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Year 1: Patho/Pharm > Pain Patho > Flashcards

Pain Patho Flashcards

1
Q

Gate control Theory
Pathophysiology

A

Substantia gellatinosa in posterior horn spinal cord
- gate, open, partially open, closed
- A beta fibres converge and decrease nociceptive signal from a delta (somatic nociceptive pain) and C delta (visceral nociceptive pain)
- CNS efferent nerves converge and increase or decrease signal

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2
Q

Pain
Definition

A

Whenever
whatever
person says it is
subjective
actual or potential tissue damage

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3
Q

3 types of pain

A
  1. acute (nociceptive)
  2. chronic
  3. neuropathic
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4
Q

Acute pain
Definition

A

Nociceptor
- sensory neuron transducts pain signal

Nociceptive pain
- pain to tissue injury or potential injury
- most common type of acut epain
- time limited
- stops when inflammatory mediators are cleared
- vital sign changes

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5
Q

3 types of nociceptive pain

A
  1. Somatic pain
  2. visceral pain
  3. referred pain
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6
Q

Somatic pain
Defintion

A

Nociceptive pain
bones, connective tissues, skin
superficial or deep
a delta fibres - sharp, localized, acute
c delta fibres - dull, aching

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7
Q

visceral pain
Definition

A

nociceptive pain
organs and lining of organs
c delta fibres: dull, aching, continuous
can cause hypotensive shock

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8
Q

A delta vs. C delta fibres

A

A delta
- fast
- large diameter
- myelinated
- sharp localized pain
- somatic nociceptive pain

C delta fibres
- slow
- small diameter
- unmyelinated
- diffuse poorly localized pain
- somatic or visceral pain
- dull aching pain

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9
Q

Referred pain
Definition

A

Type of nociceptive pain

skin afferent neurons converge on the same interneuron in the posterior dorsal horn as the visceral nociceptor

number skin receptors > number visceral nociceptor

brain interprets location of pain as the skin (distant) from the actual site

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10
Q

Purpose of acute nociceptiv epain

A
  1. quickly withdraw from stimuli
  2. learn form it
  3. rest the area
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11
Q

Chronic pain
Definition

A

Pain persists past time of expected healing
> 3 months - 6 months = chronic pain
out of proportion to the injury experienced

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12
Q

Chronic pain
Pathophysiology

A

healing resulted in change in pain pathway (PNS and CNS)
- hypersensitivity of the nociceptors (lower threshold for activation)
- decreased modulation of pain signal in the spinal cord

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13
Q

Chronic pain
Negative effects

A
  • depresison
  • stress
  • decreased healing
  • mobility
  • chronically active stress reposnse
  • imparied cognition, learning, memory, fatigue
  • no change in VS (adaptive SNS no response)
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14
Q

Neuropathic pain
Definition

A

injury to nervous system
altered sensory interpretation post healing

Paraesthesia - electrical, numb, tingling, burning, lancing, shooting

occurs with or without stimuli (spontnaeously generated)

hyperalgesia - intesity of pain increased
allodynia - painless stimuli causes pain
dysathesia - painful pareasthesiasPat

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15
Q

Pathophysiology
Neuropathic pain

A
  • hypersensitivity of nociceptor
  • spontaneous signal generated from healing neuron
  • loss of modulation (descending inhibitor pathway)
  • inflammation cytokines activating nociceptors
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16
Q

Sensation of pain
Pathophysiology

A

Nociceptor
- free nerve fibre
1. mechanical
2. thermal
3. chemical stimuli

Cell body located in the dorsal root ganglion
central proccess projects to the posterior horn (substantia gellatinosa, spinal gate)

Depolarization and fire action potential

First order neuron
1. a delta fibres - large, myelinated, fast (anterior tract, neospinothalamic)
2. c delta fibres - small, unmyelinated, slow (lateral tract, paleospinothalamic tract)

17
Q

Second order neuron
ascending spinal tracts

A
  1. spinoreticular tract
    - PONS
    - arousal to pain/emotional perceptino of pain
  2. spinomesencephalic tract
    - midbrain (periaqueductal gray aera)
    - modulation of pain (increase or decrease)
18
Q

third order neurons

A
  1. spinothalmic tract
    - third order neurons
    - cortex
    - emotion, cognitive, sensory processing of pain
19
Q

Modulation
Facilitators

A

Glutamate
Glycine
substance P
prostaglandins
bradykinin
calcitonin

20
Q

Modulators
Inhibitors of pain

A

GABA
opioids
cannabinoids
NE
serotonin

21
Q

4 phases of nociception

A
  1. transduction
  2. transmission
  3. perception
  4. modulation
22
Q

Pain threshold vs. tolerance
Life cycle

A

Theshold
- minimum amount of pain needed to register as stimuli
- lowers with repeated painful stimuli
- lower in infant and older adult and potentially child

Tolerance
- how much patient can tolerate
- varies individual and time
- decrease tolerance - stress, fatigue
- increase tolerance - opioids, CBT, distraction

23
Q

Endogenous opioids

A

Morphine like neuropeptides
- endorphines
- enkephalins
- dynorphins
- endomorphins

  • mu, kappa, delta receptors
  • bind to neurons
  • inhibit ion channels
  • neuromodulation of pain
  • prevent depolarization and activation of the pain signal (cannot release excitatory neurotransmitters in the posterior horne
24
Q

Ecosanoids = Endocannabinoids

A

synthesized from phospholipids
CB1 receptors in CNS
prevent excitatory NT release in posterior horn, midbrain, thalamus
pain decreased

CB2 receptors
memory, appetite, sleep, thermoregulation, addiction

25
Q

Modulation of pain
Pathways

A
  • Descending pathway from midbrain
  • synapse on interneuron in posterior horn
  • turns the neuron ON
  • release of inhibitory NT (GABA, opioids, NE, serotonin, cannabinoids)
  • prevent afferent pain signal (excitatory pain signal)
  • Cognitive expectation can turn on the descending inhibitory pain modulation pathway

SEGMENTAL pain inhibition
- Modulation of pain from periphry
- A beta fibres skin
- rubbing them sends afferent signal to the same interneuron in posterior horn
- turns on inhibition
- release of inhibitory NT
- decrease pain transmission from afferent nerve

HETEROSEGEMETNAL pain inhibition
- two noxious stimuli at the same time
- pain inhibits pain

26
Q

Non pharmacological therapy pain
pathophysiology

A

Exercise
- release endogenous opioids
- bind to neurons, inhibit release of excitatory (painful signals)

CBT/mindfulness
- cognitive signal
- descending apthway activated
- activates inhibitory interneurons in the posterior horn

massage, accupuncture, hot/cold
- activates pain
- heterosegmental
- two pain signals, one cancels out

Year 1: Patho/Pharm (39 decks)

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