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Brain and behaviour 2 > PBL 2 - Aches and Pains > Flashcards

PBL 2 - Aches and Pains Flashcards

1
Q

What is inflammatory, acute pain caused by?

A

Acute nociceptive pain due to muscular strain or other soft tissue injury

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2
Q

What pain travels down his leg?

A

Radicular

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3
Q

Define allodynia

A

Noxious sensation to non-painful stimuli

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4
Q

What is hyperalgesia?

A

Increased noxious perception to noxious stimulus

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5
Q

What is secondary hyperalgesia?

A

Hyperalgesia occurring outside the area of injury

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6
Q

What is peripheral sensitisation?

A

Increased sensitivity to afferent stimuli due to nerve and tissue injury

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7
Q

What inflammatory mediators are response for peripheral sensitisation?

A

Phospholipase A2
COX 1 + COX 2
Prostaglandins

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8
Q

How does phospholipase A2 cause sensitivity?

A

Releases arachidonic acid from cell membranes following injury

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9
Q

What do COX 1 and COX 2 do?

A

Uses arachidonic acid as a substrate for prostaglandin synthesis

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10
Q

What do prostaglandins do?

A

Affect ion channels

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11
Q

How do affected ion channels cause peripheral sensitisation?

A

Increase Na+ channel opening and increase in receptor presence
Also closing K+ channels reducing activation threshold and increasing responsiveness of nociceptors

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12
Q

How does central sensitisation occur?

A

Prolonged nociceptor input on dorsal horn

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13
Q

What do nociceptive afferents release in central sensitisation?

A

Glutamate and peptides

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14
Q

What do glutamate and peptides work on in central sensitisation?

A

NMDA

AMPA

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15
Q

What is gate theory?

A

Idea that thalamus and amygdala can prevent painful stimuli from occuring

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16
Q

Where do projections come from in gate theory?

A

Raphe nucleus

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17
Q

What do projections from raphe nucleus activate?

A

Inhibitory interneurones in laminae II

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18
Q

What do inhibitory interneurones in laminae II secrete?

A

GABA

ENK

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19
Q

What is the fast pain pathway also known as?

A

Neo-spinothalamic pathway

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20
Q

Which nociceptor is responsible for fast pain?

A

A delta

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21
Q

Where do A delta fibres synapse?

A

Laminae V

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22
Q

Where do A delta fibres decussate?

A

Spinal cord level

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23
Q

Where do A delta fibres travel?

A

Spinothalamic tract to ventral posterior lateral thalamus

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24
Q

Where does A delta fibres project to after ventral posterior lateral thalamus?

A

Somatosensory cortex 1 + 2 allowing for localisation and discrimination of pain

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25
Q

What is the slow pain pathway?

A

Paleo=spinothalamic pathway

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26
Q

What fibres are responsible for slow pain?

A

C fibres

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27
Q

Where do C fibres synapse?

A

laminae I + II

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28
Q

Where do C fibres decussate?

A

Spinal cord

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29
Q

Where do C fibres synapse?

A

Medial and posterior thalamus

30
Q

Where do C fibres travel up?

A

Lateral STT

31
Q

Where do C fibres travel to after thalamus?

A

Project to anterior cingulate cortex + rostral insula

32
Q

What is the paleo-spinothalamic pathway for?

A

Emotional aspect of pain

33
Q

Why does the guy have pain?

A

Slipped disc at L4/L5

34
Q

What nerve is compressed in the guy?

A

Sciatic nerve dorsal root ganglion

35
Q

How is neuropathic pain different to nociceptive pain?

A

Described as burning or electric shock

36
Q

What is the analgesic ladder?

A

Non opioid
Weak opioid
Strong opioid

37
Q

How does paracetamol work?

A

Inhibits COX 2 to prevent prostaglandin formation

38
Q

Why does paracetamol not work in the scenario?

A

There is the presence of peroxides which are abundant during inflammation which causes the pathway to be inefficient

39
Q

What does the metabolite of paracetamol do?

A

Inhibits reuptake of endogenous cannabinoids, increasing the effect of analgesia

40
Q

What does ibuprofen do?

A

NSAID which inhibits COX and COX2

41
Q

How does inhibiting COX and COX2 decrease pain?

A

Prevents prostaglandin formation and recruitments of leucocytes

42
Q

What are side effects associated with COX 1?

A

GI bleeds
Peptic ulcers
Nausea
Constipation

43
Q

What does diclofenac do?

A

NSAID which inhibits prostaglandin formation

44
Q

How does diclofenac work?

A

Inhibits COX 2 with longer activity than ibuprofen

45
Q

What are side effects of diclofenac?

A

Increased risk of heart attack and stroke

Hypertension

46
Q

What is tramadol

A

Atypical opioid which is a Mu receptor agonist

47
Q

What else is tramadol?

A

5-HT and noradrenaline reuptake inhibitor

48
Q

Side effects of tramadol?

A

Seizures
Dry mouth
Constipation
Headaches

49
Q

What does morphine do?

A

Activates mu opioid receptors (MOR)

50
Q

How does morphine work?

A

Causes neuronal inhibition by reducing excitability (Increasing K+ conductance) and inhibit NT release (decrease Ca2+ influx)

51
Q

What does morphine activate?

A

Descending inhibitory pathways that arise from periaqueductal gray (PAG) which inhibits the spinal cord

52
Q

What are side effects of opioids (morphine)?

A 
Constipation
Nausea
Psychosis
Drowsiness
Respiratory depression
53
Q

What is amitriptyline?

A

TCA antidepressant

54
Q

What does amitriptyline do?

A

Blocks serotonin and noradrenaline reuptake (as well as Na+ and Ca2+ channels)

55
Q

What are side effects of amitriptyline?

A 
Dizziness
Drowsiness
Dry mouth
Headache
Weight gain
56
Q

What is pregabalin?

A

Anticonvulsant medication used in epilepsy

57
Q

How does pregabalin work?

A

GABA analogue (works like GABA) which acts on A2 delta subunit of Ca2+ channels

58
Q

What does Pregabalin work like GABA analogue?

A

As A2 Delta subunits of Ca2+ channels are increased in neuropathic pain so drug binding reduces Ca2+ entry to inhibit NT release

59
Q

What are side effects of pregabalin?

A

Drowsiness
Dizziness
Blurred vision
Ataxia

60
Q

What is acupuncture a form of?

A

Diffuse noxious inhibitory control (DNIC)

61
Q

What is a DNIC?

A

Where pain in one part of the body reduces pain in other parts of the body

62
Q

What is activated when pins are inserted in acupuncture?

A

A-delta

PAG

63
Q

What do A-Delta and PAG do in acupuncture once stimulated?

A

Activates descending inhibitory pathways to control nociception

64
Q

What causes analgesia in acupuncture?

A

Laminae II inhibitory interneurones

65
Q

What fibres are activated in physiotherapy?

A

A-Beta fibres with non noxious stimuli

66
Q

What do A-Beta fibres activate in physiotherapy?

A

Inhibitory neurones in dorsal horn

67
Q

What happens when inhibitory neurones in dorsal horn are activated?

A

Inhibited C fibre transmissions cause analgesia

68
Q

How long should pain get better with physiotherapy?

69
Q

What may have happened to damaged muscle to cause physiotherapy to work?

A

Shortened and atrophied so muscle needs to be loosened and stretched which increases blood flow and decreases inflammation

70
Q

What will help prevent repeated injury?

A

Improving strength and maintaining good posture

71
Q

What should be used in conjunction with physiotherapy?

A

Ice and heat treatments to prevent scar tissue degradation

Brain and behaviour 2 (27 decks)

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