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Test1 Flashcards

1
Q

What are the two components of pain according to lecture?

A

Sensory - can discriminate pain signals;
Motivational - motivate a response to painful stimuli

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2
Q

According to lecture in general what is the ascending pain pathway?

A

Spinothalamic and trigeminothalamic tracts → cerebral cortex → perception of pain

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3
Q

What are four of the bodies responses to pain?

A

Attention and arousal;
Somatic and autonomic reflexes;
Endocrine responses;
Emotional changes

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4
Q

What is nociception?

A

The experience of pain with a series of complex neurophysiologic processes

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5
Q

The International Association for the Study of Pain defines pain as…?

A

complex physical emotional and psychological condition

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6
Q

What are the targets of pain reducing medications?

A

transduction;
transmission;
interpretation;
PNS and CNS pain modulation

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7
Q

What percentage of adult population has some form of chronic pain? Of these what is the most common chronic complaint?

A

40%;
Low back pain (8% to 37%)

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8
Q

In the U.S. pain cost approximately how much annually?

A

$40 billion

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9
Q

Pain Perception 1

A

Pain Perception 1

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10
Q

Pain Perception 1

A

Pain Perception 1

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11
Q

Pain Perception 1

A

Pain Perception 1

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12
Q

Pain Perception 1

A

Pain Perception 1

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13
Q

Pain Perception 1

A

Pain Perception 1

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14
Q

Pain Perception 1

A

Pain Perception 1

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15
Q

Pain Perception 1

A

Pain Perception 1

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16
Q

Pain Perception 1

A

Pain Perception 1

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17
Q

Pain Perception 1

A

Pain Perception 1

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18
Q

Pain Perception 1

A

Pain Perception 1

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19
Q

Pain Perception 1

A

Pain Perception 1

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20
Q

What is transduction?

A

Nerve endings sense painful stimuli translate into electrical impulses

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21
Q

When pain is transmitted to CNS where does the signal connect in the spinal cord?

A

Signals travel to the dorsal horn

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22
Q

Which interventions block the transmission of pain?

A

Local anesthetics;
Nerve blocks

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23
Q

What is modulation?

A

Altering pain transmission (either ↑ or ↓) at the dorsal horn

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24
Q

Where is pain perceived?

A

Thalamus routes pain signals to primary somatosensory cortex for discrimination

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25
Q

Which medications alter the perception of pain?

A

Opioids;
α2-agonists;
General anesthetics

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26
Q

Which medications modulate pain signals?

A

local anesthetics;
opioids;
ketamine;
α2-agonists

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27
Q

Which medicatins prevent transmission of pain signals?

A

local anesthetics

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28
Q

Which medications inhibit transduction?

A

local anesthetics;
NSAIDS

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29
Q

Acute pain is transmitted on which nerve fibers? Chronic pain?

A

Aδ - myelinated;
C fibers (unmyelinated)

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30
Q

Where are nociceptors located in the body?

A

skin;
muscles;
joints;
viscera;
vasculature

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31
Q

What is the ascending pain path for a stimulus to be transmitted to the brain?

A

Stimulus;
nociceptor - must exceed threshold;
Dorsal Horn;
RVM- rostral ventral medulla;
PAG- (periaquaductal grey)and PB(parabrachial nucleus);
PAGto ThalamusandPBto Amygdala;
Thalamusto Somatosensery areas I and II;
Amygdalato Cingulate cortex and Insular cortex

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32
Q

What stimulus types are transmitted on C-fibers (slow pain)?

A

heat - burning pain;
pressure - sustained pressure

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33
Q

What stimulus types are transmitted on Type 1 A-fibers (fast pain)?

A

heat;
mechanical;
chemical

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34
Q

What stimulus types are transmitted on Type 2 A-fibers (fast pain)?

A

heat

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35
Q

Describe what a Type 1 and Type 2 A-fiber is.

A

Type 1 - Aβ and Aδ;
Type 2 - Aδ

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36
Q

What is the impulse velocity of A-fibers?

A

2 m/s

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37
Q

Pain Path 2

A

Pain Path 2

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38
Q

Pain Path 2

A

Pain Path 2

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39
Q

Pain Path 2

A

Pain Path 2

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40
Q

Pain Path 2

A

Pain Path 2

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41
Q

Pain Path 2

A

Pain Path 2

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42
Q

Pain Path 2

A

Pain Path 2

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43
Q

What are the peptide chemical mediators for pain?

A

Substance P;
Calcitonin;
Bradykinin;
CGRP

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44
Q

Of all the the chemical pain mediators which type is released first?

A

Peptides are released first (bradykinin released very first of these)

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45
Q

What are the main classes of chemical mediators for pain (Class Only)?

A

Peptides;
Eicosanoids;
Lipids - PGs thromboxanes LTs endocannabinoids;
Neutrophins;
Cytokines;
Chemokines;
Extracellular proteases and protons

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46
Q

Which pain receptors and ion channels are involved in the DRG and peripheral terminals?

A

Applies to IV pain meds only!!;
Purinergic;
Metabotropic;
Glutamatergic;
Tachykinin;
TRPV I;
Neurotrophic;
Ion channels (Nav 1.8)

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47
Q

What is an important difference between acute and chronic pain?

A

chronic pain often involves sensitization

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48
Q

What is hyperalgesia?

A

Increased pain sensations to normally painful stimuli.

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49
Q

What is allodynia?

A

perception of pain sensations in response to normally non-painful stimuli.

50
Q

Which pathology was used in class as an example that combines both hyperalgesia and allodynia?

A

Arthritis can have both sensation depending on type

51
Q

What is the definition of primary hyperalgesia?

A

Hyperalgesia the original site of injury from heat and mechanical injury.

52
Q

What are four S/Sx we would see in someone with primary hyperalgesia?

A

↓ pain threshold;
↑ response to suprathreshold stimuli;
Spontaneous pain;
Expansion of receptive field

53
Q

What is the definition of secondary hyperalgesia?

A

Uninjured skin surrounding the injury experiences sensitization of central neuronal circuits

54
Q

Which structure in the spine is the relay center for nociceptor activity?

A

Dorsal Horn

55
Q

The ascending pathways in the spinal dorsal horn connect to which areas in the brain?

A

Brainstem and Forebrain (Somatosensry 1 and 2) → pain perception location intensity

56
Q

When does peripheral pain become central pain?

A

Once pain signal is received in the dorsal horn it becomes central pain

57
Q

Ascending Pathways 1

A

Ascending Pathways 1

58
Q

Ascending Pathways 1

A

Ascending Pathways 1

59
Q

Ascending Pathways 1

A

Ascending Pathways 1

60
Q

Ascending Pathways 1

A

Ascending Pathways 1

61
Q

Ascending Pathways 1

A

Ascending Pathways 1

62
Q

Ascending Pathways 1

A

Ascending Pathways 1

63
Q

Ascending Pathways 1

A

Ascending Pathways 1

64
Q

Ascending Pathways 1

A

Ascending Pathways 1

65
Q

Ascending Pathways 1

A

Ascending Pathways 1

66
Q

Ascending Pathways 1

A

Ascending Pathways 1

67
Q

Ascending Pathways 1

A

Ascending Pathways 1

68
Q

Ascending Pathways 1

A

Ascending Pathways 1

69
Q

Ascending Pathways 1

A

Ascending Pathways 1

70
Q

Which type of nerve fibers connect to Lamina 1 and 2 in the dorsal horn?

A

Lamina 1 - Aδ and C fibers;
Lamina 2 - C fibers

71
Q

What is another name for Lamina 2?

A

substantia gelatinosa

72
Q

Opioids will work specifically at which two Laminae?

A

Lamina I and Lamina II

73
Q

Which fibers connect to Laminae IV VII and the ventral horn?

A

myelinated fibers (innervate muscles and viscera)

74
Q

Which lamina is the NK-1 receptor located? Which compound is associated with NK-1 receptor?

A

Lamina III & IV;
Substance P

75
Q

What is the Gate Theory of Pain?

A

Neurologic “gate” in the dorsal horn;
Gate open: pain is projected to supraspinal brain regions.;
Gate closed: pain is not felt with simultaneous inhibitory impulses.

76
Q

Explain how Aβ Aδ and C fibers operate in the Gate Control Theory of pain

A

Aδ and C Fibers - open the gate transmit pain (small nociceptive fibers);
Aβ - close the gate inhibit transmission of pain (large fiber mechanoceptors)

77
Q

Which brain structures are responsible for the motivational-affective component of pain?

A

Limbic cortex;
Thalamus;
Makes us want to stop the pain - have to act

78
Q

Which structures in the brain depress or integrate pain info in the spinal dorsal horn?

A

PAG-RVM SYSTEM

79
Q

What substances act as neuromodulators?

A

Substance P;
Glutamate;
CGRP;
NMDA;
AMPA;
BDNF;
Cytokines

80
Q

When tissue is damaged which neuromodulators are released?

A

Substance P;
Glutamate

81
Q

If cells mast cells or platelets are damaged what neuromodulators are released?

A

Bradykinin;
Histamine;
prostaglandins;
Serotonin;
Hydrogen ion;
Lactic acid

82
Q

Which neuromodulators in the spinal cord are Excitatory?

A

Glutamate;
Calcitonin;
Neuropeptide Y;
Aspartate;
Substance P

83
Q

Which neuromodulators in the spinal cord are Inhbitory?

A

GABA;
glycine;
enkephalins;
norepinephrine;
dopamine

84
Q

What are the four Ascending Pathways for nociceptive information we discussed in class?

A

Spinothalamic;
Spinomedullary;
Spinobulbar (hindbrain);
Spinohypothalamic

85
Q

What type of nociceptive information is transmitted on the Ascending Spinothalamic path?

A

Pain;
Temp;
Itch

86
Q

Which Laminae are associated with the Ascending Spinothalamic path?

A

LaminaeI VII & VIII (all afferent fibers)

87
Q

What type of information is transmitted on the Ascending Spinobulbar path?

A

Behavior toward pain

88
Q

Which Laminae are associated with the Ascending Spinobulbar path?

A

Laminae I V & VIl

89
Q

What type of information is transmitted on the Ascending Spinohypothalamic path?

A

Autonomic;
neuroendocrine;
emotional aspects of pain

90
Q

Which Laminae are associated with the Ascending Spinohypothalamic path?

A

Laminae I V VII X

91
Q

Which areas of the brain are involved in the Supra-Spinal modulation of pain?

A

Forebrain S1 and S2;
ACC - anterior cingulate cortex;
IC - insular cortex;
Prefrontal cortex;
Thalamus;
Cerebellum

92
Q

What roles do the the Anterior Cingulate Cortex and Insular Cortex play in pain modulation?

A

process the emotional and motivational aspects of pain from signals transmitted from Amygdala

93
Q

Which areas of the brain are involved in the Supra-Spinal modulation ofDescending Inhibitorytracts?

A

PAG → RVM → Dorsolateral funiculus → synapse in dorsal horn

94
Q

Which neurotransmitters are involved with the Descending Inhibitory Tracts?

A

Endorphins;
Enkephalins;
Serotonin

95
Q

How do the Descending Inhibitory tracts actually inhibit pain (mechanism)?

A

Hyperpolarize Aδ and C fibers by ↓ release of substance P opening K+ channels closing Ca++ channels

96
Q

There are two types of Descening Pain Modulation pathways what are they?

A

Descending Inhibition Pathway (DI);
Descending Facilitation Pathway (DE)

97
Q

What are some other factors that are involved in the facilitation or inhibition of pain?

A

Other somatic stimuli;
Psychological factors (arousal attention and expectation)

98
Q

Which opioid receptors are found in the PAG-RVM system? What do they do?

A

μ κ δ;
Play a role in causing hyperalgesia and Allodynia

99
Q

Where does the pain impulse originate if it is pertaining to the descending inhibitory tract?

A

PAG-RVM

100
Q

What are the timelines for acute and chronic pain?

A

Acute pain (days to weeks after injury);
Chronic pain (> 3 to 6 months: persists beyond tissue healing)

101
Q

How do emotions affect acute/chronic pain?

A

Unpleasant emotional experiences use the same pathways - can affect the quality of the pain;
anxiety depression cognitive deficits emotional distress all can make the pain “feel” worse

102
Q

What is neuropathic pain?

A

Persists after tissue has healed → This is hyperalgesia and allodynia

103
Q

Who is at increased risk for Neuropathic pain?

A

Cancer patients d/t chemo and radiation therapy

104
Q

How can we treat neuropathic pain?

A

Opioids;
Gabapentin;
Amitryptiline;
Cannabis

105
Q

What is Visceral pain?

A

Diffuse and poorly localized;
Referred to somatic sites like muscle and skin

106
Q

What are some causes of Visceral pain?

A

ischemia;
stretching of ligamentous attachments;
spasms;
distention

107
Q

What are four specific types of pain?

A

Neuropathic;
Visceral;
Complex Regional Pain Syndrome;
Pain in Neonate and Infant

108
Q

What is Complex Regional Pain Syndrome?

A

Multiple painful conditions following injury that impairs sensory motor and autonomic systems

109
Q

What kind of S/Sx might we see related to Complex Regional Pain Syndrome?

A

Spontaneous pain;
Allodynia/Hyperalgesia;
Edema;
Autonomic abnormalities;
Active/passive movement disorders;
Trophic changes of sking and SQ tissues

110
Q

When is it believed that babies begin to feel pain?

A

23 weeks

111
Q

What is unique about the pain that babies feel?

A

They have a lower pain threshold and exaggerated pain response

112
Q

Describe the CV response to pain?

A

HTN;
Tachy;
Myocardial irritability d/t ↑ MRO2;
↑ SVR;
↓ CO and Myocardial ischemia (if LV is bad)

113
Q

What is the Pulmonary response to pain?

A

↑ total body O2consumption and CO2production;
↑ Vmand work of breathing;
Splinting;
↓ chest wall movement (leads to shunting and atelectasis);
Impaired coughing

114
Q

What is the GI/GU response to pain?

A

↑ sphincter tone ↓ motility - leads to N/V/ileus/urinary retention;
↑ secretion of acid - ulcers/aspiration;
Abdominal distention;
N/V

115
Q

What is the Endocrine response to pain?

A

↑ catabolic hormones;
↓ anabolic hormones

116
Q

What are some catabolic hormones we discussed in class?

A

Catecholamines;
Cortisol;
Glucagon

117
Q

What are some anabolic hormones we discussed in class?

A

Insulin;
Testosterone

118
Q

What effects do we see from the endocrine response to pain

A

neg nitrogen balance;
Carb intolerance;
↑ renin aldosterone AT

119
Q

What is the Hematologic response to pain?

A

All effects releated to stress…;
Platelet adhesiveness;
Reduced fibrinolysis;
Hypercoagulability

120
Q

What are some emotional responses that pain can cause?

A

anxiety;
Sleep disturbance;
Depression

121
Q

What are some immune responses that pain can cause?

A

Leukocytosis;
↓ reticuloendothelial system - leads to increased infection

Test (11 decks)

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