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Moving Exam 2 > Pain Physiology > Flashcards

Pain Physiology Flashcards

1
Q

Pain definition

A

Unpleasant sensory & emotional experience associated w or resembling that associated w actual or potential tissue damage

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2
Q

Nociception

A

Neuronal process of encoding noxious stimuli:
- reception/conduction & CNS processing of nerve signals generated by stimulation of nociceptors

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3
Q

Consequences of encoding nocicpetion

A

Autonomic (elevated BP)
Behavioral (motor withdrawal reflex)
Pain sensation is not necessarily implied

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4
Q

Nociceptive pathway

A

Primary afferent (incoming) tissue nociceptor
Crosses at spinal cord
2nd projects to brain
Tertiary projects to cortex/higher structure

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5
Q

Ascending pain pathway

A

Perception (cerebral cortex)
Modulation (spinal cord)
Transmission (sensory nerves)
Transduction (sensory nerve endings, nociceptors)

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6
Q

Transduction

A

Alpha-delta nociceptors
Composed of mechanoreceptors & mechanothermal receptors
- low thresholds (<75%)
- high thresholds (<25%)

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7
Q

Discharge of alpha-delta nociceptors

A

Discharged at higher rate than C-fiber nociceptors
- provide more discriminative info to CNS
- responsible for pricking & sharp qualities of 1st pain

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8
Q

C-fiber nociceptors

A

Almost all high threshold & respond to different types of stimulation (polymodual)
Activation is responsible for slow-onset (2nd) pain that occurs after the initial insult

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9
Q

secondary pain to c-fiber nociceptors

A

Burning & aching qualities
Signals tissues damage & inflammation that initiates self-preservation behaviors such as avoidance, guarding and disuse

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10
Q

Silent of sleeping nociceptors in transduction

A

Present in both A-delta fibers & C-fibers
High threshold activated by tissue damaging events
Important role in peripheral sensitization

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11
Q

Pathway of transducing pain to action potential

A

Lesion stimulates bradykinin, serotonin, prostaglandin, K+, histamine (from mast cell)
Sends activation of nociceptors
Depolarization of cell membrane
Action potential

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12
Q

Origination of electrical signals

A

ES are transmitted by nociceptive fibers to dorsal root ganglion at spinal cord

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13
Q

A-deltoid fibers receive electrical signals

A

Small diameter 1-4um
Myelinated
Fast conduction
Transit well, localized pricking, sharp pain
“First pain”

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14
Q

C-fibers features for receiving electrical signals

A

Small diameter 0.4-1.2um
Unmyelinated
Slow conduction
Transmit poorly localized dull or aching pain
“Second pain”

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15
Q

Tracts for transmitting signals

A

Signal cross from gray to white matter & travels through ascending tracts
Spinothalamic
Spinocervical
Spinoreticular
Spinohypothalamic

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16
Q

Spinothalamic tract

A

Most important in transmission of nociceptive information

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17
Q

Spinocervical tract

A

Important role in carnivores

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18
Q

Modulation

A

Dorsal horn of the spinal horn
Amplification (activation) or suppression (inhibition) of the nociceptive impulses
Regulation of NMDA receptor
Modulating the release of substances like P and GABA

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19
Q

Activation of modulation

A

Excitatory or inhibition Interneurons which transmit sensory information for short distance in spinal cord

20
Q

Activation of modulation - withdrawal reflex

A

Propriospinal neurons involved in segmented reflex activity extend to Supra spinal centers (midbrain & cortex) through ascending tracts to synapse the 3rd order neurons located in medulla, pons, midbrain, thalamus, hypothalamus and cerebral cortex

21
Q

Location of 3rd order neurons

A

Medulla, pons, midbrain, thalamus, hypothalamus and cerebral cortex

22
Q

Function of perception

A

End result of neuronal activity of pain transmission. Pain becomes a conscious multidimensional experience

23
Q

Cortical areas activated during perception

A

Reticular area
Somatosensory cortex
Limbic system

24
Q

Response of reticular system

A

Autonomic & motor response & warning to do something (move away from insult)

25
Q

Response during activation in Somatosensory cortex

A

Identifies intensity, type and location of pain, relates to past experience & memory

26
Q

Response to activation in limbic system

A

Emotional & behavioral responses to pain (attention, mood, motivation)

27
Q

Inhibitory mechanisms of descending pathways

A

Noradrenergic pathway
Serotonergic pathway
Opioid system

28
Q

Location & mechanisms of noradrenergic pathway

A

Locus coeruleus to dorsal horn
Stimulates adrenergic receptors (alpha 2)
Decrease in release of P
- hyperpolarizing 2nd order neuron
- depolarizing the GABAergic neurons to inhibit pain transmission

29
Q

Mechanism & function of serotonergic pathways

A

Nucleus raphe magnus to dorsal horn
Excitatory effects (5-HT2A and 5-HT3 receptors)
Release of enkephalins
- inhibit release of sub P
- hyperpolarizing 2nd order neuron

30
Q

Opioid system locations

A

Periaqueductal gray
Raphe magnus
Dorsal horn of SC

31
Q

Function of opioid system at periaqueductal gray

A

Glutamate excites enkephalins
Inhibits GABA
Activate glutamatergic neuron

32
Q

Opioid system at raphe magnus

A

Allows glutamate to excite enkephalins
Inhibits GABA
Allows excitation of serotonin neuron

33
Q

Opioid system at dorsal horn of SC

A

Acts as presynaptic opioid receptor
- inhibits Ca influx = inhibits release of subs P
Postsynaptic promotes K efflux = hyperpolarization = inhibits pain transmission
Enhances inhibition of GABA in descending modulatory neuron

34
Q

Peripheral sensitization activators

A

Primary hyperalgesia
Sub p
Neurokinin A
Calcitonin gene related peptide (CGRP)
——>

35
Q

Peripheral sensitization results

A

Excitability of sensory & sympathetic fibers
Promote vasodilation
Extravasation of plasma proteins
Recruitment of inflammatory cells

36
Q

Peripheral sensitization - sensitizing soup

A

Cytokines
Serotonin
Prostaglandins & leukotrienes
Hydrogen & potassium ions
Nitric oxide
Bradykinin
Histamine
Others

37
Q

Sensitizing soup ions function

A

Lower response threshold for A-delta and C fiber activation
Activation of silent norciceptors

38
Q

Central sensitization

A

Brain (thalamus)
Exaggerated response of normal inputs
Wind up

39
Q

Wind up includes

A

Alterations in dorsal horn neuronal function
Reduction of neuronal firing threshold
Increase in neuronal response associated w the given stimulus
After-discharge or spontaneous neuronal signaling
Spread of increased sensitivity to adjacent neurons

40
Q

Pathophysiological effects of treating pain

A

^ anxiety, depression, HR, RR, coagulability
V metabolism, immune function

41
Q

Pathophys effects - immune system

A

^ cortisol levels impair wound healing and v immune system function
^ ADH, catecholamines, renin, angiotensin II, aldosterone
V insulin and test

42
Q

Pathophys effects - neuroedocrine

A

Activated by pain
Glucogenesis is favored - hyperglycemia
Impaired metabolism results in increased protein catabolism, lipolysis and cachexia

43
Q

Pathophys effects - GIT

A

Sympathetic stimulation can cause shunting of blood, v motility, v mucosal integrity

44
Q

Pathophys effects - cardio system

A

Activation of Renin-angiotensin system
Fluid retention (water & sodium)
Elevated BP
V renal perfusion
^ HR, SV, CO and myocardial O2 consumption

45
Q

Pathophys effects - resp t

A

Atelectasis
Ventilation perfusion mismatch
Arterial hypoxemia
Hypercarbia

46
Q

Pathophys effects - coagulation system

A

^ platelet adhesiveness
V fibrinolysis
Hypercoagulation

47
Q

Psychological effects of treating pain

A

Patients quality of life is decreased w pain
Owners can feel frustration or guilty of procedures
Caregivers feel guilt or lack of compassion if unable to treat pain

Moving Exam 2 (26 decks)

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