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Physiology > Pain II > Flashcards

Pain II Flashcards

1
Q

What is the difference between primary and secondary hyperalgesia?

A 
Primary = in the periphery
Secondary = at the spinal cord
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2
Q

What are the two fibers that play a role in nociception?

A

A-delta

C fibers

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3
Q

What is the role that a-delta fibers play a role in? What do they respond to?

A

Sharp, first pain

Respond to intense mechanical

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4
Q

What is the role of the C fibers? What do they respond to?

A

Mediate poorly localized, diffuse secondary pain

Polymodal response

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5
Q

What are the three fiber types that are activated in response to pain, in order?

A
  1. A-alpha
  2. A-delta
  3. C fibers
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6
Q

What are the fibers that are found in the cutaenous tissue?

A

A-delta

C fiber

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7
Q

What are the fibers that are found in the joints?

A 
A delta
C fibers (more here)
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8
Q

Which are more prominent in joints: c fibers or a delta?

A

C fibers

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9
Q

What are the types of fibers found in muscles?

A

Similar to joint:

A-delta and C fibers, with x2 more C fibers

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10
Q

What are the types of fibers found in visceral structures?

A

C fibers

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11
Q

Where does spinal modulation occur?

A

Dorsal horn of the spine (substantia gelatinosa)

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12
Q

What is the route of innervation of pain (second and first order neurons)?

A

Spinothalamic pathway

DRG, then substantia gelatinosa, anterior white commissure, and up to the thalamus

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13
Q

What are the fibers found in lamina I and V? What type of pain is this associated with?

A

A-delta fibers–fast, acute pain

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14
Q

What are the fibers that are found in lamina V? What type of stimuli do these respond to?

A

Wide dynamic range fibers

Respond to noxious and non-noxious stimuli

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15
Q

What are the fibers that are found in lamina II and III? What type of pai is this associated with?

A

C fibers–slow, chronic pain

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16
Q

What are the wide dynamic range fibers? What fibers do they synapse with?

A

Polymodal neurons in lamina V that respond to A-alpha, A-beta, A-delta , and C fibers

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17
Q

What is the major neurotransmitter that is involved in pain transmission?

A

Glutamate

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18
Q

What are the receptors that respond to glutamate? Which response to substance P?

A

AMPA and NMDA receptors

NK1 for substance P

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19
Q

Which fiber type has the lowest threshold?

A

A-beta fibers

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20
Q

What is secondary hyperalgesia?

A

Prolonged and increased activation of nociceptors in the periphery and projection pathways at the spinal cord

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21
Q

What is the molecular basis for central sensitization or secondary hyperalgesia? (what is the primary neurotransmitter/receptor combination involved in the pain pathway? What happens to the receptor when the signal is prolonged/strong enough?)

A

Pain signal from neurons releases Glutamate, which activates AMPA receptor.

AMPA receptor will activate NMDA receptor, causing rush of Ca into cell, and “wind up”

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22
Q

What is neuronal plasticity?

A

Modulation of intracellular signaling and changes in gene expression

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23
Q

What is the chemical basis for chronic pain?

A

Exaggerated release of glutamate and substance P that results in increased gene expression of pain signals

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24
Q

What is allodynia?

A

Pain resulting from a non-noxious stimulus (sunburn)

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25
Q

What are the fibers in the DC/ML pathway? (1)

A

A-beta

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26
Q

What are the fibers in the AL system? (2)

A

C fibers and A-delta fibers

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27
Q

What is the major pathway that pain travels through? What type of fibers are utilized here?

A

Neospinothalamic tract–a-delta fibers

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28
Q

Where does the neospinothalamic tract arise from, and terminate?

A

Arises from lamina I, IV, V goes to VPL nucleus of the thalamus

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29
Q

Where does the VPL nucleus of the thalamus send projections to?

A

Primary somatosensory cortex

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30
Q

What type of information travels through the neospinothalamic tract?

A

Sharp pain, with sharp localization

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31
Q

What type of fibers are utilized by the paleospinothalamic tract?

A

C fibers

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32
Q

Where does the paleospinothalamic tract begin and terminate?

A

Begins in Lamina II, III, V

Ends in the limbic system

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33
Q

What type of pain information comes from the paleospinothalamic tract? What is the quality of pain sensed through this tract?

A

Emotional response to pain

Dull, throbbing pain

34
Q

What is the function of the spinoreticular tract?

A

Descending pain control and motor response

35
Q

What is the function of the spinomesencephalic tract?

A

Descending pain control

Regulates pain experience

36
Q

What is the function of the superior colliculus with the spinomesencephalic tract?

A

eye movement toward site of injury

37
Q

What is the tract that is utilized for the sensory/discriminative component of pain?

A

Neospinothalamic tract

38
Q

What is the tract the is utilized for the emotional component of pain?

A

Paleospinothalamic tract

39
Q

What is the route of innervation from the VPL nucleus of the thalamus to the prefrontal cortex? (5)

A
  1. Primary somatosensory
  2. Somatosensory association cortex
  3. Insular cortex
    4, Anterior cingulate cortex
  4. prefrontal cortex
40
Q

What is the function of the anterior cingulate cortex in pain?

A

Attention part of the pain

41
Q

Where do signals that go from the spinal cord to the amygdala go?

A

Prefrontal cortex

42
Q

Where do signals that go from the spinal cord to the dorsomedual nucleus thalamus go?

A

Anterior cingulate gyrus to prefrontal cortex

43
Q

What are the five things that the pain matrix contributes to pain?

A
  1. Threatening visual and auditory cues
  2. Memory of pain
    3 Anticipation
  3. Attention
  4. Empathy with others
44
Q

What are the two areas in the brain that are most active during pain and are the main parts of the pain matrix?

A

Insula and anterior cingulate cortex

45
Q

When is the ACC active in pain? (3)

A

Perception of pain
Imagining pain
Observation of pain

46
Q

What is the function of the insula in pain?

A

Relay station to the limbic system and hypothalamus

47
Q

What is the gate control theory? How does it work?

A

C fibers can be deactivated by competition from the A beta fibers

because A beta fibers are faster, and stimulate an inhibitory interneuron

48
Q

What are the three areas of the brain that are a part of the descending pain control?

A
  1. Periaqueductal gray
  2. Rostral ventral medulla
  3. Locus coeruleus -pons in brainstem
49
Q

What drugs utilized the descending pathway of pain control?

A

Opioids

50
Q

What is the role of the amygdala in pain perception?

A

Assigning a negative context to pain

51
Q

What is the role of the prefrontal cortex in the pain pathway?

A

Cognitive experience of pain

52
Q

What is the nucleus in the pons that plays a role in descending pain control?

A

Nucleus raphe magnus

53
Q

What is the role of the ventrolateral PAG?

A

Sympathetic inhibition

54
Q

What is the role of the dorsal PAG?

A

Sympathetic excitation–prepares for fight or flight

55
Q

Which is blocked by naloxone: the ventrolateral or the dorsal PAG?

A

Ventrolateral

56
Q

What is the MOA of the ventrolateral PAG?

A

Nonselective inhibition of A and C fiber input

57
Q

What is reflective pain?

A

Pain that is Perceived at a location other than the site of the painful stimulus

58
Q

What is convergence of pain?

A

somatic and visceral pain fibers converge on the same secondary afferents in the dorsal horn, causing referred pain

59
Q

What is projected pain?

A

Stimulation of a nerve along its path, causing pain in the areas that is innervates distally (hitting ulnar nerve at the medial epicondyle of the humerus

60
Q

What is the MOA of phantom pain?

A

Reorganization of the neurons in the spinal cord or brain

61
Q

What is complex regional pain syndrome?

A

Continuous burning pain long after seemingly trivial injuries

62
Q

What is the treatment for complex regional pain syndrome?

A

Sympathectomy or sympathetic nerve block

63
Q

What is central pain? What type of pain is this characterized as?

A

‘pain’ originating from a central process. A form of

neuropathic pain.

64
Q

What are the symptoms of thalamic pain?

A

Severe pain to the entire contralateral side of the body

65
Q

What are the nociceptive specific neurons?

A

Neurons in laminas I, II, and III that receive only noxious input

66
Q

Which is wider: primary or secondary hyperalgesia?

A

Secondary

67
Q

What is the “wind up” phenomenon?

A

Activation of the NMDA receptor, causing Ca to rush in and activate lots of pain stuff

68
Q

What is the cause of allodynia?

A

WInd up effect

69
Q

What is the MOA of opioids?

A

Release of met-enkephalin on the presynaptic spinothalamic neurons, to
reduce excitability

70
Q

Which is more laterally located: the neospinothalamic tract, or the paleospinothalamic tract? Which has a smaller receptive field?

A

Neospinothalamic (for both)

71
Q

True or false: the DC/ML pathway has nothing to do with pain, only discriminative touch and proprioception

A

False–carries visceral pain

72
Q

The nucleus Raphe uses what neurotransmitter?

A

5HT

73
Q

The locus ceruleus uses what neurotransmitter?

A

NE

74
Q

What is the MOA of the locus ceruleus and Raphe nucleus in the descending pain control system?

A

Activate inhibitory neurons in the spine

75
Q

What is the role the PAG plays in the descending pathway?

A

Activates the Raphe and Locus Ceruleus

76
Q

What is the gate control theory of pain?

A

Fast conducting mechanoreceptor activation stimulates an inhibitory interneuron with the primary afferents (a-delta and C fibers) pathway

77
Q

What is projected pain?

A

Pain produced by irritation of a axon at an ectopic site (like hitting funny bone)

78
Q

What is the basis for phantom limb pain?

A

reorganization of the somatosensory cortex and probably other subcortical areas,
including the spinal cord

79
Q

What is sympathetic mediated pain?

A

continuous burning pain that may develop following a

traumatic peripheral injury.

80
Q

What is required to develop sympathetic mediated pain?

A

Intact SNS

81
Q

What is the basis for Sympathetic Mediated Pain (SMP)?

A

tonic release of NE by a damaged sympathetic fibers can activate/sensitize the nociceptors
eliciting ‘pain’

Physiology (75 decks)

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