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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
Q

what is allodynia ?

A

decreased threshold for a response

- hyperalgesia that to light touch

26
Q

what is spontaneous pain ?

A

spontaneous activity in nerve fibres

27
Q

when can spontaneous pain occur?

A

post surgery if a nerve has been cut and an axon triggering APs spontaneously causing pain

28
Q

what three neurones synapse with the dorsal root projection neuron ?

A

interneurone
primary afferent neurone
descending neurone from PAG

29
Q

what are the three main components of central sensitisation ?

A

wind up
classical
long-term potentiation

30
Q

what does central sensitisation result in ?

A

chronic pain

31
Q

what is peripheral sensitisation ?

A

when the threshold for pain is reduced so patents feel pain chronically

32
Q

what are the three types of peripheral sensitisation ?

A

allodynia
hyperalgesia
spontaneous pain

33
Q

what is the difference between peripheral and central sensitisation ?

A

peripheral results in 1st neurone sensitisation

central results in 2nd neurone sensitisation

34
Q

when a stimulus is triggered during central sensitisation does the component “wind up” occur?

A

yes

35
Q

when the stimulus is stopped does central sensitisation wind up still occur ?

A

no

- wind up only occurs when the stimulus is present and neurotransmitters are being released

36
Q

state what occurs during wind up central sensitisation

A

when there is a stimulus there is an exaggerated response and many neurotransmitters are released

37
Q

is the wind up component of central sensitisation homosynaptic or heterosynaptic ?

A

homosynaptic

38
Q

how does the classical component of central sensitisation work?

A

involves opening up new synapses

39
Q

is the classical component of central sensitisation homosynaptic or heterosynaptic ?

A

heterosynaptic

- because other new neurons are introduced

40
Q

when the stimulus is stopped, does the central sensitisation component classical continue ?

A

yes

- the classical component will outlast the initial stimulus as “silent nociceptors” have been activated

41
Q

what is secondary hyperalgesia ?

A

where the area surrounding the injury site is also painful and where the touch also becomes painful

42
Q

when does the classical component of central sensitisation occur?

A

when the intensity of stimulus is high the neurones call in help from silent nociceptors

43
Q

when does long -term potentiation occur?

A

with very intense stimuli

44
Q

does long term potentiation involve activated or inactive synapses ?

A

activated

45
Q

what is nociceptive pain?

A

A sensory experience that occurs when specific peripheral sensory neurones (nociceptors) respond to noxious stimuli

46
Q

What is neuropathic pain?

A

Pain initiated or caused by a primary lesion or dysfunction in the somato-sensory nervous system

47
Q

does acute pain serve protective function?

A

yes

48
Q

does chronic pain serve protective function?

A

no

49
Q

can acute pain occur without noxious stimuli ?

A

no

50
Q

can chronic pain occur without noxious stimuli ?

A

yes

51
Q

is nociceptive pain typically localised ?

A

yes

52
Q

how is nociceptive pain usually described ?

A

throbbing
aching
stiffness

53
Q

is neuropathic pain localised ?

A

may not be localised to the site of injury

54
Q

does neuropathic pain respond well to analgesias ?

A

no

55
Q

does nociceptive pain respond well to analgesias ?

A

yes

56
Q

what are the four stages that pain can be modulated by medical intervention ?

A

transduction
transmission
perception
descending modulation

57
Q

what four options is there for transduction pain ?

A

NSAIDs
Ice and warm packs
Rest
Local anaesthetic blocks

58
Q

what pain modulation options are there for transmission stage ?

A

nerve blocks
opioids
anticonvulsants
surgery

59
Q

how can perception be changed to modulate pain ?

A 
education 
cognitive behavioural 
distraction 
relaxation 
graded motor imagery 
mirror box therapy
60
Q

what options are available for descending modulation of pain?

A

placebos
opioids
antidepressants
spinal cord stimulation

61
Q

is pain subjective ?

A

yes

62
Q

does chronic pain serve any protective function ?

A

no

Y2 Neurology (52 decks)

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