Physiology of Pain Flashcards

1
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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2
Q

What are the three forms of pain and are they adaptive or maladaptive

A

Nociceptive pain - adaptive
Inflammatory pain - adaptive
Pathological pain - maladaptive

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3
Q

What is nociceptive pain

A

Acute pain that occurs immediately at the time of inury

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4
Q

What is the purpose in nociceptive pain

A

Helps us limit damage to the body and avoid further damage

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5
Q

What is inflammatory pain

A

More persistent pain that generally subsides after healing

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6
Q

What is pathological pain?

A

Pain that persists after injury that has been resolved or arises out of the blue with no precipitating injury. It has outlived its biological purpose

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7
Q

What type of pain is the most difficult to treat

A

Pathalogical pain

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8
Q

What are nociceptors?

A

Specific peripheral primary sensory afferent neurones normally activated preferntially by intense stimuli (thermal, chemical or mechanical) that are harmful

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9
Q

What do nociceptors do?

A

They are first order neurones that relay information to second order neurones in the CNS by chemical synaptic transmission

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10
Q

Describe how noceiceptors work when exposed to an intense stimuli

A

The free nerve ending in the peripheral location senses the harmful stimuli and depolarisation occurs due to this. If the depolarisation is large enough, it triggers an action potential which then goes along the axon to the soma which then triggers the release of transmitter substances in the central terminal

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11
Q

Nociceptive pain is high threshold. What does this mean?

A

It is provoked only by intense stimuli that activate nociceptors

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12
Q

What does Nocicpetive pain overide

A

Most other ongoing activities of the nervous system

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13
Q

Inflammatory pain is both adaptive and protective. True or False

A

True

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14
Q

What causes inflammatory pain

A

Activation of the immune system in injury or infection

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15
Q

What does pain hypersensitivity cause

A

Heightened sensitivity to noxious stimuli and allodynia (innocuous stimuli now elicit pain)

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16
Q

How does inflammatory pain help the body to heal

A

It discourages physical contact and discourages movement

17
Q

What is required to alleviate suffering

A

Reduction in ongoing inflammation (rheumatoid arthritis)

18
Q

How do nerve cells in inflammatory pain become more sensitive

A

Due to the increase of inflammatory cells such as macrophages, mast cells, neutrophils and granulocytes in the affected area

19
Q

How does pathological pain arise?

A

It results from abnormal nervous system function - may be neuropathic or dysfunctional

20
Q

How do we describe what pathological pain is

A

Maladaptive with no protective function

21
Q

WWhat happens in the absence of pain?

A

Gross damage to the body

22
Q

Patients with congenital insensitivity to pain (CIP) may have what types of injuries?

A
Anything:
lip and tongue injury 
bruises and cuts 
multiple scars 
bone fractures 
joint deformity 
premature mortality due to multiple injuries/ infections
23
Q

What do nocicpetors innervate

A

Peripheral tissues

24
Q

WHat are the 2 different types of nociceptor fibres

A

A delta and C fibres

25
What are A delta fibres
Mechanical/ thermal nociceptors that are THINLY myelinated. They mediate first pain They respond to noxious mechanical and thermal stimuli
26
What are C fibres
Nociceptors that are unmyelinated They respond to all noxious stimuli Mediate second pain
27
Gibe examples of the sensation of first pain
Lancinating Stabbing Pricking sensations
28
Give examples of the sensation of second pain
Burning Throbbing Cramping Aching sensations
29
How do chemical stimuli activate the peripheral terminal
H+ activates acid sensing ion channels, ATP activates P2X and P2Y receptor, bradykinin activates B2 receptors
30
How do thermal stimuli activate the peripheral terminal
members of the transient receptor potential (TRP) family particulalry TRPV1 activated by noxious heat. TRPV1 is greatly sensitised in inflammation to become active at body temperature
31
What does a stimulus do to ion channels in a nerve terminal and what does this do
Opens the ion channels to elicit a depolarising receptor potential
32
Describe the amplitude of the generator potential
It is grades and proportional to stimulus intensity
33
What does the local current flow trigger?
All or none action potentials at a frequency proportional to the amplitude of the receptor potential I.e. the greater the depolarisation or the receptor potential, the greater the action potential frequency
34
Where are the nociceptor neurones most sensitive
At the lower end of the stimulous strength
35
What is the unusual property of peptidergic polymodla nociceptors
They have both afferent and efferent functions
36
What are the afferent functions
Transmit nociceptive information to the CNS via release of glutamate and peptides within the dorsal horn
37
What are the efferent function
They release pro-inflammatory mediators (e.g. calcitonin gene related peptide, substance P) frmo peripheral terminals - contributes to neurogenic inflammation
38
What does the noxious stimulation in the long term do?
Increases spinal excitability contributing to hyperalgesia and allodynia
39
Why are C fibres described as being peptigerdic
They utilise peptides as their neurotransmitter at the central termius