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Pharm 2 > Pain pathways > Flashcards

Pain pathways Flashcards

1
Q

Pain is a complex phenomenon that includes two components, what are they?

A

1) Sensory discriminative
2) Motivation Affective responses

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2
Q

What is sensory discriminative?
What is the pathway of this?

A

Ascending pathways
spinothalamic & trigemino-thalamic tracts –> cerebral cortex –> perception of pain

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3
Q

Motivation- affective responses to painful stimuli include? (4 things)

A

`1) Attention and arrousal
2) somatic and autonomic reflexes
3) Endocrine responses)
4) Emotional changes

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4
Q

The international association for the study of pain emphasizes the complex nature of pain as _____, _______, _______.

A

Physical, emotional, Psychological

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5
Q

What is “The experience of pain with a series of complex neurophysiologic processes?”

A

Nociception

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6
Q

What are the 4 places that medications target to treat pain?

A

Transduction, transmission, interpretation and modulation in CNS and PNS

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7
Q

Does the degree of damage to tissue that is present always correlate with patient’s experience of pain?

A

No!

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8
Q

Chronic pain in ____ % of adult population.

A

40%

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9
Q

Low back ___% to ____ % in 45 to 60 yr olds.

A

8% to 37%

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10
Q

____ million with MS pain condition.

A

40 million

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11
Q

Annual cost of pain in society?

A

40 billion!!! This doesn’t factor in surgeries and lost day of work.

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12
Q

What part of nociception? “Nerve/electrical impulses start at the nerve endings”

A

Transduction

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13
Q

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

A

Transmission

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14
Q

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

A

Modulation

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15
Q

Thalamus acting as the central relay station for incoming pain signals & the** primary somatosensory cortex** serving for discrimination of specific sensory stimuli.

A

Perception

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16
Q

What step in nociception do local anesthetics work on for peripheral nerve blocks?

A

TRANSMISSION

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17
Q

What is the central relay station in the brain?

A

Thalamus

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18
Q

What is the primary area serving for discriminiation of specific sensory stimuli?

A

Sematosensory cortex

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19
Q

Where do the modulation of pain impulses occur?

A

Dorsal Horn

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20
Q

Location of Nociceptors at the peripheral level? (5)

A

Skin, muscles, joints, viscera, vasculature

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21
Q

What is the pathway of the peripheral nerve pain?

A

Stimulus –> Nociceptor: Resting Threshold –> Transmission –> Modulation –> Interpretation

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22
Q

Unmyelinated pain fibers?
What type of pain?
How fast does it travel?
Acute or chronic?

A

C- Fibers
Burning pain from heat and pressure from sustained pressure.
SLOW pain: 2 m/s
Chronic

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23
Q

Myelinated fibers?
types?
what kind of pain do they transmit?
Speed of transmission?
Acute or chronic?

A
  • A fibers
  • type 1 A-beta and A -delta: heat, mechanical, chemical
  • Type 2 fibers: A- delta: heat
  • FAST PAIN: > 2 m/s
  • Acute pain
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24
Q

Name the main groups of chemical mediators. (7)

A

Peptides
Eicosanoids
Lipids
Neutrophins
Cytokines
Chemokines
Extracellular proteases and protons

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25
Q

What are specific peptide chemical mediators?

A

Substance P
Bradykinin (1st released)
CGRP

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26
Q

What are the specific lipid mediators?

A

Prostaglandins
Thomboxanes
Leukotrienes
Endocannbinoids

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27
Q

What drug that we commonly use acts on the lipids ?

A

NSAIDS

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28
Q

What chemical mediator does cannabis act on?

A

Endocanninoids

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29
Q

What group of chemical mediators is targeted by spinal/ epidural anesthetics?

A

Peptides

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30
Q

What are the Receptors and Ion Channels Dorsal root ganglion & peripheral terminals?

A

Purinergic
Metabotropic
Glutamatergic
Tachykinin
TRPV I
Neurotrophic
Ion channels

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31
Q

What is sensitization?

A

the increased responsiveness of peripheral neurons responsible for pain transmission

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32
Q

What is acute pain?

A

acute pain is short term and limited to days to weeks after injury. Provides important protective mechanism signaling body to protect the area.

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33
Q

What is chronic pain?

A

pain that persists even after the tissue healing is complete and extends beyond the expected period of healing. Chronic pain receptors fire even in the absence of tissue damage.

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34
Q

What is Hyperalgesia?

A

Increased pain sensations to normally painful stimuli.

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35
Q

What is allodynia?

A

perception of pain sensations in response to normally non-painful stimuli.

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36
Q

What is primary Hyperalgesia?

A

increased pain sensation at the original site of injury from heat and mechanical injury.

37
Q

Primary hyperalgesia causes an ____ in pain threshold.

A

Decrease!
It’s easier for them to experience pain, they have a more exaggerated response

38
Q

____ response to suprathreshold stimuli.

A

INCREASED
They have an expansion of their receptive field

39
Q

Does primary or secondary hyperalgesia cause spontaneous pain?

A

Primary hyperalgesia

40
Q

What is secondary hyperalgesia?
This can only occur from what type of stimuli?

A

increased pain sensation to the unijured skin surrounding the injury.
Mechainal stimuli

41
Q

What is the Relay center for nociceptive & other sensory activity?

A

Spinal Dorsal Horn

42
Q

Where do the Ascending pathways take information?

A

To brainstem and forebrain (SI and SII) for determination of perception of pain location & intensity

43
Q

Lamina 1 is also called?
What fibers go here?

A

Marginal layer
Afferent C fibers

44
Q

What is another name for lamina 2?
What fibers are here?
What drugs work specifically in this lamina?

A

Substantia gelatinosa
C fibers
Opioids

45
Q

Lamina I, IV, VII, and Ventral Horn have what fibers there?
Which innervate what kind of structures?

A

Myelinated fibers (A- beta, A-delta)
Muscles and viscera

46
Q

Lamina III and IV have what receptor which is stimulated by what chemical mediator?

A

NKI receptor stimulated by substance P

47
Q

Describe the gate control theory of pain.
When gate is open what fibers are acting?
When gate is closed what fibers are acting?

A

When the gate is open A- delta and C fibers transmit pain to the brain. But by applying pressure to the site of injury it closes the gate and A-beta fibers deliver information about the pressure and touch information, while inhibiting the A delta and C fiber pain transmission.

48
Q

What area is responsible for perception of motivational- affective pain components?

A

Limbic cortex and thalamus

49
Q

What area is responsible for depression or facilitating the integration of info in the spinal dorsal horn to the thalamus to be relayed to the sematosensory cortex?

A

Periaqueductal gray - rostral ventromedial Medulla system
(PAG-RVM)

50
Q

Name the 7 Neuromodulators of the CNS.

A

Substance P
Glutamate
CGRP
NMDA (specific neuromodulator to ketamine)
AMPA
BDNF
Cytokines

51
Q

Which neuromodulator is specific to ketamine? and what is the full name?

A

NMDA
N-methyl-d-aspartate

52
Q

What are two major CNS neuromodulators that are important to anesthesia?

A

Substance P and NMDA

53
Q

Tissue injury releases what chemical mediators?

A

Substance P and Glutamate

54
Q

Damaged cells, mast cells and platelets release what chemical mediators? (6)

A

Bradykinin
Histamine
prostaglandins
Serotonin
Hydrogen ion
Lactic acid

55
Q

Primary excitatory impulse mediator?

A

Glutamate

56
Q

E or I?
Glutamate

A

excitatory

57
Q

E or I?
Calcitonin

A

Excitatory

58
Q

E or I?
GABA

A

Inhibitory

59
Q

E or I
Glycine

A

Inhibitory

60
Q

E or I?
Enkephalins

A

Inhibitory

61
Q

E or I
Norepinephrine

A

Inhibitory

62
Q

E or I
Calcitonin

A

Excitatory

63
Q

E or I
Neuropeptide Y

A

Excitatory

64
Q

E or I
Dopamine

A

inhibitory

65
Q

E or I
Aspartate

A

Excitatory

66
Q

E or I
Substance P

A

Excitatory

67
Q

What are the four ascending pathways of Nociception information

A

Spinothalamic
Spinomedullary
Spinobulbar
Spinohypothalamic

68
Q

Spinothalamic transmits what type of pain?
What fibers?
what laminae?

A

Pain, temp, itch
ALL fibers (a beta, a delta, C fibers)
Laminae I, VII, VIII

69
Q

Spinobulbar pathways detemines what?
What laminae?

A

Behavior towards pain
Laminae I, V, VII

70
Q

Spinohypothalamic determines what 3 aspects of pain?
Laminae?

A

Autonomic, neuroendocrine, and emotional aspects of pain.
Laminae: I, V, VII, and X

71
Q

What part of the brain determines Location and intensity of pains?

A

Forebrain S1 and S2 (somatosensory 1 and somatosensory 2)

72
Q

What parts of the amygdala determine the emotinal and motivational aspects of pain?

A

Anterior cingulate cortex (ACC) and
Insular Cortex (IC)

73
Q

What other parts of the brain are mentioned that deal with pain? (he didn’t say anything specific about these, just read them off the slide..)

A

Prefrontal cortex
Thalamus (RELAY CENTER)
Cerebellum

74
Q

Describe the descending inhibitory pain pathway.
What NT’s are involved?
What is the end result of the pathway?

A

The periaqueductal gray is where this pain pathway originates. It passes through the Rostral VentroMedial Medulla, then through the dorsolateral funiculus and synapses at the Dorsal horn.
NT’s : endorphins, enkephalins, serotonin
Hyperpolarization of A-delta and C-fibers which decreases the release of Substance P through opening of K+ channels and inhibition of Ca+ channels.

75
Q

Where does the pain impulse originate if it is pertaining to the descending inhibitory tract?

A

PAG-RVM

76
Q

What is neuropathic pain?
Who’s at increased risk for this pain?
What is treatment?

A

Persists after the tissue has healed, allodynia and hyperalgesia
Increased risk: Cancer patients d/t chemo and radiation therapy
Treatment: symptomatic (opioids, gabapentin, amitryptiline, cannabis)

77
Q

What is visceral pain?
What are causes?

A

Diffuse & poorly localized (referred to somatic sites: muscle & skin)
Causes: ischemia, stretching of ligamentous attachments, spasms, distention

78
Q

what is Complex regional pain Syndrome?
What are symptoms of this?

A

A variety of painful conditions following injury in a region with impairment of sensory, motor, and autonomic systems

Symptoms include: Spontaneous pain, allodynia, hyperalgesia, edema, autonomic abnormalities, active and passive movement disorders, and trophic changes of skin & SQ tissues.

79
Q

What is the earliest pain is felt in gestation?

A

23 weeks

80
Q

Pain in neonates and infants has __ threshold and ____ pain responses.

A

Decreased,
increased

81
Q

Cardiovascular responses to pain?

A

Hypertension
Tachycardia
Myocardial irritability
↑ SVR
Could compromise LV function and lead to decreased CO and MI

82
Q

Pulmonary response to pain?

A

Increased total body oxygen consumption and CO2 production.
Increased minute ventilation

83
Q

Decreased movement of chest wall d/t pain can lead to?

A

Atelectasis and intrapulmonary shunting

84
Q

Physical manifestations of pain r/t pulm system?

A

Splinting, decreased movement of chest wall, imparied coughing

85
Q

GI/GU response to pain?
and complications?

A

Enhanced sympathetic tone…↑ sphincter tone, and ↓ motility
causes ileus and urinary retention

Hypersecretion of acid
Causes Stress ulceration and Aspiration

N/V
Abdominal distention

86
Q

Endocrine Response to pain?

A

↑ catabolic hormones
Catecholamines
Cortisol
Glucagon
↓ anabolic hormones
Insulin
Testosterone
Effects
Negative nitrogen balance
Carbohydrate intolerance
Increases renin, aldosterone, angiotensin

87
Q

Hematologic response of pain?
(effects on platelets, fibrin, and coagulation?)

A

Platelet adhesiveness

Reduced fibrinolysis

Hypercoagulability

88
Q

Emotional responses?

A

anxiety, sleep distrubances, and depression

Pharm 2 (4 decks)

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