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Nervous System > Pathophysiology of Pain > Flashcards

Pathophysiology of Pain Flashcards

1
Q

what is pain?

A

an unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of damage.

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2
Q

is pain a stimulus?

A

no

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3
Q

describe the pain pathway from the periphery to modulation

A

> periphery there is detection and transmission to the spinal cord via first order neurons
spinal cord there is processing and transmission to the brain (thalamus) via second order neurons
brain there is perception, learning and response
modulation is the descending tracts

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4
Q

what is nociception?

A

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

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5
Q

what are nociceptors?

A

free nerve ending of A delta and C fibres

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6
Q

what do nociceptors respond to?

A

thermal, chemical, mechanical noxious stimuli

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7
Q

where is the first order neurons cell body?

A

in the dorsal root ganglion

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8
Q

describe A alpha and A beta fibres

A

> myelinated
large diameter
proprioception and light touch

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9
Q

describe A-delta fibres

A

> lightly myelinated
medium diameter
nociception
fast/sharp pain

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10
Q

describe C fibres

A

> unmyelinated
small diameter
slow conducting
innocuous temperature, itch, dull pain

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11
Q

describe the neurons that will receive the input in the spinal dorsal horn

A

> nociceptive specific
low threshold mechanoceptive
wide dynamic range

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12
Q

what does the lateral spinothalamic tract convey?

A

fast and slow pain (pain and temperature sensations)

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13
Q

what does the anterior spinothalamic tract convey?

A

sensation of simple touch

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14
Q

what rexed lamina does the spinothalamic tract arise from?

A

2 and 5

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15
Q

what is the second relay station?

A

the thalamus

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16
Q

what are the connections to the thalamus?

A

> cortex
limbic system
brainstem

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17
Q

where does pain perception occur?

A

in the somatosensory cortex

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18
Q

what is hyperalgesia?

A

increased perception of pain or even the perception of non-noxious stimuli as noxious.

19
Q

when does hyperalgesia occur?

A

whenever there is a tissue injury and inflammation, it occurs in the surrounding uninjured tissue

20
Q

what is allodynia?

A

is type of hyperalgesia where there is a decreased threshold for pain

21
Q

describe the changes in nociceptor in allodynia

A

there is decreased threshold for response

22
Q

describe the changes in nociceptor in hyperalgesia

A

exaggerated response to normal and supranormal stimuli

23
Q

describe gate control theory

A

non painful input closes the gate to the painful input, stopping it from travelling to the central nervous system. stimulation of a non-noxious input is able supress pain

24
Q

describe the changes in nociceptors in spontaneous pain

A

there is spontaneous activity in nerve fibres

25
Q

what is central sensitisation?

A

the response of second order neurons in the CNS to normal input both noxious and non-noxious

26
Q

name three main components in central sensitisation

A

> wind up
classical
long term potentiation

27
Q

describe wind up central sensitisation

A

> involves only activated synapses
homosynaptic activity dependent progressive increase in response of the neurons
manifests over the course of the stimuli and terminated with the stimuli

28
Q

in classical central sensitisation what is opened up in the dorsal horn?

A

new synapses, silent nociceptors

29
Q

in classical central sensitisation what is heterosynaptic activity dependent on?

A

plasticity

30
Q

describe onset of classical central sensitisation

A

it is immediate with the appropriate stimuli

31
Q

can the classical sensitisation outlast the initial stimuli duration?

A

yes and it can be maintained at low levels of ongoing stimuli

32
Q

describe long term potentiation

A

> involves mainly activated synapses

> occurs primarily for very intense stimuli

33
Q

what conditions involves supracentral sensitisation?

A

> fibromyalgia
chronic widespread pain
painful physical symptoms of depression/anxiety

34
Q

describe acute pain

A 
> less than a month
> usually obvious tissue damage
> increased nervous system activity
> resolves on healing
> serves protective function
> usually nociceptive
35
Q

describe chronic pain

A 
> 3-6months or more
> beyond expected period of healing
> no protective function
> degrades health and function
> nociceptive/neuropathic/mixed
36
Q

what is nociceptive pain?

A

a sensory experience that occurs when specific peripheral sensory neurons respond to noxious stimuli

37
Q

in nociceptive pain is there often specific localisation?

A

yes, often describes and throbbing, aching, stiffness

38
Q

what is neuropathic pain?

A

pain initiated or caused by a primary lesion or dysfunction in the somatosensory nervous system

39
Q

describe the painful region in neuropathic pain

A

it is not necessarily in the same region as the site of injury but occurs in the neurological territory of the affected structure

40
Q

which responds to conventional analgesics better, nociceptive pain or neuropathic pain?

A

nociceptive pain

41
Q

what works on transduction of pain?

A

> NSAIDs
Ice
Rest
LA blockers

42
Q

what works on transmission of pain?

A

> nerve blocks
drugs (opioids, anticonvulsants)
surgery (DREZ, cordotomy)

43
Q

what works on the perception of pain?

A 
> education
> congnitive behavioural therapy
> distraction
> relaxation
> graded motor imagery
> mirror box therapy
44
Q

what works on descending modulation?

A

> placebos
drugs (opioids, antidepressants)
surgery (spinal cord stimulation)

Nervous System (45 decks)

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