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BMS150 Midterm 2 > Pathophysiology of Pain > Flashcards

Pathophysiology of Pain Flashcards

1
Q

Pain definition?

A

Unpleaseant sensation and emotional experience associated with actual or potential tissue damage, or describes in terms of such damage

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2
Q

What aspect of pain makes it unique?

A

Emotional aspect

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3
Q

Any abnormal sensation described by a patient as unpleasant?

A

Dyesthesia

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4
Q

A sensation that is typically described as “pins-and-needles” or “prickling”, but is not notably unpleasant

A

Paresthesia

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5
Q

Reduction or loss of pain perception

A

Analgesia

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6
Q

Reduced perception of all touch & pain sensation

A

Anaesthesia

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7
Q

Decreased sensation and raised threshold to painful stimuli

A

Hypoalgesia

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8
Q

Exaggerated pain response from a normally painful stimulus

A

Hyperalgesia

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9
Q

Abnormal perception of pain from a normally non-painful mechanical or thermal stimulus

A

Allodynia

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10
Q

Exaggerated perception of a touch stimulus

A

Hyperesthesia

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11
Q

Burning pain in the distribution of a peripheral nerve

A

Causalgia

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12
Q

Pain does not exhibit ______, unlike almost all other perceptions

A

adaptation

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13
Q

The CNS regulates _______ and _________ of pain from lower levels, using multiple different molecules and pathways

A

perception and transmission

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14
Q

Pain transmission can actually cause ______ in peripheral tissues

A

inflammation

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14
Q

What are widely distributed through multiple layers of the skin as well as many visceral organs?

A

Nociceptors

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15
Q

Dermal pain description?

A

sharp or burning

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16
Q

Skeletal/cardiac muscle pain description?

A

dull, pressure like pain

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17
Q

Joints and bone pain description

A

sharp, dull, achy

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18
Q

Blood vessel pain description?

A

dull

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19
Q

Hollow viscera pain description?

A

often dull, cramping but can be sharp

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20
Q

Mesothelial lining pain description?

A

sharp

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21
Q

Type of nociceptors: activated by temperatures > 45 C or less than 5 C

A

Thermal nociceptors

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22
Q

Type of nociceptor: activated by intense pressure applied to a structure (i.e. skin)

A

Mechanical nociceptor

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23
Q

Type of nociceptor: activated by high intensity mechanical, chemical, or thermal stimuli

A

Polymodal nociceptors

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24
Q

Type of nociceptors: receptors that are widely distributed through viscera (but can also be found in the skin) that do not normally transmit pain information (only awakened in a setting of continuous damage or pain)

A

Silent nociceptors

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25
Q

Nociceptors appear to be very similar to what?

A

Neurons

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26
Q

2 major types of nociceptors?

A

C fibers and A fibers

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27
Q

Type of fiber: unmyelinated axons with cell body in the dorsal root ganglia

A

C fibers

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28
Q

fibers responsible for conducting slow pain and thermoception?

A

C fibers

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29
Q

Fibers responsible for carrying itching sensations

A

C fibers

30
Q

Dull, poorly localized pain in large receptive areas is experienced by what fibers?

A

C fibers

31
Q

Type of fiber: myelinated axons with cell body in the dorsal root ganglia

A

A-delta fibers

32
Q

Fibers responsible for conducting sharp, pricking pain and some thermoception?

A

A-delta fibers

33
Q

What are the transient-receptor potential receptors (TRP) capable of recognizing?

A
  • Cold and heat
  • Low pH and free radicals
  • Capsaicin
34
Q

ASIC receptors are responsible for detecting what?

A

Low pH

35
Q

Nociceptors also express receptors for molecules released during inflammatory processes such as:

A
  • Prostaglandins (GPCRs)
  • Bradykinin
  • Histamine
  • Substance P
  • Serotonin, acetylcholine, ATP
36
Q

Bradykinin can increase the activation of _____, making it more likely _____

A

TRP; open

37
Q

Major nociceptive sensory pathway?

A

Spinothalamic tracts

38
Q

Where do peripheral afferent pain fibers of both A-delta and C fibers have their cell bodies?

A

Dorsal root ganglia

39
Q

Within the spinal cord, many of the thinnest fibers (C) from what?

A

Discrete bundle - tract of Lissauer

40
Q

Peripheral afferent fibers usually terminate where?

A

Same segment as their spinal nerve

41
Q

The fibres of the spinothalamic tract usually cross over ______ levels superior to where the 1st-order neurons enter the spinal cord

A

Two or three levels

42
Q

How does the paleospinothalamic tract travel?

A
  • Fibers ascend in cord more medially
  • Project through medulla
  • Synapse in thalamic nuclei or brainstem areas
43
Q

Where does visceral pain sensation likely ascend?

A

Along the anterior spinothalamic tract

44
Q

Where does better-localized skin-associated pain sensation likely ascend?

A

Lateral spinothalamic tract

45
Q

Fast pain?

A
  • well-localized, sharp pain
  • carried by A-delta fibres
46
Q

Slow pain?

A
  • Poorer-localization, duller
  • carried by C fibers
  • Lasts longer
47
Q

Most famous brainstem area that can cause profound analgesia?

A

Periaqueductal gray matter

48
Q

The periaqueductal gray matter tract directly inhibits pain where?

A

At the spinal level

49
Q

What is the periaqueductal gray matter tract mediated by?

A

Opiate receptors

50
Q

______ and ______ systems from the brainstem project to the spinal cord and activate inhibitory interneurons

A

Norepinephrine and serotonergic

51
Q

How do norepinephrine and serotonergic systems activate inhibitory neruons?

A

Releasing enkephalins that inhibit nociceptor pre-synaptic NT release

52
Q

Opioid receptor likely responsible for top-down modulation of pain transmission?

A

mu receptor

53
Q

Endogenous agonists of opioid receptors?

A

opiates

54
Q

What do opiates include?

A

enkephalins, endorphins, and dynorphins

55
Q

Opiate peptide sequence?

A

Tyr-Gly-Gly-Phe

56
Q

What fibers have higher concentrations of mu opioid receptors?

A

C fibers

57
Q

Gate pain theory?

A

Presence of non-nociceptive stimuli at a similar site/spinal level tends to reduce pain perception

58
Q

Peripheral tissue damage can result in increase in pain _____ or _______

A

sensitivity, hyperalgesia

59
Q

Molecules released at the site of tissue damage or inflammation increase the effectiveness of nociception?

A

Peripheral sensitization

60
Q

Synaptic remodelling in the dorsal horn, leading to increased effectiveness of pain transmission?

A

Central sensitization

61
Q

In central sensitization, pro-inflammatory cytokines trigger release of what?

A

Nerve growth factor from mast cells

62
Q

What does nerve growth factor increase the release of?

A

BDNF from C fibers

63
Q

What direction do action potentials move in?

A

BOTH ways down a pain fiber

64
Q

Orthodromic?

A

Periphery -> spinal cord

65
Q

Antidromic?

A

Spinal cord -> periphery

66
Q

Specific substances C fibers release?

A

Substance P and CGRP

67
Q

What can cause mast cell degranulation, vasodilation, and edema?

A

Substance P

68
Q

What can cause vasodilation?

A

CGRP

69
Q

Process that helps us protect a damaged tissue from further damage?

A

Neurogenic inflammation

70
Q

What likely makes C fibers transmit impulses for longer periods of time?

A

Substance P

71
Q

Why do neuropathies frequently cause neuropathic pain and not just analgesia?

A

May be related to pain gate theory

72
Q

Pain perception and mood disorder areas in the CNS?

A

Amygdala, cingulate gyrus, insular cortex

73
Q

Deep pain has indefinite boundaries and its location is ______ from the damaged visceral structure

A

distant

BMS150 Midterm 2 (14 decks)

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