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Neuroscience Block 4 > Pain Disorders > Flashcards

Pain Disorders Flashcards

1
Q

Epicritic pain. (Also describe threshold)

A

This is pain that is identified with well-defined and discriminative qualities

Shows low threshold but accurate localization

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2
Q

Protopathic pain (and threshold)

A

This is emotion-laden pain of a chronic nature with poorly defined qualities

Shows high threshold but poor localization

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3
Q

Which type of pain is less responsive to opioid therapy?

A

epicritic pain

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4
Q

What do nociceptors sense? (Obviously pain but what triggers the response)

A

allow awareness of tissue injury

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5
Q

Where are nociceptors found?

A

in all tissues except the brain

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6
Q

Fast pain travels in unmyelinated or myelinated fibers?

A

myelinated

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7
Q

Describe fast pain.

A

sharp, localized, stabbing pain perceived with injury; sharp pain, pricking pain, acute pain, and electric pain

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8
Q

Slow pain (how it presents) (unmyelinated or myelinated fibers)

A

longer lasting dull diffuse pain traveling in unmyelinated fibers.

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9
Q

What type of chemicals stimulate pain fibers in the viscera?

A

bradykinin, histamine, prostaglandin

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10
Q

Each nociceptive receptor subtype is mediated by one or more members of what ion channel family?

A

TRP-Vanilloid ion channel family

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11
Q

Receptor for extreme heat is mediated by what ion channel family?

A

Vanilloid family

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12
Q

What fiber type carries sharp, pricking pain>

A

A (delta)

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13
Q

What fiber type carries slow burning and sharp, pricking pain?

A

A (delta)

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14
Q

What fiber group carries hot, burning sensation, extreme cold and crude touch?

A

C fibers (unmyelinated)

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15
Q

PG increases sensitivity of pain terminals to which chemicals?

A

bradykinins and other pain producing substances

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16
Q

What does substance P do?

A

vasodilation, neurogenic edema and BK release

also causes Histamine (H) release from mast cells; and 5HT from platelets

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17
Q

Mechanisms of action of neuropathic pain.

A

Following injury, increased sensitization of nociceptive afferents and terminals causes impulse generation in absence of stimulation

Induced by
Local increase conc. of Na+ channels
Epinephrine sensitivity

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18
Q

What are the 2 broad groups by which central pain pathways are grouped?

A

neospinothalamic pathway

paleospinothalamic pathway

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19
Q

What senses does the neospinothalamic pathway mediate?

A

Pathway mediates conscious awareness of well-defined pain (epicritic pain) & temperature sensations

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20
Q

Another name for the paleospinothalamic pathway?

A

anterior spinothalamic pathway

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21
Q

Describe the path from DRG to 3rd order neurons of General Paleospinothalamic pathway.

A

1st order in DRG
2nd order in dorsal horn
cross the midline
3rd order projects to midline and intralaminar thalamic nuclei

Ends in cerebral cortex especially the cingulate gyrus

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22
Q

What sensations does the paleospinothalamic pathway mediate?

A

Pathway mediates arousal and integration of pain sensations with diverse learned behavioral/ emotional responses

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23
Q

Describe path of spino-reticulo-thalamo-cortical pathway.

A

1st order: DRG
2nd order terminate on medullary and pontine ARAS
3rd order: fibers from ARAS project to midline and intralaminar thalamic nuclei

then project diffusely to cerebral cortex

Fibers from ARAS also project directly to cerebral cortex

24
Q

What senses does the spino-reticulo-thalamo-cortical pathway mediate?

A

Pathway probably mediates integration of painful stimuli with alertness; fly or fight response

25
Q

What is the spino-mesencephalo-limbic pathway route?

A

1st order: DRG
2nd order: dorsal horn terminate in PAG of midbrain level
3rd: PAG at midbrain level and project to amygdala via parabrachial nuclei of pons

PAG also projects downstream to dorsal horn via raphe nuclei of brainstem

26
Q

What sensation does the spino-mesencephalo-limbic pathway mediate?

A

pain modulation

integration of painful stimuli with fear, rage and related autonomic and homeostatic responses

27
Q

Regarding pain modulation from the periphery….

Large cutaneous afferent terminals for pain modulation contain what type of fibers? (Where do they synapse)

A

A Beta fibers

which synapse on enkephalin-mediating interneurons in dorsal horn of spinal cord
explain pain reduction while rubbing area of skin around painful stimuli

28
Q

Pain modulation from central structures.

Be able to explain pain modulation (pain reduction) via PAG.

A
  1. PAG projects to nucleus raphe magnus (NRM) in rostral medulla
  2. NRM (5-HT mediated) in turn projects to enkephalin-mediating (EK) interneurons in dorsal horn of spinal cord.
  3. EK neurons in turn inhibit pain fibers pre-synaptically and 2nd order pain neurons post synaptically.
29
Q

Pain modulation from central structures.

Describe the noradrenergic pathway of pain modulation from the brain. (pain reduction

A
  1. NE containing nuclei in rostral Pons (locus ceruleus) descend to spinal levels to synapse on enkephalin-mediating (EK) interneurons in dorsal spinal cord.
  2. EK neurons in turn inhibit pain fibers pre-synaptically and 2nd order pain neurons post synaptically.
  3. Process results in pain reduction
30
Q

Describe how rubbing a sore on the arm reduces pain through spinal gating.

A

descending analgesic fibers from reticular formation travel down reticulospinal tract to dorsal horn
- secrete inhibitory substances that block
pain fibers from secreting substance P
- pain signals never ascend

dorsal horn fibers inhibited by input from mechanoreceptors

31
Q

Glutamate and substance P pain modulation. (Where exactly released)

A

is released at axonal terminals of pain afferents in spinal cord

32
Q

Where are opiate receptors present?

A

are present on pre-synaptic axonal terminals of pain fibers terminating in spinal cord as well as on dendrites of 2nd order neurons in pain pathway

33
Q

Enkephalin is released where?

A

released from terminals of enkephalinergic inhibitory interneurons located in dorsal horn

34
Q

What does EK act on and how does in modulate pain?

A

EK acts on pre-synaptic opiate receptors on pain afferents to reduce Ca+ entry and decrease glutamate and substance P release at afferent pain terminals.

EK also acts post-synaptically on opiate receptors on 2nd order pain neurons, hyperpolarizes the neurons through increased K+ conductance and attenuates effects of nociceptive stimuli

35
Q

Serotonin and NE from Nucleus raphe medullaris (NRM) and Nucleus Locus Ceruleus (NLC) respectively excite what type of neurons located in dorsal horn of spinal cord to facilitate their actions?

A

EK inhibitory neurons

36
Q

Lesions of the neospinothalamic tract in the spinal cord, will cause what to happen?

A

Contralateral loss of pain and temperature from one or two segments below level of lesion down and throughout the rest of the body.

37
Q

Lesions of the lateral division of the dorsal root that mediate pain afferents to the spinal cord, will cause what to happen?

A

Ipsilateral loss of pain and temperature at affected spinal segmental level(s)

Ipsilateral loss of nociceptive induced spinal segmental reflexes at affected levels (e.g. loss of flexor withdrawal reflex)

38
Q

Lesions of the neospinothalamic tract in the brainstem and thalamus will cause what to happen?

A

Contralateral hemi-anesthesia (loss of pain) and temperature in the body relative to the lesion

39
Q

Hyperalgesia

A

Enhancement of pain sensation

An exaggerated response due to excessive excitation of pain pathway

40
Q

In particular what happens to receptors which precipitates hyperalgesia?

A

sensitization of nociceptors

41
Q

What are the causes of hyperalgesia?

A

excessive sensitivity of Pain receptor ( primary hyperalgesia) and
facilitation of sensory transmission( secondary hyperalgesia) in spinal
cord and thalamus

42
Q

What is a known substance causing nociceptor sensitization?

A

Prostaglandin E2

43
Q

Describe phantom limb pain.

A

Describes pain felt by an amputee from missing limb

Over-activity of 2nd order pain-mediating neurons in spinal cord of amputated side creates false feeling of pain

44
Q

Describe thalamic pain.

A

Lesion in Ventral Posterior Lateral nucleus of thalamus especially involving terminals of DCML

Chronic, excruciating pain occurs in response to non-noxious stimuli on the body.

Pain is not ameliorated by standard pain relievers

45
Q

How does one treat thalamic pain?

A

Relief is mainly through use of antiepileptics and/or surgical intervention

46
Q

Neuralgia

A

Describes severe and persistent pain in distribution of a cranial or spinal nerve, e.g. Trigeminal neuralgia, TN, Post-herpetic neuralgia, etc.

47
Q

Trigeminal neuralgia is usually characterized by what and not responsive to what?

A

Episodic stabbing pain in distribution of CN5

Non-responsiveness to standard pain relievers

48
Q

How would one treat trigeminal neuralgia?

A

Relief is usually through surgical intervention; e.g. alcohol injection of trigeminal nerve, or carefully placed lesion to damage descending spinal tract of V in dorsolateral medulla or SCA decompression

49
Q

Referred pain. (Also what is a name for it?)

A

Describes pain arising from deep visceral structures that is felt at sites on body surface

Also called misinterpreted pain and reflective pain

50
Q

Mechanism of action of referred pain.

A

Convergence of nociceptive and general cutaneous afferents from same spinal segment on same 2nd order dorsal horn cells is advanced to explain phenomenon

51
Q

What type of pain is characteristic of higher centers incorrectly ascribe pain sensation to emanate from skin rather than deep visceral structure?

A

refered pain

52
Q

What is another name for referred pain?

A

reflective pain aka misinterpreted pain

53
Q

Allodynia

A

Describes condition of painful response to stimuli that would not normally cause pain.

54
Q

MOA of allodynia

A

Dysfunction in pain modulation due to misalignment of interaction between mechanoceptive and nociceptive pathways and

Molecular level sensitization of CNS neurons in the pain pathway

55
Q

What are some complications of Chronic pain syndrome?

A

Depressed mood, fatigue, sleep disorders
Reduced activity, dependent behavior
Alcohol and other substance abuse

56
Q

What are Steinbach’s 6 D’s of somatization?

A

Dramatization of complaints, Dysfunction/Disuse, Dependency, Depression, Disability and Drug misuse

57
Q

Waddell’s sign?

A

may indicate non-organic or psychological component to chronic low back pain. Historically they have also been used to detect malingeringin patients with back pain.

Neuroscience Block 4 (6 decks)

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