Physiology of Pain Flashcards
Pain is classified by what three forms?
- Nociceptive pain: maladaptive.
- Inflammatory pain: adaptive.
- Pathological pain: maladaptive.
Describe nociceptive pain.
- Adaptive.
- Immediate protective response.
- Short-lived.
Describe inflammatory pain.
- Adaptive.
- Assists in healing.
- Persists over days, possibly weeks.
Describe pathological pain.
- Maladaptive.
- No physiological purpose.
- Persists over months, years or even a lifetime.
Acute mild pain is often controlled effectively by what?
- NSAIDs +/- paracetamol.
Moderate severe cases of pain may require addition of what to NSAIDs/paracetamol?
Opioids
Chronic pain may sometimes be managed by alternative drug classes such as?
- Anti-depressants.
- Anti-convulsants.
- Local anaesthetics.
How may pain in skin present?
- Well localised.
- Pricking, stabbing, burning.
How may pain of muscle present?
- Poorly localised.
- Aching, soreness/tenderness, cramping/stabbing/burning.
How may pain of viscera present?
- Poorly localised (often referred to a somatic structure).
- Dull, vague, fullness, nausea.
What are nociceptors?
Specific peripheral primary sensory afferent neurones.
What normally activates nociceptors?
Preferentially activated by intense noxious stimuli e.g. thermal, mechanical, chemical.
Describe the relay of nociceptors to the CNS.
- Nociceptors are 1st order neurons relaying information by APs to 2nd order neurons of CNS by chemical synaptic transmission.
Nociceptors innervate what?
They are primary afferent neurons innervating peripheral tissues.
Nociceptors are comprised of what type of fibres?
- Aδ- and C-fibres.
NB not all of these fibres are nociceptors.
Aδ-fibres are what kind of nociceptors?
Mechanical/thermal nociceptors that are thinly myelinated
Aδ-fibres contribute to nociceptors that respond to what?
Noxious mechanical and thermal stimuli.
Aδ-fibres mediate what kind of pain?
- First or fast pain.
C-fibres are what kind of nociceptors?
Unmyelinated.
C-fibres contribute to nociceptors that respond to what?
ALL noxious stimuli - they are polymodal.
C-fibre nociceptors mediate what kind of pain?
“second”/slow pain.
Describe “first”/fast pain of Aδ-fibre nociceptors.
- Lancinating, stabbing, pricking.
Describe “second”/slow pain of C-fibre nociceptors.
- Burning, throbbing, cramping, aching sensations.
Noxious thermal stimuli activate which receptors?
Members of the transient receptor potential (TRP).
- Especially TRPA1, TRPC3, TRPV1.
Which member of the transient receptor potential (TRP) family is greatly sensitised in inflammation to become active at body temperature?
TRPV1.
Chemical stimuli activates what?
- H+: Acid sensing ion channels (ASICs).
- ATP: P2X and P2Y receptors.
- Bradykinin: B2 receptors.
Where do the axons of nociceptor (1st order) synapse with 2nd order neurons?
Dorsal (posterior) horn of spinal cord.
The afferent branch of peptidergic polymodal nociceptors have which function?
To transmit nociceptive info to CNS via release of glutamate and peptides within the dorsal horn.