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Neuroanatomy 2 > Pain lecture > Flashcards

Pain lecture Flashcards

1
Q

Define acute pain

A
  1. well-defined source
  2. autonomic and reflex signs
  3. emotional distress abates when cause is eliminated
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2
Q

What is nociceptive pain?

A
  1. injury to muscles,bones,ligaments, skin
  2. can be nociceptive somatic OR
  3. nociceptive visceral (gut, uterus, stomach)
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3
Q

Define pain

A

subjective experience -

associated with tissue damage or described in such

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4
Q

Prevalence of chronic non cancer pain (CNCP)

A

10-17% prevalence
maybe up to 29%
- prevalence varies according to population

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5
Q

Define disease

A
  1. Disease - clinical entity associated with disturbed function or structure of body part
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6
Q

Define illness

A

1- symptom perception
2 - symptom interpretation
3 - symptom expression
4 - coping behaviors

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7
Q

How does the medical model of disease view illness?

A
  1. Physical pathology
  2. Proportional to symptoms and disability
  3. psychological elements are secondary
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8
Q

What determines the nature/extent of a painful experience?

A
  1. attention
  2. appraisal
  3. coping strategies
  4. social experiences
  5. cultural variations
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9
Q

What are pain behaviours?

A
  1. verbal (verbalization,moaning)

2. non-verbal (grimacing, limping, gesturing)

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10
Q

When does the vulnerability to chronic pain increase?

A
  1. Physical or sexual abuse
  2. Marital discord
  3. Family violence
  4. psychoemotional trauma
  5. family members with pain/disability
  6. exposure to psychosocial or personal stressors
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11
Q

Define chronic pain

A
  1. lasts >6 months
  2. beyond regular healing time
  3. autonomic and reflex changes diminish with time
  4. psychological responses augment
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12
Q

When is chronic pain a biomedical condition?

A
  1. persistent/recurrent pain of nociceptive/neuropathic origin
  2. Life goes on despite limitations
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13
Q

when is chronic pain a disorder or syndrome?

A
  1. persistent/recurrent ALL the time
  2. underlying pathology has healed
  3. sadness,hopelessness, social isolation….
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14
Q

What are some red flags for the development of chronic pain disorders?

A
  1. Intense prolonged pain
  2. spreading pains or new pains
  3. failure to respond to treatment
  4. PTSD, anxiety, seriously depressed after injury
  5. Mistaken/pessimistic beliefs
  6. workplace difficulties
  7. employer can’t provide modified work
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15
Q

What is neuropathic pain?

A
  1. primary injury or dysfunction of CNS or PNS

2. injures peripheral nerves, spinal cord, brain

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16
Q

How do we explain extraordinary trauma in cultures?

A
  1. Internal pain blockers (endorphins)
  2. Altered states of mind (hypnosis)
    BOTH
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17
Q

What are alpha waves?

A
  1. Fast waves, occur at 8-13 cycles/sec

2. during regular, conscious activities

18
Q

What are theta waves?

A
  1. slower waves, 4-7 cycles/sec

2. seen during light sleep, creative thought, detach from reality

19
Q

which types of waves are seen in hook-hanging etc?

A

Theta waves

20
Q

How does hypnosis suppress pain?

A
  1. Splitting consciousness
  2. activating spinal cord descending pathways (block pain signals)
  3. alters the meaning of pain - targets unpleasantness
21
Q

How does hypnosis NOT work to suppress pain

A

By mobilizing the endogenous opioid system

22
Q

what is a placebo?

A
  1. ineffective treatment believed to be effective

2. change in illness due to symbolic effect not pharm effect

23
Q

What can placebo responses do?

A
  1. relieve pain
  2. Angina
  3. bronchospasm
  4. twisted posture or tremors or increase range of movement
24
Q

what % of treatments have a placebo effect?

A

70%!

25
Q

how is the placebo effect mediated?

A

partially by ENDORPHINS

26
Q

How do nocebo responses occur?

A

Occur with negative suggestions but unknown mechanisms

27
Q

what is fMRI based on?

A

Blood oxygenation level detection - due to different properties of deoxy and oxy hemoglobin

28
Q

what are the two types of fMRI measures?

A
  1. evoked responses within a brain area

2. correlated activity between brain areas

29
Q

What is seen in GM structures in chronic pain?

A
  1. cortical thinning of cingulate and insular cortex

2. discrepancy in thalamus, 1 somatosensory, prefrontal cortices

30
Q

What is thought to signal emotional pain?

A

Mid and anterior Cingulate Cortex - ACC but it responds to situations that demand attention/emotionally charged

31
Q

what is thought to be responsible for Subjective PAIN PERCEPTION?

A

Anterior portion of ACC and Posterior INSULA -

32
Q

what do large areas in the ACC and INsula detect

A

Thermal stimuli

and non-painful tasks

33
Q

Morphological brain changes have been seen in which conditions?

A
  1. Chronic back pain
  2. fibromyalgia
  3. CRPS
  4. Knee OA
  5. IBS
  6. temperomandibular disorder
  7. headaches/animal models of pain
34
Q

what is thought to be behind mindfulness therapies?

A
  1. enhanced dorsal anterior insula activity
  2. mid cingulate cortex
  3. reduced baseline activity in other brain regions
35
Q

What does CBT do?

A

Increases Gray Matter volume compared with controls but REDUCES gray matter in supplementary motor areas

36
Q

Decreased pain catastrophizing is associated with

A

Increased gray matter in left dorsolateral cortex

37
Q

what does yoga do?

A

Improve pain tolerance

38
Q

Subjects who have had hypnosis have

A

Greater functional connectivity between left dorsolateral prefrontal cortex

39
Q

Which brain structure is linked with an individual’s ability for endogenous pain control?

A

white matter integrity! - placebos

40
Q

what are nondermatomal somatosensory deficits?

A
  1. prevalent problem in chronic pain
  2. may appear after insignificant trauma
  3. bad prognostic sign
  4. emotional charged conditions/personality organization

Neuroanatomy 2 (25 decks)

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