Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anesthesia Pharm (A) > Pain Pathway (2) > Flashcards

Pain Pathway (2) Flashcards

1
Q

What are the 2 components of pain?

A

Sensory (discriminative)

Motivational (affective)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the ascending pain pathways?

A

Spinothalamic and Tigemino-thalamic tracts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What part of the brain does pain transmit to?

A

Cerebral cortex for perception of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Responses to painful stimuli include:

A

Attention and arousal
Somatic and autonomic reflexes
Endocrine responses
Emotional changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why is pain described as having complex nature?

A

emphasizes the complex nature of pain as a physical, emotional, and psychological condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is nociception? What do medications target?

A

The experience of pain with a series of complex neurophysiologic processes

Meds target causes of pain by actions on transduction, transmission, interpretation, and modulation in both PNS and CNS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hyperalgesia:

A

Increased pain sensations to normally painful stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Allodynia:

A

Perception of pain sensations in response to normally non-painful stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Chronic pain in ___% of the population

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Annual cost related to pain:

A

$40 billion (not including surgery and lost workdays)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most common reason for people seeking medical care:

A

Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Low back pain __% - ___% in people 45-60y/o

A

8-37

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pathway after nociception stimulation?

A
  • Transduction
  • Transmission
  • Modulation
  • Perception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nerve/electrical impulses/signals start at the nerve endings:

A

Transduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Travel of nerve/electrical impulses to the nerve body connecting to the dorsal horn of the spinal cord:

A

Transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Process of altering (inhibitory/excitatory) pain transmission mechanisms at the dorsal horm to the PNS and CNS:

A

Modulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Thalamus acting as the central relay station from incoming pain signal and the primary somatosensory cortex serving for discrimination of specific sensory stimuli:

A

Perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the central relay station for incoming pain signals?

A

Thalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where is the primary discrimination area for specific sensory stimuli?

A

Somatosensory Cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where does modulation of pain transmission occur?

A

Dorsal horn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where does transduction of nerve impulses start?

A

Nerve endings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What meds affect transduction of pain from mechanical, chemical, and thermal stimuli into action potentials?

A

LA, NSAIDS (peripheral nociceptors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What med modulates transmission of pain action potentials via A delta and C fibers?

A

Local Anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What meds modulate afferent signals of pain in the dorsal horn of spinal cord?

A

LA, opioids, ketamine, A2 agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What meds alter perception of pain by activating descending inhibitory pain pathway and memory?
Opioids, A2 agonists, General Anesthetics
26
Where does the modulation of pain impulses occur?
Dorsal horn
27
Where are nociceptors located?
* Skin * Muscles * Joints * Viscera * Vasculature
28
How does pain pathway progress from peripheral nerve?
Stimulus→ nociceptor→ resting threshold → transmission→modulation→interpretation
29
What type of fibers are afferent unmyelinated fibers? What type of pain is transmitted on these fibers?
C fibers: burning pain from heat and pressure from sustained pressure
30
What type fibers (I and II) are afferent myelinated fibers?
Type I fibers ( Aβ & Aδ fibers): heat, mechanical, chemical Type II fibers (Aδ fibers): heat
31
What are the chemical mediators for pain in the periphery?
Peptides (substance P, Calcitonin, bradykinin, CGRP) Eicosanoids Lipids (PGs, TXA, leukotrienes, endocannabinoids) Neutrophins Cytokines Chemokines Extracellular Proteases and protons
32
What chemical mediator is released first in response to pain?
Bradykinin
32
What do chemical mediators of pain cause?
Vasodilation, Inflammation, expansion of pain
33
Decreased pain threshold at the original site of injury from heat and mechanical injury:
Primary hyperalgesia
33
What happens as a result of Primary hyperalgesia?
Decreased pain threshold Increased response to suprathreshold stimuli Spontaneous pain Expansion of receptive field
34
Uninjured skin surrounding the injury (only mechanical stimuli):
Secondary Hyperalgesia
35
What happens with secondary hyperalgesia?
Sensitization of central neuronal circuits
36
What is the relay center for nociceptive and other sensory activity in the CNS?
Spinal dorsal horn
37
What is the path for the ascending pain pathway?
Goes to brainstem and forebrain→perception of pain location and intensity
38
What is another term for lamina I? What fibers synapse here?
Lamina marginalis Afferent C fibers
39
What is another term for lamina II? What fibers synapse here?
Substantia Gelatinosa Afferent C fibers
40
Where do myelinated fibers synapse? What are they innervating?
Lamina I, IV, VII and ventral horn (A fibers) Innervating muscles and viscera
41
Which lamina do opioids work to inhibit pain transmission?
Lamina II
42
Which lamina affect NKI receptor with substance P?
Lamina III and IV
43
When did the gate control theory of pain come about?
1965
44
What does the "gate open" indicate? What fibers are involved when gate is open?
Pain is projected to supraspinal brain regions A delta fibers (small, myelinated) and C fibers (unmyelinated)
45
What does "gate closed" indicate? What fibers are involved?
Pain is not felt with simultaneous inhibitor impulses (EX: rubbing bumped elbow) A beta fibers (larger diameter and myelinated)
46
Which fibers deliver info about pressure and touch?
A beta fibers→large, myelinated
47
Where is perception of motivational-affective pain components sent?
Limbic cortex and thalamus
48
Area in the brain that depresses or facilitates the integration of pain info in the spinal dorsal horn:
Periaqueductal gray (PAG) / Rostral Ventromedial Medulla (RVM)
49
Neuromodulators of the CNS:
* Substance P * Glutamate * CGRP * NMDA * AMPA * BDNF * Cytokines
50
Tissue injury releases _______ and ________ to the nociceptor.
* Substance P * Glutamate
51
What mediators do damaged cells, mast cells, and platelets release?
* Bradykinin * Histamine * PGs * Serotonin * H+ ions * Lactic Acid
52
A excitatory impulse mediator:
Glutamate
53
Excitatory impulse modulation in the spinal cord:
* Glutamate * Calcitonin * Neuropeptide Y * Aspartate * Substance P
54
Inhibitory impulse modulation in the spinal cord:
* GABA * Glycine * Enkephalins * Norepinephrine * Dopamine
55
What are the different ascending pathways of nociceptive info?
* Spinothalamic * Spinomedullary * Spinobulbar * Spinohypothalamic
56
Which ascending pathway is responsible for pain, temp, and itch?
Spintothalamic (lamina I, VII, VIII) all afferent fibers
57
Which ascending pathway involves the behavior toward pain?
Spinobulbar (laminae I, V, VII)
58
Which ascending pathway involves autonomic, neuroendocrine, and emotional aspects of pain?
Spinohypothalamic (Laminae I, V, VII, and X)
59
What part of the forebrain is involved with identifying pain location?
SI: primary somatosensory cortex
60
What part of the forebrain is involved with intensity of pain?
SII
61
Where does supraspinal modulation of nociception occur?
* Forebrain (SI and SII) * Anterior cingulate cortex ()ACC * Insular cortex: ACC and IC: emotional/motivational aspects * Prefrontal Cortex * Thalamus * Cerebellum
62
Where does the descending inhibitory tract originate? Where does the signal travel through and then synpase?
Periaqueductal gray (PAG) → Travels through rostral ventromedial medulla (RVM) → dorsolateral funiculus → Synpase in dorsal horn
63
What neurotransmitters are involves in descending inhibitory tract?
Endorphins, Enkephalins, Serotonin
64
What is the MOA of descending inhibitory tract?
Hyperpolarize: uses A delta and C fibers Decrease release of substance P→ opening of K+ channels/ inhibition of Ca++ channels
65
What factors affect the descending inhibition/facilitation pathways?
Other somatic stimuli: lack of sleep, stress, prior experiences, etc Psychosocial factors: arousal, attention, and expectation
66
Which receptors are part of the the PAG-RVM system?
Mu, Kappa, Delta (hyperalgesia and allodynia)
67
Where does the pain impulse originate if it is pertaining to the descending inhibitory tract?
PAG-RVM
68
How long does pain have to last to classify as chronic?
>3-6 months→ persists beyond tissue healing
69
Unpleasant emotional experiences use the same pathways as ________ __________.
Chronic pain anxiety, depression, cognitive deficits, emotional distress
70
Type of pain that persists after the tissue has healed:
Neuropathic pain→ allodynia and hyperalgesia
71
Who is at increased risk for neuropathic pain?
Cancer patients d/t chemo and radiation therapy
72
What is the treatment for neuropathic pain?
Treat based on symptoms (opioids, gabapentin, amitryptiline, cannabis)
73
Diffuse, poorly localized pain: What are causes of this?
Visceral Pain Ischemia, Stretching of ligament attachments , spasms, distention
74
Complex Regional Pain Syndromes:
A variety of painful conditions following injury in a region with impairment of sensory, motor, and autonomic systems Spontaneous pain, allodynia, hyperalgesia, edema, autonomic abnormalities, active and passive movement disorders, and trophic changes of skin & SQ tissues
75
How does the CV system respond to pain?
↑BP ↑HR ↑SVR ↑ myocardial irritability ↓CO ↓Myocardial ischemia
76
How does pulmonary system respond to pain?
↑ total body O2 consumption/CO2 production ↑ Vm and work of breathing Splinting Decreased movement of chest wall Atelectasis Intrapulmonary shunting Impaired coughing
77
How does GI/GU respond to pain?
Increased sphincter tone Decreased mobility (ileus, urinary retention) Hyper secretion of acid (stress ulcers, aspiration) N/V ABD distention (decrease peristalsis)
78
Endocrine system response to pain:
↑ catabolic hormones * Catecholamines * Cortisol * Glucagon ↓ anabolic hormones * Insulin * Testosterone Effects * Negative nitrogen balance *Carbohydrate intolerance *Increases renin, aldosterone, and angiotensin
79
What are hematologic responses to pain?
Stress related: * Platelet Adhesiveness * Reduced fibrinolysis * Hyper-coagulability
80
How does the immune system respond to pain?
Stress related * Leukocytosis * Depressed reticuloendothelial system (increased infection)
81
What are some emotional responses to pain?
* Anxiety * Sleep disturbance * Depression

Anesthesia Pharm (A) (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions