
  • Knee pain patterns differ by stage of disease
  • Early stages: intermittent activity related pain
  • Later stages: pain becomes more persistent, even when resting
22
Q

How often does pain persist in patients who have had knee replacements?

A
  • 20-30% of patients
23
Q

What is the pathology of OA?

A
  • Sustained mechanical and inflammatory stimuli in the joint may lead to peripheral sensitization.
  • Leads to constant activation of nociceptors around the joint
  • Leads to activation of pain signal which is sent up the dorsal route ganglion and activating the ascending pathways in the cortex and the thalamus
24
Q

What is found in the descending inhibitory pathway in the people who experience chronic pain?

A

-The descending pathway is not fully functioning/working

25
Q

What is central sensitisation?

A
  • concept that although peripheral signal that initially triggers sensitization
  • CNS amplifies pain pathway
26
Q

What is noticed in patients with OA?

A
  • Heightened pain sensitivity

- Inadequate descending modulation

27
Q

What are 3 clinical clues?

A
  • Allodynia
  • Hyperalgesia
  • Radiating pain
28
Q

What is allodynia?

A
  • Pain or movements in locations that should not be painful
29
Q

What is hyperalgesia?

A
  • Enhanced pain in structures that should be painful
30
Q

What is radiating pain?

A
  • Pain that is felt in places other than damaged area

Clinical Neuro (6 decks)

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