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Anesthesia Pharm (Spring 2023) Drugs and Doses Only > Pain Pathways (Exam II) > Flashcards

Pain Pathways (Exam II) Flashcards

1
Q

Differentiate the sensory-discriminative & motivational-affective aspects of pain.

A
  • Sensory-discriminative - Ascending pathways and the perception of pain (location, intensity, sensation, etc.)
  • Motivational affective - responses to painful stimuli (Ex. arousal, reflexes, endocrine responses, and emotional changes)
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2
Q

What is nociception?

A
  • The experience of pain through a series of complex neurophysiologic processes.
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3
Q

What are the four stages of pain perception?

A
  1. Transduction (tissue level)
  2. Transmission (via nerves)
  3. Modulation (via spinal cord)
  4. Perception (CNS, thalamus)
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4
Q

Where does the modulation of pain impulses occur?

A
  • Dorsal horn of the spinal cord
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5
Q

What drugs are used to affect the transduction of pain?
What specifically is being affected by these drugs?

A
  • Local anesthetics & NSAIDs
  • Peripheral nociceptors
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6
Q

What drugs are used to affect the transmission of pain?
What specifically is being affected by these drugs?

A
  • Local anesthetics
  • Αδ and C fibers
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7
Q

What drugs are used to affect the modulation of pain?
What specifically is being affected by these drugs?

A
  • LA’s, opioids, ketamine, α2 agonists
  • Afferent fibers of the dorsal horn
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8
Q

What drugs are used to affect the perception of pain?
What specifically is being affected by these drugs?

A
  • General anesthetics, opioids, α2 agonists
  • Brain
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9
Q

Where are nociceptors located?

A
  • Skin
  • Muscles
  • Joints
  • Viscera
  • Vasculature
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10
Q

What characterizes afferent C-fibers?

A
  • Unmyelinated
  • Pain from heat (burning) & sustained pressure
  • Slow (less than 2 m/s)
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11
Q

What characterizes Aδ fibers?

A

-Myelinated
- Type I: Aβ & Aδ (heat,mechanical, chemical)
- Type II: Aδ (heat)
- Fast (>2 m/s)

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12
Q

What chemical mediators of pain are targeted with spinal anesthetics?

A

Peptides

  • Substance P
  • Calcitonin
  • Bradykinin
  • CGRP
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13
Q

Which chemical mediator is released first in response to injury?

A
  • Bradykinin
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14
Q

What chemical mediators of pain are inhibited by NSAIDs?

A

Lipids
- Prostaglandins
- Thromboxanes

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15
Q

What chemical mediators of pain are inhibited by cannabis?

A

Lipids
- Endocannabinoids

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16
Q

What is sensitization?

A
  • Decreased pain threshold (likely due to upregulation of receptors)
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17
Q

Differentiate hyperalgesia and allodynia.

A
  • Hyperalgesia - ↑ pain sensations to normally painful stimuli.
  • Allodynia - perception of pain to things that aren’t normally painful.
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18
Q

What characterizes primary hyperalgesia?

A

Hyperalgesia at original site of injury.

  • Lower pain threshold
  • Spontaneous pain
  • Expansion of receptive field
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19
Q

What characterizes secondary hyperalgesia?

A
  • Sensitization of CNS → hyperalgesia from uninjured skin surrounding injury.
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20
Q

What area of the brain accounts for the perception (location & intensity) of pain?

A
  • Somatosensory Cortex I & II (SI & SII)
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21
Q

What is the relay center for nociceptive and sensory activity?
How does sensory activity travel from this area to the cerebrum?

A
  • Spinal Dorsal Horn
  • Ascending pathways
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22
Q

What areas of the brain may depress or facilitate the integration of painful information in the spinal dorsal horn?

A
  • PAG - Peraqueductal Gray Matter
  • RVM - Rostral Ventral Medulla
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23
Q

Where are afferent C-fibers located in the spinal column?

A
  • Dorsal horn: Lamina I & II
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24
Q

What is another name for Lamina II?
What drugs work here?

A
  • Substantia gelatinosa
  • Opioids
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25
What nerve fibers are associated with an "open-gate" for pain? What nerve fibers can shut this gate?
- Aδ & C-fibers = **open** - Aβ fibers = **closed**
26
What receptors does ketamine target for pain modulation?
- NMDA
27
The excision of what structure would result in the complete loss of perception of pain?
Amygdala *Bonus points if you just said the whole brain you degenerate*.
28
What neurotransmitters propagate excitatory transmissions in the spinal column?
- Glutamate - Calcitonin - Neuropeptide Y - Aspartate - Substance P
29
What neurotransmitters propagate inhibitory transmissions in the spinal column?
- GABAA - Glycine - Enkephalins - NE - Dopamine
30
What are the four ascending pain pathways?
- Spinothalamic - Spinomedullary - Spinobulbar - Spinohypothalamic
31
What information is carried by the spinothalamic pathway? What laminae are used?
- Pain, Temp, & Itch - Laminae I, VII, and VIII
32
What information is carried by the spinobulbar pathway? What laminae are used?
- Behavior towards pain - Laminae I, V, and VII
33
What information is carried by the spinohypothalamic pathway? What laminae are used?
- Autonomic, neuroendocrine & emotional aspects of pain - Laminae I, V, VII, & X.
34
What part of the suprapinal pathway differentiates where pain is coming from?
S1 & S2 (Somatosensory cortex 1 & 2)
35
What supraspinal areas deal with the emotional/motivational aspects of pain?
- Anterior cingulate cortex (ACC) - Insular Cortex (IC) - Amygdala
36
Where do the descending inhibitory tracts originate? Where do they then synapse at?
- PAG (periaqeueductal gray matter) - Synapse at dorsal horn
37
What neurotransmitters are increased with exercise?
- Endorphins - Enkephalins - Serotonin
38
How do inhibitory tracts inhibit the propagation of painful stimuli?
**Hyperpolarizing Aδ & C fibers** - ↓ release of substance P - ↑ pK⁺ and inhibiting Ca⁺⁺ channels
39
Where does the pain inhibiting impulse originate from in the descending inhibitory tracts?
PAG-RVM areas
40
When is pain considered chronic rather than acute?
- If > 3 - 6 months - If pain persists beyond tissue healing
41
Who is at increased risk of neuropathic chronic pain?
- Cancer patients - Diabetics
42
What is the treatment for chronic neuropathic pain?
- Opioids - Gabapentin - Amitriptyline - Cannabis *All situation dependent*
43
How is visceral pain characterized? What examples were given in lecture?
- Diffuse and poorly localized
44
What is complex regional pain syndrome?
- Variety of painful issues following an injury (sponateous pain, hyperalgesia, edema, etc.)
45
When can babies begin to perceive pain?
23 weeks
46
How does pain affect the GI/GU system?
- ↑ SNS = ↑ sphincter tone and ↓ peristalsis = **N/V, ileus, distension**, etc. - Stress ulcers
47
How can the effects of pain in the cardiovascular system be summarized?
↑ SNS *↑BP, HR, etc.*
48
What hormones experience a decrease in response to chronic pain?
**Anabolic Hormones** - Insulin - Testosterone
49
What are the pulmonary effects of chronic pain?
- Shallow breathing → **atelectasis and pneumonia.**
50
Pain
* emphasizes the complex nature of pain as a physical, emotional, and psychological condition * Degree of tissue damage?
51
What is Hyperalgesia
Increased pain sensations to normally painful stimuli.
52
What is Allodynia
perception of pain sensations in response to normally non-painful stimuli.
53
What are unmyelinated afferent fibers
C- fiber: burning pain from heat and pressure from sustained pressure.
54
What are myelinated afferent fibers
A-fiber: Type I fibers ( Aβ & Aδ fibers): heat, mechanical, chemical Type II fibers (Aδ fibers): heat
55
What are the cheical mediators of pain?
* Peptides (Substance P, Calcitonin, Bradykinin [1st released], CGRP) * Eicosanoids * Lipids (Prostaglandins, Thromboxanes, Leukotrienes, Endocannabinoids) * Neutrophins * Cytokines * Chemokines * Extracellular proteases and protons
56
What are the receptors ion Channels of peripheral nerve physiology of pain?
* (Dorsal Root Ganglion & Peripheral Terminals) * Purinergic * Metabotropic * Glutamatergic * Tachykinin * TRPV I * Neurotrophic * Ion channels (Nav 1.8)
57
What are the cardiovascular response to pain?
* Prominent * Hypertension * Tachycardia * Myocardial irritability ↑ SVR * Compromised LV ↓ CO * Myocardial ischemia
58
What is the pulmonary Response pain ?
* ↑ total body O2 consumption/CO2 production ↑ Vm and work of breathing * Splinting * Decreased movement of chest wall Atelectasis Intrapulmonary shunting Impaired coughing
59
What is the Gi/Gu Response
* Enhanced sympathetic tone…↑ sphincter tone, and ↓ motility Ileus Urinary retention * Hypersecretion of acid Stress ulceration Aspiration * N/V * Abdominal distention
60
What is the endocrine reponse to pain
* ↑ catabolic hormones o Catecholamines o Cortisol o Glucagon * ↓ anabolic hormones o Insulin o Testosterone * Effects o Negative nitrogen balance o Carbohydrate intolerance o Increases renin, aldosterone, angiotensin
61
What is the hematologic reponse to pain
* Stress Related o Platelet adhesiveness o Reduced fibrinolysis o Hypercoagulability
62

Anesthesia Pharm (Spring 2023) Drugs and Doses Only (20 decks)

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