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PT 631 Neuroanatomy > Pain Pathways > Flashcards

Pain Pathways Flashcards

1
Q

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

A

pain

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2
Q

what two things can influence clinical decision making and patient outcomes for each individual patient

A

pain and pain tolerance

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3
Q

what is the 5th vital sign

A

pain

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4
Q

what affects more people than DM, heart disease and cancer combined

A

chronic pain

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5
Q

what are the most common sources of pain

A

spinal pain, HA, arthritis

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6
Q

what can pain impact

A
  • pain receptors do not follow predictable rules
  • pain can lead to changes in autonomic function (increaed HR, BP, RR)
  • pain impacts your affect
  • pain impacts motivation
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7
Q

pain results from direct nociceptive stimulation and triggers inflammatory response via release of substance P and other chemical mediators at the site of tissue injury

A

physiologic pain (nociceptive)

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8
Q

pain results from direct injury to CNS/PNS structures and associated with incomplete or maladaptive regeneration of axons following injury in PNS and CNS structures

A

neuropathic pain

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9
Q

examples of neuropathic pain

A

DM neuropathy, phantom pain, thalamic pain

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10
Q

what are the 6 steps in nociceptive process

A

transduction
inflammation
conduction
transmission
modulation
perception

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11
Q

activated by intense pressure on the skin

A

mechanical nociceptors

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12
Q

what fibers do mechanical nociceptors travel on

A

A delta

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13
Q

activated by extreme temperatures

A

temperature nociceptors

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14
Q

what fibers do thermal nociceptors travel on

A

A delta

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15
Q

activated by intense mechanical, thermal, or chemical stimuli

A

chemically sensitive and polymodal nociceptors

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16
Q

what do chemically sensitive and polymodal nociceptors travel via

A

C

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17
Q

what are the 2 types of afferents that allow for conduction from the nociceptor to the spinal cord

A

afferent a delta to DRG (immediate pain)
afferent C fibers to DRB (slow pain)

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18
Q

small myelinated fibers for fast pain response, sends noxious information from skin and mucous membranes

A

A deltas

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19
Q

acute, sharp, well localized pain

A

a deltas

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20
Q

small unmyelinated fibers for slow pain and send noxious information from muscles, tendons, digestive tract, skin and heart

A

C fibers

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21
Q

chronic pain, dull, burning, aching, poorly localized or referred pain

A

C fibers

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22
Q

what is triggered to be released when tissue to damaged to trigger an inflammatory response and what is an example

A

cytokines - prostaglandins

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23
Q

sensory nerve fibers (primary afferent) receive the signal and carry it to the info to the dorsal horn of the spinal cord via the

A

1st order neuron

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24
Q

a delta and C fibers for mechanical/thermal pain go to which laminar level

A

1 and 2

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25
Q

A beta and C fibers for mechanical and pain stimulus from muscle, viscera and skin go to which laminar levels

A

4 and 5

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26
Q

sensory information after passing the DRG will synapse to what and cross over to the opposite ALS

A

2nd order neuron

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27
Q

which afferent spinal tract carries pain

A

ALS

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28
Q

what 2 types of cell bodies allow for transmission of the afferent to the gray dorsal horn

A

nonspecific/wide dynamic range neurons (WDR) and specific neurons

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29
Q

where are cells bodies for nonspecific/wide dynamic range neurons located and which fibers do information travel via

A

lamina V
A beta and C afferents

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30
Q

nonspecific wide dynamic range neurons area activated by what

A

mechanical and nociceptive stimuli from viscera, muscle, and skin

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31
Q

axons from the nonspecific wide dynamic range neurons form which tract

A

paleospinaothalamic tract (slow pain)

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32
Q

specific neuron cells bodies are located in which lamina and receive information via which afferents

A

lamina I and II
A delta and C afferents

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33
Q

specific neurons are activated by

A

mechanical/thermal nociceptive pain

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34
Q

axons of specific neurons form which tract

A

neospinothalamic tract (fast pain)

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35
Q

what are the main neurotransmitters associated with pain messaging in the spinal cord

A

glutamate and substance P

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36
Q

what binds with AMPA type receptors that are for fast excitatory post-synaptic potentials (EPSP)

A

glutamate

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37
Q

what is released from C afferents onto lamina I and II eliciting slow EPSPs

A

substance P

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38
Q

neurotransmitters that are inhibitory and mediate analgesia and reduction of hyperalgesia

A

adenosine and GABA

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39
Q

what neurotransmitter is a second messenger enzyme involved in hyperalgesia

A

protein kinase A

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40
Q

endorphins, enkephalins, serotonin, and norepinephrine for central mediation of pain

A

supraspinal descending afferents

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41
Q

participate in receptor expression and clearing away of neurotransmitters that remain in the synaptic cleft

A

glial cells

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42
Q

which tract mediates slow pain

A

paleospinalthalamic (paramedial ascending system)

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43
Q

what type of pain are associated with paleospinalthalamic tract

A
  • strong emotional response (annoying pain)
  • not easily localized and difficult to rate intensity
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44
Q

what fibers carry pain from paleospinalthalamic tract

A

C

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45
Q

travels to reticular formation, parafasiculus, and then centromedian thalamus and then to several other cortical areas

A

paleospinalthalamic tract

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46
Q

mediates crude touch, temperature, and fast pain

A

neospinothalamic

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47
Q

what are the two components of ALS for the transmission of pain

A

paleospinalthalamic and neospinothalamic tracts

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48
Q

mediates pain that is easily located and rated intensely, but is short lasting

A

neospinothalamic tract

49
Q

how to test neospinothalamic tract

A

pinprick on sharp dull test

50
Q

what fibers carry information from neospinothalamic tract to the cord

A

A delta

51
Q

travels to ventral posterolateral (VPL) nucleus of thalamus and then to the primary somatosensory cortex

A

neospinothalamic tract

52
Q

neospinothalamic and paleospinothalamic axons travel together in the

A

ALS

53
Q

in the ALS, dorsolateral is associate with and ventromedial is associated with

A

Dorsal - LE
Ventral - UE

53
Q

in the ALS, dorsolateral is associate with and ventromedial is associated with

A

Dorsal - LE
Ventral - UE

53
Q

in the ALS, dorsolateral is associate with and ventromedial is associated with

A

Dorsal - LE
Ventral - UE

54
Q

in the brainstem, which tract are on the lateral edge between the inferior olivary complex and spinal trigeminal complex

A

neospinothalic

55
Q

what does the neospinothalamic tract merge with to ascend to the VPM/VPL thalamus

A

trigeminal nucleus

56
Q

which tract axons give off branches to reticular formation which produces arousal response to painful stimuli and stays medial

A

paleospinothalamic tract

57
Q

which tract has axons that arranged somato-tropically

A

neospinothalamic

58
Q

no somatotropic arrangement and courses medially at the brainstem

A

paleospinothalamic axons

59
Q

what are the multiple tracts that make up the paleospinothalamic tract

A

spinoreticular tract
spinomesencephalic tract
spinohypothamic tract
spinomeotional tract

60
Q

at the level of the medullar and pons via raphe nuclei and responsible for arousal/attention/sleep wake cycles (slow pain alters sleep)

A

spinoreticular tract

61
Q

goes to periaqueductal gray at midbrain to superior colliculus and periaqueductal gray (PAG); has superior colliculus and PAG

A

spinomesencephalic tract

62
Q

what part of the spinomesenchalic tract turns eyes toward the pain location

A

superior colliculus

63
Q

what part of spinomesencephalic tract activates descending pathway to inhibit pain

A

PAG

64
Q

travels to the hypothalamus and activates autonoimic and endocrine responses to pain

A

spinohypothalamic tract

65
Q

located at VPM which projects to dorsolateral prefrontal cortex, anterior cingulate gyrus, and amygdala and activates in controlling emotional, sensory and motor response to pain

A

spinoemotional tract

66
Q

thalamocortical pathways carry nociceptive information to the cortex which is the _____, a complex network of synaptic links

A

pain neuromatrix

67
Q

the VPL to where responds to intensity and location of pain from the contralateral body and face

A

Brodmann’s area 1 (primary somatosensory cortex)

68
Q

the VOL to where recongnizes and signals eyes/head turn toward pain stimulus, learns about and remembers painful events

A

secondary primary somatosensory area in insula (SII)

69
Q

from the palospinothalmic and trigeminothalamic pathways to the VPM to what provides affect, motivation toward, and response selection for nociceptive stimuli

A

cingulate gyrus

70
Q

endogenous opioids bind to peripheral afferents receptors to limit nociceptive response

A

level 1 periphery

71
Q

local interneurons release encephalin/dynorphin via counterirritant effect, the gating mechanism

A

level 2 dorsal horn

72
Q

descending cortical input or endogenous opioids bind to receptors; narcotic bind to these same receptors, serotonin and norephinephrine

A

level 3 fast acting descending from PAG, medulla, locus coeruleus

73
Q

periventricular gray and pituitary gland release beta-endorphine, and adrenal medulla; low frequency TENS, rhythimic activities, stress mediated

A

level 4 hormonal system

74
Q

emotional aspects of pain; placebo, distractions, excitement and also activated by opiate drugs

A

level 5 amygdala and cortex

75
Q

two types of cortical modulation of pain

A

descending cortical pain modulation and ascending cortical pain modulation

76
Q

descending cortical pain modulated comes from ____ and ___ and terminated on _____ in midbrain

A

cortex
hypothalamus
PAG

77
Q

descending cortical pain modulation also have projections from _____ in the brainstem to ______ using noradrenergic neurotransmitters

A

locus coeruleus
dorsal horn

78
Q

ascending cortical pain modulation occurs bc neurons in the ______ pathway have receptors that bind with interneurons in the dorsal horn that trigger the release of enkephalin or dynorphin inhibiting 1st and 2nd order neurons

A

paleospinothalamic

79
Q

cortical pain responses is a _____ regulation

A

top down

80
Q

what does cortical pain response depend on

A

psychologic, physiologic, social and genetic factors

81
Q

during cortical pain response, what determines response to either inhibit afferent nociceptive input or amplify afferent nociceptive input

A

pain neuromatrix

82
Q

neurons in the PAS pathway have receptors that are sensitive to and will bind with

A

endorphins

83
Q

modulate pain signals by blocking signal to inhibit release of Ca++ into presynaptic terminal of DRG to decrease neurotransmitters or by opening K+ channels in post synaptic membrane to hyperpolarize to inhibit action potentials of 2nd order neurons

A

endorphins

84
Q

what can activate descending opioid system without noxious stimuli

A

endorphins

85
Q

3 classes of endorphines

A

beta-endorphin, met-enkephalin, dynorphin

86
Q

what is the way pain is modulated locally in the periphery

A

gate control theory

87
Q

what located in the spinal cord may modulate the transmission of pain signal in the gate control theory

A

interneurons

88
Q

pain modulation in the gate control theory is only achieved if _____ fibers are activated bc they are able to excite interneurons in lamina V to inhibit pain messsage by closing the gate to both pre and post synaptic neurons

A

A beta

89
Q

what can be used in the clinic to apply gate control theory

A

TENS, exercise, trigger point massage, acupuncture

90
Q

what are the 3 ways the dorsal horn processes nociceptive input

A

normal
anticociceptive - suppressed
pronociceptive

91
Q

what are the two types of pronociception

A
  • sensitized - hyperalgesia –> heightened response to less stimuli
  • reorganized - allodynia –> changes to dorsal horn
92
Q

what can occur with sensitization and reorganization

A

neuropathic pain

93
Q

occurs when receptors become increasingly responsive or the threshold for a noxious stimulus decreases

A

hyperalgesia

94
Q

sustained inflammatory response during hyperalgesia occurs due to

A
  • release of histamine and serotonin at site of injury by mast cells
  • prostaglandins released by fibroblasts
  • indirectly by interleukin-1, bradykinin, substance p
95
Q

altered processing by WDR neurons in lamina V of non-nociceptive incoming information on A-beta afferents

A

allodynia

96
Q

if input by C fibers is intense and there is an increased of glutamate and substance P released in the dorsal horn, WDR neurons are _____

A

depolarized

97
Q

reduces pain by increasing local blood circulation to flush out inflammatory irritants at the site of tissue damage and also stimulated A beta resulting in gate control theory

A

touch and massage

98
Q

high frequency TENS stimulated which fibers and low frequency TENS stimulates which fibers

A

A delta/A beta - gate control theory
C fibers - activates descending inhibitory pathway

99
Q

how does acupuncture work to decrease pain

A

activation of descending central modulation

100
Q

how long do you have to have pain for it to be considered chronic

A

> 3 months

101
Q

neuropathic pain is produced by what 3 main mechanisms

A

central sensitization
ectopic foci
ephaptic transmission

102
Q

what is associated with an injury to the somatosensory system and what are examples

A

neuropathic pain
phantom limb, thalamic pain syndrome, complex regional pain syndromes

103
Q

during phantom limb pain, the brain perceives that the limb is still present until ______ is complete

A

cortical reorganization

104
Q

pain following CVA or thalamus lesion on the ventrobasal complex; described as unremitting pain, aching, boring, gnawing, burning, and/or crushing

A

thalamic pain syndrome

105
Q

occurs following a lesion or series of traumas; results in abnormal sensory changes, altered blood flow, excessive sweating due to sympathetic denervation; pain described as severe, persistent or burning

A

complex regional pain syndrome CRPS

106
Q

reflex sympathetic dystrophy - trauma to distal extremity

A

CRPS 1

107
Q

causalgia - trauma to peripheral N

A

CRPS 2

108
Q

most common HA that is induced by stress, strain and/or pressure on face, neck and scalp muscles
leads to poor concentration, visual disturbances, tinnitus, dizziness, clumsinnes, TTP, sleep disorders

A

tension HA

109
Q

more common in young M; induced by stress, emotional trauma, allergies, alcohol, or high altitudes
throbbing pain behind nose or one eye, usually due to vasodilation of one external carotid A, eye may water and skin may be red

A

cluster HA

110
Q

what are the 4 phases of migraines

A

prodromal
aura
headache
postdrome

111
Q

premonition that migraine is coming: euphoria, depression, irritable, food cravings, constipation, neck stiffness, yawning

A

prodromal

112
Q

visual disturbance that develops 5-20 minutes and last less than 1 hour and is due to cortical spreading depression

A

aura phase

113
Q

what is the primary source of intracranial pain in migraines and what N innervates this

A

dura matter
trigeminal N

114
Q

what are examples of ablative techniques

A

rhizotomu, sympathectomy, cordotomy

115
Q

destruction of dorsal root

A

rhizotomy

116
Q

disruption/destruction/removal of sympathetic chain

A

sympathectomy

117
Q

disruption/destruction of spinal cord segment

A

cordotomy

PT 631 Neuroanatomy (17 decks)

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