Physiology of Pain

Question 1

What is nociception?

Answer 1

Ability to feel pain, caused by stimulation of a nociceptor

Question 2

What are the four processes of nociception?

Answer 2

• Transduction
• Transmission
• Modulation
• Perception

Question 3

What is transduction?

Answer 3

Process of changing external stimuli into action potential

Question 4

What is CIPA?

Answer 4

Congenital indifference to pain, with anhidrosis

Question 5

How can chronic pain present?

Answer 5

Altered functions within the MS and visceral systems

Question 6

Chronic pain is caused by what?

Answer 6

Overstimulation of peripheral nerve in a permanent alteration in the dorsal horns (facilitated segments)

Question 7

Why does chronic pain gets worse?

Answer 7

Leads to more activation of nerves

Question 8

Sharp or pricking pain is fast or slow?

Answer 8

Fast

Question 9

Burning, aching, throbbing pain is fast or slow?

Answer 9

Slow

Question 10

What temp does tissue damage occur?

Answer 10

113 F

Question 11

Chemical pain can only elicit fast or slow pain?

Answer 11

Slow

Question 12

What are the chemical mediators of pain? (4)

Answer 12

• Bradykinin
• 5HT
• Histamine
• K

Question 13

How do bradykinins and other chemokines elicit pain?

Answer 13

Increase [K] and make nerves more permeable

Question 14

True or false: prostaglandins cause pain

Answer 14

False–only enhances sensitivity of nerve endings

Question 15

How do muscles spasms cause pain?

Answer 15

Stimulating mechano-sensitive pain receptors and compressing blood vessels, causing ischemia

Question 16

What are pain receptors?

Answer 16

C fibers (free nerve endings)

Question 17

True or false: pain receptors adapt very little and sometimes not at all

Answer 17

True

Question 18

What are the fibers that transmit acute/fast pain?

Answer 18

A-delta

Question 19

What is the fast pathway for pain?

Answer 19

Neospinothalamic pathway

Question 20

What is the slow pathway for pain?

Answer 20

Paleospinothalamic

Question 21

What is the neurotransmitter involved in the neospinothalamic pathway?

Answer 21

Glutamate

Question 22

What is the neurotransmitter involved in the paleospinothalamic pathway?

Answer 22

substance P

Question 23

True or false: viscera have sensory receptors for no other kind of sensation besides pain

Answer 23

True

Question 24

What is the MOA Of referred pain?

Answer 24

Visceral pain synapse in the spinal cord on the same nerve endings that receive pain from the skin

Question 25

What is the trifurcation that nerves undergo? What is the consequence of this?

Answer 25

Afferents go up, down, and at spinal level in the dorsal horn Pain spreads to more than just the spinal level involved

Question 26

How does the brain stop pain?

Answer 26

Sends signals down the dorsal horn of the spinal cord

Question 27

What are the transmitter substances that block pain signals going up?

Answer 27

enkephalins and 5HT

Question 28

Stimulation of what fibers from peripheral receptors can depress the transmission of pain signals?

Answer 28

A-beta

Question 29

Where do opioids act in the body to prevent pain?

Answer 29

Brain | Dorsal horn

Question 30

Where do NSAIDS act in the body to prevent pain?

Answer 30

Peripherally

Question 31

True or false: in pts with chronic pain, there is no relationship between the damage the body has undergone and the level of their pain

Answer 31

True

Question 32

Most deep tissues are not extensively supplied with pain endings, but can still cause pain. Why?

Answer 32

Widespread tissue damage causes a summation effect to cause the slow/chronic aching pain in those areas

Question 33

Pain receptors cannot adapt to a stimuli like other nerves. What is the consequence of this?

Answer 33

Person is kept apprised of the tissue damage

Question 34

Stimulation of what fibers in the periphery can depress the transmission of pain signals? What can you do to simulate these fibers?

Answer 34

A-beta Rubbing skin

Question 35

What is the medical model of pain? How accurate is this?

Answer 35

Degree of injury or disease correlates with the degrees of pain Inaccurate

Question 36

What is the biopsychosocial model of pain?

Answer 36

Model of pain that takes into account social/economic factors

Question 37

True or false: patients who transition from acute to chronic pain undergo a psychological change

Answer 37

True

Question 38

What are the physical signs that point toward psychological in patients with pain? (3)

Answer 38

- Overreaction - Odd emotions - Inappropriate response to physical exam