sleep and Pain 2 (Gronseth)

Question 1

Fibers carrying fast pain are ______ whereas slow pain is carried on ______

Answer 1

Fast pain only thinly myelinated alpha delta fibers

Slow pain carries on unmyleinated C fibers

Question 2

Fast pain feels like ____

Answer 2

Fast pain feels like pricking pain

Question 3

The Neospinothalamic tract foes to the primary sensory cortex whereas the paleospinothalamic tract goes to large parts of the cortex and contains what are important for anesthesia?

Answer 3

Periaqueductal Gray

Question 4

if you removed a specific part of the brain why wouldn’t the pain be removed?

Answer 4

there is less orderly arrangement of pain inputs to the cortex

Question 5

What chemical mediators decrease the peripheral and CNS pain threshold?

Answer 5

Bradykinin (prostaglandins)

Substance P

Question 6

Pathologic pain is

Answer 6

the abnormal sensitization to pain that has no physiological value.

This can be abnormal sensitization, conduction, modulation, and perceptions as we saw examples of in class

Question 7

Visceral pain clinica characteristics?

Answer 7

Can present as referred pain to somatic structures (skin)

Higher proportion of C fibers (2:1 in the skin and 10:1 in the gut)

Question 8

What is it called when you have a painful input but it is experienced as more painful?

Answer 8

Hyperalgesis

Question 9

what about when there isn’t a painful input but you experience pain?

Answer 9

Allodynia

Question 10

Clinical characteristics of complex regional pain disorder (causalgia/reflex sympathetic dystrophy*)

Answer 10

Persistent hyperpathia (hyperalgesia, allodynia, and spontaneous pain)

usually after someone has been in a sling and they’re well healed but have this oversensitization to stimuli

Question 11

How will hyperpathia typically present?

Answer 11

Unilateral pain or allodynia in a limb

skin changes/trophic issues

Question 12

4 strategies for treating pathological pain

Answer 12

Aggressive mobilization
Pain control
sympathetic blockade

Question 13

Why is the periaqueductal gray important for central pain control?

Answer 13

It is rich in opiate receptors

Question 14

The rostroventral medulla is a descending inhibitory pathway to the

Answer 14

Dorsal horn (NE and 5HT)

Excites Enkaphlin producing interneurons

Question 15

Trigeminal neuroalgia presents as pain where

Answer 15

on the cheek or side of the face

Focal demyelination of the trigeminal from repeated cramped quarters (ephaptic transmission)

tx: tegretol (carbamazapine)

Question 16

Shingles (Zoster) and post herpetic neuralgia deafferentation presents with pain because of what theory

Answer 16

The gate control theory that says you are getting non-pain and pain inputs and if you damage the non-pain one you will feel the pain inputs

Question 17

methods of decreasing pain conduction

Answer 17

nerve block
Spinothalamic tractotomy
Stabilize nerves

Question 18

methods of increasing modulation of pain

Answer 18

Increase non-painful stimuli: mechanical stimulation, transcut, posterior column, periaqueductal gray

antidepressants and opiates

Question 19

What does RAS do?

Answer 19

involved in arousal and alertness.

in the brainstem

Question 20

Inputs to the Thalamnic reticular network are _____ergic

Answer 20

GABAergic

Question 21

EEG measures the ______potential

Answer 21

Resting membrane potential differences between large cortical neurons

NOT THE ACTION POTENTIALS

Question 22

2 patterns assoc with wakefullness in adults?

Answer 22

alpha: wake with eyes closed
beta: alerta and awake

Question 23

STages of sleep and respective EEG patterns

Answer 23

Awake: Alpha and beta

Stage 1: alpha—>theta

Stage 2: Sleep spindles and k-complexes

Stage 3/4: slow wave sleep

REM: mainly beta

Question 24

Stages of sleep and phasic or tonic neurons

Answer 24

Awake: tonic (depolarized)

Stage 1: phasic (hyperpolarized)

Stage 2: phasic (hyperpolarized)

Stage 3/4: synchronized phasic

REM: desynchronized, mainly beta, tonic

Question 25

how long for one complete slow-wave/REM cycle?

Answer 25

about 90 minutes then REM

REM precedes waking up

Question 26

Which diencephalic nucleus is believe to synchronize EEG and neurotransmitter?

Answer 26

GABA

Question 27

Diffiusley projecting neuronal systems that influence sleep

Answer 27

RAS
Cholinergic
Serotinergic
Noradrenergic
Dopaminergic

Question 28

The suprachiasmatic nucleus in the anterior hypothalamus monitors light and dark cycles via input from what ganglia and regulates the _____ _____?

Answer 28

Melanopsin

Circadian rhythm

Question 29

Nucleus and where is responsible for regulating the circadian rhytmn?

Answer 29

suprachiasmatic nucleus in the anterior hypothalamus