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MSK lectures > Physiology of Pain 05/10/18 > Flashcards

Physiology of Pain 05/10/18 Flashcards

1
Q

Why is pain difficult to assess?

A

It is very subjective

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2
Q

What is the time period for pain to be termed chronic?

A

Over 3 months

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3
Q

What age group is chronic pain highest in?

A

Over 65s

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4
Q

What is pain?

A

An unpleasant sensory and emotional experience, associated with actual tissue damage or described in terms of such damage

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5
Q

What are the 4 processes in the physiology of pain?

A

Transduction
Transmission
Modulation
Perception

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6
Q

What is transduction?

A

Translation of noxious stimulus into electrical activity at the peripheral nociceptor

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7
Q

What is transmission?

A

Propagation of pain signal as nerve impulses through the nervous system

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8
Q

What is modulation?

A

Modification/hindering of pain transmission in the nervous system e.e. by inhibitory neurotransmitters like endogenous opioids

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9
Q

What is perception?

A

Conscious experience of pain

Causes physiological and behavioural responses

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10
Q

What are Nociceptors?

A

Type of free nerve ending

Outgoing sensory neurones

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11
Q

How are nociceptors activated?

A

Intense noxious stimuli

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12
Q

What order of neurone is a nociceptor and what does it relay information to?

A

First order neurones

relays to second order neurones in the CNS

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13
Q

How do 1st order neurones transfer information to 2nd order neurones?

A

Chemical synaptic transmission

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14
Q

What is the nociceptive pathway?

A

Noxious stimuli acts on the free nerve ending
Creating an action potential along the 1st order neurone
Synapses with the second order neurone in the dorsal horn of the spinal cord
Axon is projected out

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15
Q

What are the neurotransmitters in the N pathway?

A

Glutamate and peptides
Substance P
Neurokinin A

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16
Q

Whwere do 2nd order neurones ascend?

A

In the anterolateral systen and terminate in the thalamus

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17
Q

What are the 2 main components of the anterolateral system?

A

Spinothalmic tract

Spinoreticular tract

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18
Q

What is the spinothalmic tract involved in?

A

Perception of pain

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19
Q

What is the spinoreticular tract involved in?

A

Autonomic responses to pain, arousal, emotional responnses and fear of pain

20
Q

What are the two types of nociceptor?

A

A delta fibres

C fibres

21
Q

What do A-delta fibres respond to?

A

noxious mechanical and thermal stimuli

Mediate fast pain

22
Q

What do the C fibres respond to?

A

Poly modal
All noxious stimuli
Mediate slow pain

23
Q

What are four ways of classifying pain and some examples?

A

Mechanisms - nociceptive, inflammatory, pathological
Time course - acute, chronic
Severity - mild, moderate, severe
Source of origin - somatic or visceral

24
Q

What does nociceptive pain represent?

A

Normal response to injury of tissues by noxious (damaging) stimuli

25
Q

What provokes nociceptive pain?

A

Intense stimulation by noxious stimuli

26
Q

Is nociceptive pain adaptive?

A

Yes

27
Q

What is the function of nociceptive pain?

A

Early warning physiological protective system to detect and avoid noxious stimuli

28
Q

What causes inflammatory pain?

A

Activation of the immune system by tissue injury or infection

29
Q

What is inflammatory pain activated by?

A

Variety of mediators released at the sit of inflammation by leucocytes, vascular endothelium and tissue resident mast cells

30
Q

What does inflammatory pain cause?

A

Heightened pain sensitivity to noxious stimuli (hyperalgesisa) and pain sensitivity ti innocuous stimuli (allodynia)

31
Q

What does inflammatory pain discourage?

A

Physical contact
Discourages movement
of inflammed part

32
Q

Is inflammatory pain adaptive?

A

Yes

33
Q

What are two types of pathological pain?

A

Neuropathic or Dysfunction

34
Q

What is neuropathic pain caused by?

A

Damage to neural tissue

35
Q

What are examples of neuropathic pain?

A 
Compression neuropathies
Peripheral neuropathies
Central pain
Postherpetic neuralgia
Trigeminal neuralgia
Phantom limg
36
Q

What can neuropathic pain be percieved as?

A

Burning
shooting
Numbness
Pins and needles

37
Q

What is dysfunctional pain?

A

No identifyable damage or inflammation

38
Q

What are examples of dysfunctional pain?

A 
Fibromyalgia
IBS
Tension headache
Temporomadibular joint disease
Interstitial cystitis
39
Q

Are simple analgesics effective in pathological pain?

A

No

40
Q

What can sometimes treat pathological pain?

A

Anti-depressants
Anti-epileptics
Opioids

41
Q

Is pathological pain protective?

A

No

It is maladaptive

42
Q

What is referred pain?

A

Pain developed in one part of the body is felt by another

43
Q

What types of pain can be felt as referred pain?

A

Deep

Visceral

44
Q

What is referred pain caused by?

A

Convergence of nociceptive visceral and skin afferents upon the same spinothalmic neurons at the same spinal level

45
Q

What are some examples of referred pain?

A

Liver pain felt in shoulder
Heart pain felt in arm and jaw
Appendix pain felt in central stomach/umbilical region

MSK lectures (50 decks)

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