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Y2 Neurology > Pathophysiology of Pain > Flashcards

Pathophysiology of Pain Flashcards

1
Q

what is pain?

A

an unpleasant sensory and emotional experience which is associated with tissue damage

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2
Q

is pain a stimulus ?

A

no

- pain is a perception of a stimulus

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3
Q

where does pain perception occur in the brain ?

A

somatosensory cortex

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4
Q

from the dorsal root the neurone cross over to the contralateral side before moving up the spinal cord ?
- where then does the neuron go after this to get to the thalamus ?

A

brain stem
mid brain
thalamus

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5
Q

what three areas can the neurone go after the thalamus to get a response ?

A

somatosensory
limbic system
cingulate cortex

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6
Q

where does gate control modulation from descending PAG come from?

A

Limbic system

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7
Q

what are the four steps of pain perception ?

A
  1. detection in the periphery
  2. processing and transmission in the spinal cord
  3. perception and response in the brain
  4. modulation in the descending tracts
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8
Q

what is nociception ?

A

detection of tissue damage by specialised transducers connected to A delta and C fibres

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9
Q

what are nociceptors ?

A

free nerve ending of A delta and C fibres

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10
Q

what stimulus is detected by nociceptors?

A 
response to 
- thermal 
- chemical 
- mechanical 
noxious stimulus
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11
Q

describe the path of the 1st order neurones ?

A

start at the skin and move into the dorsal horn cross over to the contralateral side and synapse at the thalamus

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12
Q

what are the 4 types of primary afferent fibres ?

A

A alpha
A beta
A delta
C fibres

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13
Q

which fibres are most myelinated ?

A

A alpha

A beta

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14
Q

which primary afferent fibre is unmeylinated ?

A

C fibres

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15
Q

what neurons are used for touch ?

A

A alpha

A beta

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16
Q

what fibre is used for fast pain?

A

A delta

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17
Q

what fibres are used for slow fibres ?

A

C fibres

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18
Q

is grey matter on the inside or outside ?

A

inside

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19
Q

what does PAG stand for?

A

Periaqeductal grey

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20
Q

where abouts is the Periaqeductal grey in the mid brain?

A

lateral to the cerebral aqueduct

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21
Q

does the PAG usually increase or decrease the nociceptor signal?

A

usually decreases as the stimulus is determined to not be noxious

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22
Q

what neurotransmitter is released from the PAG system ?

A

noradrenergic

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23
Q

what area is part of descending control of pain?

A

PAG

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24
Q

what is hyperalgesia ?

A

Increased perception of pain of non-noxious stimuli as noxious stimuli

  • the threshold for pain perception is reduced so non-noxious stimulus are painful
  • exaggerated response
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25
what is allodynia ?
decreased threshold for a response | - hyperalgesia that to light touch
26
what is spontaneous pain ?
spontaneous activity in nerve fibres
27
when can spontaneous pain occur?
post surgery if a nerve has been cut and an axon triggering APs spontaneously causing pain
28
what three neurones synapse with the dorsal root projection neuron ?
interneurone primary afferent neurone descending neurone from PAG
29
what are the three main components of central sensitisation ?
wind up classical long-term potentiation
30
what does central sensitisation result in ?
chronic pain
31
what is peripheral sensitisation ?
when the threshold for pain is reduced so patents feel pain chronically
32
what are the three types of peripheral sensitisation ?
allodynia hyperalgesia spontaneous pain
33
what is the difference between peripheral and central sensitisation ?
peripheral results in 1st neurone sensitisation central results in 2nd neurone sensitisation
34
when a stimulus is triggered during central sensitisation does the component "wind up" occur?
yes
35
when the stimulus is stopped does central sensitisation wind up still occur ?
no | - wind up only occurs when the stimulus is present and neurotransmitters are being released
36
state what occurs during wind up central sensitisation
when there is a stimulus there is an exaggerated response and many neurotransmitters are released
37
is the wind up component of central sensitisation homosynaptic or heterosynaptic ?
homosynaptic
38
how does the classical component of central sensitisation work?
involves opening up new synapses
39
is the classical component of central sensitisation homosynaptic or heterosynaptic ?
heterosynaptic | - because other new neurons are introduced
40
when the stimulus is stopped, does the central sensitisation component classical continue ?
yes | - the classical component will outlast the initial stimulus as "silent nociceptors" have been activated
41
what is secondary hyperalgesia ?
where the area surrounding the injury site is also painful and where the touch also becomes painful
42
when does the classical component of central sensitisation occur?
when the intensity of stimulus is high the neurones call in help from silent nociceptors
43
when does long -term potentiation occur?
with very intense stimuli
44
does long term potentiation involve activated or inactive synapses ?
activated
45
what is nociceptive pain?
A sensory experience that occurs when specific peripheral sensory neurones (nociceptors) respond to noxious stimuli
46
What is neuropathic pain?
Pain initiated or caused by a primary lesion or dysfunction in the somato-sensory nervous system
47
does acute pain serve protective function?
yes
48
does chronic pain serve protective function?
no
49
can acute pain occur without noxious stimuli ?
no
50
can chronic pain occur without noxious stimuli ?
yes
51
is nociceptive pain typically localised ?
yes
52
how is nociceptive pain usually described ?
throbbing aching stiffness
53
is neuropathic pain localised ?
may not be localised to the site of injury
54
does neuropathic pain respond well to analgesias ?
no
55
does nociceptive pain respond well to analgesias ?
yes
56
what are the four stages that pain can be modulated by medical intervention ?
transduction transmission perception descending modulation
57
what four options is there for transduction pain ?
NSAIDs Ice and warm packs Rest Local anaesthetic blocks
58
what pain modulation options are there for transmission stage ?
nerve blocks opioids anticonvulsants surgery
59
how can perception be changed to modulate pain ?
``` education cognitive behavioural distraction relaxation graded motor imagery mirror box therapy ```
60
what options are available for descending modulation of pain?
placebos opioids antidepressants spinal cord stimulation
61
is pain subjective ?
yes
62
does chronic pain serve any protective function ?
no

Y2 Neurology (52 decks)

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