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neurology > physiology and pathophysiology of pain > Flashcards

physiology and pathophysiology of pain Flashcards

1
Q

what part of the brain does pain get transmitted to?

A

thalamus

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2
Q

what is nociception?

A

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

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3
Q

what are nociceptors?

A

free nerve ending of A delta and C fibres

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4
Q

what do nociceptors respond to?

A

thermal,chemical, mechanical noxious stimuli

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5
Q

where do nociceptors synapse?

A

spinal cord

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6
Q

what type of pain are A delta fibres responsible for?

A

sharp or “first” pain

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7
Q

what type of pain are C fibres responsible for?

A

dull pain which comes after the initial sharp pain

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8
Q

what are the 3 types of neurons that are predominantly found in grey matter?

A

low threshold mechanoreceptive neurons
nociceptive specific neurons
wide dynamic range neurons

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9
Q

where do the spinothalamic tracts relay information to in the brain?

A

thalamus

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10
Q

what rexed areas does the spinothalamic tract arise from?

A

2 and 5

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11
Q

where does the LATERAL STT terminate?

A

ventroposterior thalamic nuclei

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12
Q

where do the ventroposterior thalamic nuclei feed to?

A

somatosensory cortex

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13
Q

where does the VENTRAL STT terminate?

A

medial thalamic nuclei

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14
Q

where do the medial thalamic nuclei project to?

A

limbic system
anterior cingulate cortex
insular cortex

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15
Q

where does pain perception occur?

A

somatosensory cortex

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16
Q

what is the lateral part of the pain matrix composed of?

A

somatosensory cortex

ventroposterior thalamic nuclei

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17
Q

what is the medial part of the pain matrix composed of?

A 
amygdala
hippocampus
cingulate and prefrontal cortexes
insula
brainstem centres
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18
Q

what is the lateral part of the pain matrix involved in?

A

sensory discriminative part of nociception

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19
Q

what is the medial part of the pain matrix involved in?

A

affective and emotional components as well as descending control of pain

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20
Q

where are descending pathways located?

A

from the brain to the dorsal horn

21
Q

what is the usual effect of descending pathways?

A

usually decrease pain signal

22
Q

what kind of system are descending pathways?

A

noradrenergic system

23
Q

what is hyperalgesia?

A

leftward shift of the stimulus response curve; increased perception of pain or perception of non noxious stimuli as noxious

24
Q

when does hyperalgesia occur?

A

whenever there is tissue damage and inflammation?

25
Q

what is primary hyperalgesia?

A

hyperalgesia at the site of injury

26
Q

what is secondary hyperalgesia?

A

hyperalgesia in tissue surrounding the injury

27
Q

what is allodynia?

A

dynamic mechanical hyperalgesia brought on by light touch

28
Q

what changes occur in nociceptors in hyperalgesia?

A

exaggerated response to normal and supranormal stimuli

29
Q

what is central sensitization?

A

response of second order neurons in the CNS to normal input which can be both noxious or non noxious

30
Q

what are the 3 components of central sensitization?

A

wind up
classical
long term potentiation

31
Q

what kind of synapses does the wind up phase of central sensitization involve?

A

only activated synapses

32
Q

what effect does the wind up phase have on the neurons it affects?

A

progressively increases the response of the neurons

33
Q

when does the wind up phase manifest?

A

only over the course of a stimulus and ends with the stimulus

34
Q

what does the classic phase of central sens. involve?

A

opening of new synapses - new synapses start to receive input and record nociception

35
Q

what is the wind up mechanism chemically mediated by?

A

substance P and CGRP

36
Q

what receptor when activated by glutamate can trigger classical central sensitization?

A

NMDA

37
Q

what is the clinical reuslt of classical central sensitization?

A

secondary hyperalgesia

38
Q

how can classical central sens. be maintained after it has been activated?

A

low intensity of the offending stimuli

39
Q

what are 2 types of central sensitization?

A

segmental

suprasegmental

40
Q

what is nociceptive pain?

A

pain that occurs when specific peripheral sensory neurones respond to noxious stimuli

41
Q

what are some features of nociceptive pain?

A

pain typically localised at site of injury
usually time limited and resolves when damaged tissue heals
tends to respond to conventional analgesics

42
Q

what is neuropathic pain?

A

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

43
Q

what are some features of neuropathic pain?

A

painful region occurs in the neurological territory of the affected structure of the brain
almost always chronic
responds poorly to conventional anaesthetics

44
Q

what are some methods to stop pain transduction?

A

NSAIDs
Ice
rest

45
Q

what are some methods to stop pain transmission

A

opioids
anticonvulsants
DREZ
cordotomy

46
Q

what are some ways to stop pain perception?

A

distraction
relaxation
mirror box therapy
cognitive behavioural therapy

47
Q

does chronic pain serve a protective function?

A

no

48
Q

what are some ways to stop descending modulation of pain?

A

opioids
antidepressants
spinal cord stimulation

neurology (29 decks)

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