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PHYSL 372 > Pain System 1 > Flashcards

Pain System 1 Flashcards

1
Q

What is pain according to the International Association for the Study of Pain (IASP)?

A

“An unpleasant SENSORY AND EMOTIONAL experience associated with ACTUAL OR POTENTIAL tissue damage, or described in terms of such damage.”

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2
Q

nociception

A

physiological processing of tissue damaging information

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3
Q

Why does pain exist in our biology?

A

protective mechanism to prevent tissue injury and permit recovery from injury

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4
Q

hyperalgesia

A

heightened pain (e.g. when damaged tissue is exposed to noxious stimulus)

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5
Q

TRUE or FALSE: a sunburn is an example of allodynia

A

FALSE: hyperalgesia

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6
Q

Draw and label allodynia and hyperalgesia on a pain sensation vs stimulus intensity graph.

A

slide 5

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7
Q

allodynia

A

pain arising from gentle touch (painful response to a stimulus that would not normally be painful)

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8
Q

TRUE or FALSE: allodynia is paradoxical pain

A

TRUE

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9
Q

What are the 2 components of pain perception?

A
  • somatosensory component
  • affective component
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10
Q

Describe the 2 responses of musculoskeletal and other mild pain.

A
  • initial response to tissue damage sensed by free nerve endings (pricking pain = first pain)
  • secondary response is ongoing pain caused by release inflammatory soup at site of lesion (burning/diffuse pain = second pain)
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11
Q

What fiber transmits first pain

A

sensory A-delta fibers

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12
Q

What fiber transmits second pain?

A

C fibers

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13
Q

What is another name for nociceptive pain?

A

deep pain

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14
Q

What is deep pain treated with?

A

opioids

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15
Q

Describe deep pain,

A

deep ACHING pain, felt as deep to the body surface, poorly localized

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16
Q

What is deep pain initiated by?

A

major trauma (postop pain, injury, or childbirth)

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17
Q

What does neuropathic pain result from?

A

nerve injury or infection

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18
Q

TRUE or FALSE: neuropathic pain is normally treated with opioids

A

FALSE: neuropathic pain responds POORLY to opioids

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19
Q

What is used to treat neuropathic pain?

A

antidepressants, cannabinoids, anticonvulsant

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20
Q

Which anticonvulsants can be used to treat neuropathic pain?

A

pregabalin and gabapentin

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21
Q

Is neuropathic pain stimulus dependent?

A

no, it is spontaneous and stimulus-independent

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22
Q

What is neuropathic pain characterized by?

A

allodynia, hyperalgesia, causalgia, and spontaneous (stimulus-independent) pain

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23
Q

classify the following as good or bad pain:
- musculoskeletal pain
- deep pain
- neuropathic pain

A

good pain: musculoskeletal and deep
bad pain: neuropathic

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24
Q

Which afferent fibers are non-pain fibers?

A

A-alpha and A-beta

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25
Q

What is the level of myelination and condution for A-alpha and A-beta fibers?

A

myelinated; rapidly conducting

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26
Q

What kind of information is transmitted via A-alpha and A-beta fibers?

A

touch, pressure, muscle afferent information

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27
Q

What is the level of myelination and conduction for A-delta fibers? What kind of information is transmitted?

A
  • thinly myelinated; slow conduction
  • carry first pain
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28
Q

What kind of receptors are associated with A-delta fibers?

A

high-threshold mechanoreceptors (mechanical nociceptors)

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29
Q

Where do A-delta fibers terminate?

A

in spinal lamina I (marginal zone) and lamina II and lamina V

(lamina I, II, V)

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30
Q

What is the level of myelination and conduction in C fibers? What kind of information is transmitted?

A
  • unmyelinated; very slow conduction
  • carry second pain
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31
Q

What are the 2 main types of C fibers?

A

peptidergic and isolectin B4 Positive (IB4+)

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32
Q

What kind of receptors (and stimuli) are associated with peptidergic C fibers?

A
  • high threshold mechanoreceptors (strong mechanical stimulation)
  • polymodal nociceptors (noxious heat mechanical stimuli, chemical irritants)
33
Q

What kind of receptors (and stimuli) are associated with IB4+ C fibers?

A

Low threshold mechanoreceptors (gentle mechanical stimulation)

34
Q

Which type of fiber is known as a silent nociceptor?

A

IB4+ C fiber

35
Q

Which NT do all sensory neurons use?

A

all use glutamate

36
Q

Which NT do A beta fibers use?
Which NT do A delta fibers use?
Which NT do peptidergic C fibers use?
Which NT do non-peptidergic C fibers use?

A

A beta = glutamate
A delta = glutamate, sub P, CGRP
pep C = glutamate, sub P, CGRP
non-pep C = glutamate

37
Q

Which afferent fiber is classified by the following:
- heavily myelinated
- fast conduction velocity
- large soma diameter
- transduce low threshold
- innocuous stimuli

38
Q

Which afferent fiber is classified as the following:
- thinly myelinated
- medium conduction velocity
- medium soma diameter
- can transduce innocuous/noxious stimuli

39
Q

Which afferent fiber is classified as the following:
- non-myelinated
- slow conduction velocity
- transduce noxious stimuli

A

peptidergic C

40
Q

Which afferent fiber is classified as the following:
- non-myelinated
- slow conduction velocity
- small soma diameter
- transduce noxious stimuli
- binds IB4
- does not produce pro-nociceptive peptides (CGRP/SubP)

A

non-peptidergic C

41
Q

Which receptor makes a cell/fiber peptidergic?

42
Q

What does the receptor TrkA bind?

A

NGF (nerve growth factor) - keeps cell alive by nociceptor

43
Q

TRUE or FALSE: peptidergic C fibers depend on NGF for survival and function, whereas non-peptidergic C fibers depedns on GDNF

44
Q

Where do pain fibers project to in the spinal cord? Which horn?

A
  • lamina II (substantia gelatinosa)
  • lamina I (marginal zone)
  • lamina V

(dorsal horn)

45
Q

Which lamina in the dorsal horn exclusively has pain-sensing cells (A delta, C)?

A

lamina I (marginal zone)

46
Q

Which lamina in the dorsal horn has integrators of different sensory stimuli?

47
Q

Where do lamina I projection neurons project to?

A
  • brainstem
  • parabrachial nucleus
  • hypothalamus
  • thalamus
48
Q

What kind of neurons are involved in local withdrawal and autonomic reflexes?

A

local circuit interneurons

49
Q

Which laminae have dendrites of wide dynamic range?

50
Q

What kind of receptors does the glutamate released form afferent fibers bind to?

A

AMPA and NMDAR

51
Q

Which receptor is responsible for faster first pain?

52
Q

What act as modulators for pain signals in the dorsal horn?

A
  • GABA/Gly interneurons
  • substance P and CGRP
53
Q

Which endogenous opioids can be released by some inhibitory INs?

A

enkephalin and endorphin

54
Q

Which 2 NTs are mostly responsible for preventing pain?

A

5HT and NA

55
Q

TRUE or FALSE: 5HT can be excitatory or inhibitory

56
Q

Where do descending pathways come from to release endogenous opioids?

A

rostroventral medulla (RVM)

57
Q

Most axons of lamina I and lamina V projection neurons cross midline and ascend in the _______________ quadrant of the spinal cord.

A

anteriolateral

58
Q

What are the 3 main pain tracts in the spinal cord?

A
  1. spinothalamic tract
  2. spinoreticular tract
  3. spinomesencephalic tract
59
Q

TRUE or FALSE: the pain pathways cross over at the midbrain

A

FALSE: cross at spinal cord

60
Q

TRUE or FALSE: the lateral division of the spinothalamic tract is phylogenetically old, whereas the medial division is recent

A

FALSE: lateral = recent; medial = old

61
Q

What is another name for the medial and lateral divisions of the spinothalamic tract?

A
  • medial = paleospinothalamic tract
  • lateral = neospinothalamic tract
62
Q

Where does the paleospinothalamic tract project to? neospinothalamic tract?

A
  • paleo = intralaminar thalamic neurons –> association and prefrontal cortex
  • neo = ventroposteriolateral (VPL) nucleus of the thalamus –> somatosensory cortex –> parietal lobe
63
Q

Which division of the spinothalamic tract transmits affective and alerting aspects of pain?

A

medial/paleo

64
Q

What kind of pain is the medial ST tract associated with? lateral?

A
  • medial = slow (second) pain
  • lateral = fast (first) pain
65
Q

Which division of the ST tract lacks a somatotopic map? What does this imply about the pain you feel? Instead of a somatotopic map, what does this ST tract have?

A
  • medial lacks map
  • poorly localized pain
  • large receptive fields from dorsal horn cells
66
Q

TRUE or FALSE: The lateral division of the ST tract carries localized and discriminative aspects of pain

67
Q

What percentage of VPL neurons are nociceptive?

68
Q

TRUE or FALSE: the spinoreticular tract is topographically organized

A

FALSE: spinoreticular tract LACKS topographical organization

69
Q

Where does the SR tract project to?

A

spinal cord –> reticular formation –> thalamus

70
Q

Do reticular neurons have a wide or narrow receptive field?

A

wide (like paleoST tract dorsal horn cells)

71
Q

What aspect of pain information does the SR tract carry?

A

general aspects of pain perception (e.g. ALERTS ONSET OF PAIN)

72
Q

Where does the spinomesencephalic tract project to?

A

spinal cord –> midbrain PAG –> hypothalamus (lateral parabrachial area) –> NTS –> amygdala

73
Q

What occurs in the PAG in terms of pain transmission? Which tract is this part of ?

A
  • ascending pain signals interact with descending analgesic info from emotional centers (e.g. amygdala)
  • SM tract
74
Q

What kind of responses to pain does the hypothalamus, NTS, and amygdala deal with?

A

autonomic, affective, and neuroendocrine responses to pain

75
Q

TRUE or FALSE: the lateral parabrachial area adds value to sensory information

A

FALSE: the amygdala

(note: lateral parabrachial area is part of the hypothalamus)

76
Q

Which cortical structures are involved in pain processing?

A
  • anterior cingulate cortex
  • prefrontal cortex
  • insular cortex
  • somatosensory cortex
77
Q

Which aspect of pain is the ACC responsible for?

78
Q

Which aspect of pain is the PFC responsible for?

A

decision-making/judging the stimulus

79
Q

Which aspect of pain is the insular cortex responsible for?

A

emotional value in pain processing

PHYSL 372 (21 decks)

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