PainNMSControl and Biofeedback Flashcards
stages of the death and dying model
Denial, anger, bargaining, depression, acceptance
How applicable is death and dying model for athletic injury?
not good
Cognitive Appraisal Models of pain state that response to injury depends on?
understanding of the injury
What is the purpose of pain?
- warns of impending injury
- essential for survival
- protects body
- signifies something is wrong
- limits further injury
Which superficial mechanoreceptors are associated with pressure and touch?
meissners corpuscles, pacinian corpuscles
Which superficial mechanoreceptors are associated with skin stretch/pressure?
Merkle cells, Ruffini endings
What deep sensory/proprioceptors are associated with change in muscle length and spindle tension?
Golgi Tendon organs
Which deep sensory/proprioceptors are associated with change in joint position and vibration?
pacinian corpuscles
Which proprioceptors are associated with joint end range and possible heat?
Ruffini endings
Pain can occur at the
- periphery
- spinal level
- ascending pathway
- supraspinal level
- descending pathway
sight, taste, smell, hearing and balance are examples of what type of receptors
Special sensory receptors
Hunger, nausea, distension are examples of what
visceral receptors
Process of changing energy of nociception
into electrical action potential in the neuron
transduction
First order afferents are typed according to structural and functional
characteristics such as:
• Diameter of nerve (velocity of transmission)
• Degree of myelination (velocity of transmission)
• Function of nerve (determines type of info carried
by nerve)
– Light touch, pressure, pain or temperature
Examples of A-beta first order afferents
Hair follicles, Meissners corpuslces, Pacinian
corpuscles, Merkle cell endings, Ruffini
endings
- Touch, vibration, and hair deflection
- Large diameter (6-12 micrometer um)
- Myelinated
A-beta fibers
Myelinated 1st order afferent
– Fast conduction velocity 36-72 microseconds
– Low threshold
A-beta fibers
Warm and cold receptors, hair follicles, free nerve endings
• Touch, pressure, temp and pain
• Free nerve endings respond to noxious stimuli such as pricking, pinching and crushing
A-delta fibers
Myelinated first order afferents
– Smaller diameter (1-6 um)
» Slower conduction velocity (6-36 usecs)
A-delta fibers
Pain, touch, pressure, temperature (skin)
– Pain (receptors of muscle)
• Include efferent postganglionic fibers of SNS, mechanoreceptors, nociceptors and thermoreceptors
• Smallest peripheral nerves associated with pain
C fibers
Unmeylinated first order afferent
– Small diameter
C fiber
First order neuron synapses in ___
spinal cord dorsal
horn
Cell body of second order neuron (T cell) is in ___
the dorsal horn
Multiple tracts carry information through the SC to the brain • cell bodies of third order neurons are located in
VPL (ventral posterior lateral) and VPM (ventral posterior
medial) of the thalamus
Ascending pain fibers from body synapse in this part of the thalamus
VPL
Fibers from the head and face synapse in this part of the thalamus
VPM
Thalamus modulates input and transmits to ___ where localization and discrimination occur in the ___.
somatosensory cortex, post central gyrus
Regulates emotional, autonomic and endocrine
responses to pain (affective motivational component
limbic system
Phase where any activity after the cortex has received input
modulation phase
When these areas are not inhibited can lead to
affective emotional response similar to shock
Hypothalamus, pituitary, reticular formation,
Raphe nucleus
Network of messages and activation of brain centers may exacerbate the painful event and lead to
“windup”
Increases threshold
• More difficult to stimulate
• Fewer pain impulses transmitted to SC
• May try to decrease effects of chemical mediators in inflammatory process
Pain modulation targeted at desensitizing of
peripheral nociceptors
– Decrease effects of chemical mediators
– Decrease speed of pain transmission
ice
Non-painful stimulus can block the transmission of noxious stimulus
Gate Theory
in dorsal horn of spinal cord acts as a “switch operator”
Substantia gelatinosa
Interneuron that utilizes ___is present in substantia gelatinosa – Inhibits pain transmission w/in dorsal horn
enkephalin
Shaking your hand gives ___stimulation. This can cause inhibitory interneurons to be stimulated
– Blocks pain transmission
– TENS gives sensory feedback at a non painful level to stimulate A-beta fibers
A-beta
– Low frequency, high intensity stimulation of peripheral nerves (Motor TENS)
– Causes activation of Reticular Formation and pituitary gland
– Descending Endogenous Opiate System (DEOS)
• Endogenous opioid (endorphin) release
– Inhibitory effect on lower pain pathways
– Descending pain modulation (analgesia)
Motor Pain Modulation
– Electrical stimulation of C fibers in the injury area (Noxious TENS)
– Activates Periaqueductal Gray (PAG) and Raphe nucleus
– Serotonin neurons in dorsal horn inhibit second order neuron directly or through an interneuron
– Also ice stimulation of C fibers during burning and aching sensation
Noxious Pain Modulation
When stimulation encroaches on the refractory period of the sensory nerve and causes inhibition by continual stimulation • Russian stimulation, Interferential current
Nerve Block/ Wedenskis Pain Modulation
decreased pain sensation during physical activity
Increased endogenous opioids (endorphins) and catecholamines (epinephrine/norepinephrine) during exercise
Exercise Induced Hypoalgesia
