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(Steele) Anesthesia Pharm Grayson (Spring 2023) > 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.)
  • spinothalamic and trigemino-thalamic –> cerebral cortex –> perception of pain
  • 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, nerve endings)
  2. Transmission (via nerves)
  3. Modulation (via spinal cord, PNS and CNS)
  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
  • Can be inhibitory or excitatory
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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 (A-delta) 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 does the modulation of pain impulses occur?

A. Thalamus
B. Dorsal Horn
C. Cortex
D. CNS

A

B. Dorsal Horn

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10
Q

Where are nociceptors located?

A
  • Skin
  • Muscles
  • Joints
  • Viscera
  • Vasculature
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11
Q

What characterizes afferent C-fibers?

A
  • Unmyelinated
  • Pain from heat (burning) & sustained pressure
  • Slow (less than 2 m/s)
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12
Q

What characterizes A-fibers?

A

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

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13
Q

What chemical mediators of pain are targeted with spinal anesthetics?

A

Peptides

  • Substance P
  • Calcitonin
  • Bradykinin
  • CGRP
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14
Q

Which chemical mediator is released first in response to injury?

A
  • Bradykinin
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15
Q

What chemical mediators of pain are inhibited by NSAIDs?

A

Lipids
- Prostaglandins
- Thromboxanes

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16
Q

What chemical mediators of pain are inhibited by cannabis?

A

Lipids
- Endocannabinoids

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17
Q

What can be found on the pain pathway after transmission and before modulation?

A

The Dorsal Root Ganglion

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18
Q

Receptors and channels found in the DRG and the Peripheral Terminals (7)

A
  • Purinergic
  • Metabotropic
  • Glutamatergic
  • Tachykinin
  • TRPV I
  • Neurotrophic
  • Ion Channels
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19
Q

What is sensitization?

A
  • Decreased pain threshold (likely due to upregulation of receptors)
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20
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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21
Q

What characterizes primary hyperalgesia?

A

Hyperalgesia at original site of injury.

  • Lower pain threshold
  • Spontaneous pain
  • Increased response to suprathreshold stimuli
  • Expansion of receptive field
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22
Q

What characterizes secondary hyperalgesia?

A
  • Sensitization of CNS → hyperalgesia from uninjured skin surrounding injury only from mechanical stimuli.
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23
Q

What area of the brain accounts for the perception (location & intensity) of pain and is also called the forebrain?

A
  • Somatosensory Cortex I & II (SI & SII)
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24
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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25
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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26
Q

The perception of motivational-affective pain components are found where?

A

Limbic Cortex and Thalamus

27
Q

What are the 2 main parts of the brain stem?

A
  • PAG - Peraqueductal Gray Matter
  • RVM - Rostral Ventral Medulla
28
Q

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

A
  • Dorsal horn: Lamina I & II
29
Q

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

A
  • Substantia gelatinosa
  • Opioids
30
Q

Where are the NK-1 receptors found?

A

On Laminae III and IV where substance P is used

31
Q

What NT is targeted when using spinal anesthesia?

A

Substance P

32
Q

Gate open part of theory, pain is projected to the ____ regions

A

supraspinal brain

33
Q

What nerve fibers are associated with an “open-gate” for pain?
What nerve fibers can shut this gate?

A
  • Aδ & C-fibers = open
  • Aβ fibers = closed
34
Q

Aβ fibers are?
They are found in?

A

Large, myelinated, and faster

Laminae I, IV, and VII in ventral horn

35
Q

What receptors does ketamine target for pain modulation?

36
Q

The excision of what structure would result in the complete loss of perception of pain?

A

Amygdala

Bonus points if you just said the whole brain you degenerate.

37
Q

What neurotransmitters propagate excitatory transmissions in the spinal column?

A
  • Glutamate
  • Calcitonin
  • Neuropeptide Y
  • Aspartate
  • Substance P
38
Q

What neurotransmitters propagate inhibitory transmissions in the spinal column?

A
  • GABAA
  • Glycine
  • Enkephalins
  • NorEpi
  • Dopamine
39
Q

What are the four ascending pain pathways?

A
  • Spinothalamic
  • Spinohypothalamic
  • Spinomedullary
  • Spinobulbar
40
Q

What information is carried by the spinothalamic pathway?
What laminae are used?

A
  • Pain, Temp, & Itch
  • Laminae I, VII, and VIII
41
Q

What information is carried by the spinobulbar pathway?
What laminae are used?

A
  • Behavior towards pain
  • Laminae I, V, and VII
42
Q

What information is carried by the spinohypothalamic pathway?
What laminae are used?

A
  • Autonomic, neuroendocrine & emotional aspects of pain
  • Laminae I, V, VII, & X.
43
Q

What part of the supraspinal pathway differentiates where pain is coming from?

A

Forebrain: S1 & S2 (Somatosensory cortex 1 & 2)

44
Q

What supraspinal areas deal with the emotional/motivational aspects of pain?

A

The limbic system:

  • Anterior cingulate cortex (ACC)
  • Insular Cortex (IC)
  • Amygdala
45
Q

Where do the descending inhibitory tracts originate?
Where do they then synapse at?

A
  • PAG (periaqeueductal gray matter)
  • Synapse at dorsal horn
46
Q

What neurotransmitters are increased with exercise?
What part of the pain tract are they a part of?

A
  • Endorphins
  • Enkephalins
  • Serotonin

The supraspinal descending inhibitory tracts

47
Q

How do inhibitory tracts inhibit the propagation of painful stimuli?

A

Hyperpolarizing Aδ & C fibers

  • ↓ release of substance P
  • ↑ pK⁺ and inhibiting Ca⁺⁺ channels
48
Q

Where does the pain inhibiting impulse originate from in the descending inhibitory tracts?

A

PAG-RVM areas

49
Q

What are two aspects of the descending pathways of pain modulation?

A

Descending Inhibition Pathway (DI)
Descending Facilitation Pathway (DF)

50
Q

When is pain considered chronic rather than acute?

A
  • If > 3 - 6 months
  • If pain persists beyond tissue healing
51
Q

Who is at increased risk of neuropathic chronic pain?

A
  • Cancer patients
  • Diabetics
52
Q

What are the two types of neuropathic pain?

A

Allodynia and hyperalgesia

53
Q

What is the treatment for chronic neuropathic pain? (4)

A
  • Cannabis
  • Opioids
  • Amitriptyline
  • Gabapentin

All situation dependent

54
Q

How is visceral pain characterized?
What examples were given in lecture?

A
  • Diffuse and poorly localized
  • referred to somatic sites - skin and muscles
55
Q

Causes of visceral pain

A

Ischemia
stretching of ligaments
spasms
distention

56
Q

What is complex regional pain syndrome?

A
  • Variety of painful issues following an injury
  • IE: Spontaneous pain, allodynia, hyperalgesia, edema
57
Q

When can babies begin to perceive pain?

A

23 weeks

Lower pain threshold and exaggerated responses

58
Q

How does pain affect the GI/GU system?

A
  • ↑ SNS = ↑ sphincter tone and ↓ peristalsis = N/V, ileus, distension, etc.
  • Stress ulcers –> aspiration

N/V - intraop could be from gasses, Post op could be from pain

59
Q

How can the effects of pain in the cardiovascular system be summarized?

A

↑ SNS

↑BP, HR
Myocardial ischemia
Myocardial irritability
Compromised LV
↓ CO

60
Q

What hormones experience a decrease in response to chronic pain?

A

Anabolic Hormones
- Insulin
- Testosterone

61
Q

What are the pulmonary effects of chronic pain?

A
  • Shallow breathing → atelectasis and pneumonia.
  • Intrapulmonary shunting
  • impaired coughing
62
Q

What hormones experience an increase in response to chronic pain?

A

Catabolic hormones
- Catecholamines
- Cortisol
- Glucagon

63
Q

Pain effects on the hematologic system

A
  • platelet adhesiveness
  • Reduced fibrinolysis
  • hypercoagulability
64
Q

Immune responses to pain

A

Stress related
- Leukocytosis
- Depressed reticuloendothelial system
- increased infection

(Steele) Anesthesia Pharm Grayson (Spring 2023) (20 decks)

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