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Year 2 Neuro (JK) > Physiology and pathophysiology of pain > Flashcards

Physiology and pathophysiology of pain Flashcards

1
Q

What is pain?

A

Unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of such damage or both

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2
Q

What does the periphery do in the pain pathway?

A

Detect stimulus

transmission to spinal cord - 1st order neuron

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3
Q

What does the spinal cord do in the pain pathway?

A

process

transmission to brain (thalamus) - 2nd order neuron

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4
Q

What does the brain do in the pain pathway?

A

perception, learning and response

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5
Q

What part of the pain pathway modulates the pain?

A

descending tracts

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6
Q

What is nociception?

A

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

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7
Q

What are nociceptors?

A

Free nerve endings of A delta and C fibres which respond to thermal, chemical, mechanical noxious stimuli

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8
Q

Where are 1st order neurons cell body and where do they synapse?

A

DRG

spinal cord

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9
Q

4 types of afferent sensory fibres

A

A alpha, A beta, A delta and C

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10
Q

What are the 3 kinds of neurons which receive input in the spinal dorsal horn?

A

nociceptive specific
low threshold mechanoreceptor
wide dynamic range

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11
Q

What are the 2 types of spinothalamic tratcs?

A

Anterior and lateral

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12
Q

Where does spinothalamic tract arise (which rexed lamina)?

A

2,5

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13
Q

Where does the lateral STT terminate?

A

ventroposterior thalamic nuclei

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14
Q

Where does the anterior STT terminate?

A

medial thalamus

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15
Q

Connections of the thalamus

A

cortex
limbic system
brain stem

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16
Q

Where does pain perception occur?

A

somatosensory cortex

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17
Q

Why is the limbic system important?

A

make memory of event

add emotional component

18
Q

Where do descending pathways travel from and what is the major part?

A

brain to dorsal horn

periaqueductal grey

19
Q

What type of system is the descending pathway?

A

noradrenergic

20
Q

What is hyperalgesia?

A

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

21
Q

When does hyperalgesia occur?

A

Whenever there is tissue injury and inflammation

22
Q

Where does primary and secondary analgesia occur?

A

primary - site of injury

secondary - surrounding uninjured tissue

23
Q

What is alodynia?

A

A form of hyperalgesia

Dynamical mechanical hyperalgesia to light touch for example

24
Q

Changes in nociceptor in allodynia

A

Decreased threshold for response

25
Q

Changes in nociceptor in hyperalgesia?

A

Exaggerated response to normal and supranormal stimuli

26
Q

Changes in nociceptor in spontaneous pain

A

Spontaneous activity in nerve fibres

27
Q

3 main components of central sensitisation

A

wind up
classical
long term potentiation

28
Q

What is central sensitisation?

A

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

29
Q

Briefly describe wind-up

A

Involves only activated synapses and starts and terminates with stimulus and progressively increases

30
Q

Briefly describe classical central sensitisation

A

opening up new silent synapses and starts with stimuli and can outlast the termination

31
Q

Long term potentiation - briefly describe

A

Involves mainly activated synapses

occurs primarily in very intense stimuli

32
Q

How long does chronic pain last?

A

3-6 months

33
Q

Briefly describe acute pain eg tissue damage, pain, protection

A

Physiological and usually nociceptive

obvious tissue damage, protective, pain resolves after healing

34
Q

Briefly describe chronic pain eg tissue damage, pain, protection

A

pathological with no protective function which degrades health
can be nociceptive or neuropathic pain or mixed

35
Q

What is nociceptive pain?

A

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

36
Q

Does nociceptive or neuropathic pain usually respond to conventional analgesics?

A

nociceptive

37
Q

What is neuropathic pain?

A

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

38
Q

Transduction treatments

A

NSAIDS, ice, rest, LA blocks

39
Q

Transmission treatments

A

nerve blocks, surgery, drugs eg opoids, anticonvulsants

40
Q

Perception treatments

A

Education, CBT, relaxation, distraction, mirror box therapy

41
Q

Descending modulation treatments

A

Placebos, drugs eg opoids, antidepressants, surgery, spinal cord stimulation

Year 2 Neuro (JK) (50 decks)

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