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The Locomotor System > The Physiology of Pain > Flashcards

The Physiology of Pain Flashcards

1
Q

Where do pain signals originate

A

Nociceptors

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2
Q

where are pain signals transmitted to

A

Pain signals are transmitted from nociceptors in the peripheral nervous system to the brain in the central nervous system.

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3
Q

Which parts of the central nervous system receive pain signals

A

The brain including the higher centres and the somatosensory cortex.

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4
Q

Why is pain difficult to assess

A

Because it is subject to experience and often has a psychological component

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5
Q

What are two conditions in which peripheral pain sensation can be lost

A
  • Leprosy
  • Diabetes
    (Neuropathic diseases)
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6
Q

What are the consequences of the loss of pain sensation

A

The natural instinct to remove the part of your body from the source of the pain or to not use that part of the body is lost which can lead to further damage.

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7
Q

What is an example of a situation where there is loss of sensation in joints which are damaged

A

This leads to a Charcot joint where there is complete disruption to the joint architecture as the patient continues to use the joint even though it is damaged.

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8
Q

What other symptoms may pain also be associated with

A

Anxiety, depression, insomnia, anorexia.

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9
Q

What are the 5 different kinds of pain

A
  • Physiological
  • Inflammatory
  • Vascular
  • Neuropathic
  • Psychogenic
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10
Q

What are two other names for physiological pain

A

Visceral and somatic.

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11
Q

Where does somatic sensation come from

A

Somatic sensation is sensation that occurs around the periphery of the body.

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12
Q

Where does visceral sensation come from

A

Visceral sensation relates to the nociceptors which sense pain in the internal organs.

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13
Q

What are the features of physiological pain

A

Physiological pain tends to be acute, transient and heals over a period of time.

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14
Q

How does inflammatory pain come about

A

Inflammatory mediators released in inflammation can trigger activity in nociceptors.

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15
Q

What is an example of condition which causes inflammatory pain

A

Rheumatoid Arthritis.

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16
Q

How does vascular pain come about

A

When the blood supply is cut off this leads to lack of oxygen supply, ischaemia, overproduction of lactic acid and death of cells. This can trigger nociceptors and subsequently painful responses.

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17
Q

What is an example of a type of vascular pain

A

Migraine. This results from an instability of the vascular supply around the head.

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18
Q

What triggers neuropathic pain

A

Neuropathic pain does not come from nociceptors but from damage to nerves themselves.

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19
Q

Give examples of things that can cause neuropathic pain

A
  • Phantom limb pain in amputee
  • Slipped disc
  • Neuralgia
  • Stroke
  • Diabetes
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20
Q

What is psychogenic pain

A

Pain which is related to a psychological disorder

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21
Q

What is acute pain

A

A short term natural defence reaction that prevents further damage to the body. Acute pain disappears once tissue damage resolves.

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22
Q

What is chronic pain

A

This is pain that goes on for a long period of time, persisting for weeks, months or years. It is often associated with a chronic disease process.

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23
Q

What is referred pain

A

This is pain experienced in one part of the body related to physical damage in another part of the body.

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24
Q

What is an example of referred pain

A

Pain in the left arm due to angina as a result of starvation of oxygen to the myocardium.

25
Q

What are the four stages of pain perception

A

1) Pain “sensing”
2) Pain transmission to the spinal cord
3) Impulses to the brain
4) Analysis of information

26
Q

What is the process of pain perception

A

First nociceptors are activated in response to physical damage in the peripheral tissues. This response leads to pain transmission through afferent nerve fibres to the spinal cord from the periphery. In the spinal cord impulses are carried up ascending tracts to the brain. Information is then analysed in higher brain centres and an action can be initiated.

27
Q

What can inhibit the transmission of pain through ascending tracts in the spinal cord

A

Descending inhibitory tracts.

28
Q

What is the location of nociceptors

A

Nociceptors are present in somatic locations such as the skin, joints, tongue, teeth etc. and in visceral locations like in internal organs - heart, gut etc.

29
Q

What is the difference in pain localisation in visceral nociceptors compared to somatic nociceptors

A

Somatic nociceptors are good at localising pain and locating exactly where it is coming from. Visceral nociceptors are not good at localising where pain is coming from. Pain is often diffuse and can be referred.

30
Q

What are the four reasons why some people are more susceptible to pain than others

A
  • Genetics affects the way sodium channels on nociceptors respond
  • Opioid receptor differences
  • Experience
  • Family attitude.
31
Q

What can activate nociceptors

A
  • Release of chemicals by local cells - histamine and bradykinin
  • Mechanical forces
  • Temperature - hot or cold
  • Tissue injury
  • Nerve damage
32
Q

What is the role of prostaglandins in pain

A

Prostaglandins do not directly activate nociceptors but increase their sensitivity to pain.

33
Q

What is neurogenic inflammation

A

Neurogenic inflammation in the phenomena by which pain can lead to an enhanced inflammatory process.

34
Q

How does neurogenic inflammation come about

A

A peripheral afferent nerve which senses pain can lead to inflammation in subsequent nerve endings. The nerve cell is activated as a result of activation of nociceptors but nerve endings from the same neuron can respond by releasing inflammatory mediators in another area.

35
Q

What are the two types of peripheral afferent pain fibres

A

Myelinated A delta fibres and unmyelinated C fibres.

36
Q

What kind of pain is experienced with transmission of impulses through myelinated A delta fibres

A

Nerve impulse through myelinated A delta fibres is extremely rapid. The pain experience is sharp, fast and intense.

37
Q

What kind of pain is experienced with transmission of impulses through unmyelinated C fibres

A

Nerve impulse through unmyelinated C fibres is slow. The pain experience is a dull, slow, throbbing, aching pain.

38
Q

Pain transmitted though which type of afferent nerve fibre - Myelinated A delta or unmyelinated C - is easier to localise

A

Pain which is transmitted through A delta fibres is easier to localise and identify the source.

39
Q

What is the location of the cell bodies for peripheral nerve fibres

A

The dorsal root ganglion.

40
Q

What are three key groups of excitatory neurotransmitters which act at the synapse between afferent fibres and the ascending nociresponsive neurons

A
  • Amino acids - glutamate
  • Neurokinins - Substance P
  • Other neuropeptides
41
Q

What is the synapse between the peripheral afferent neuron and the ascending nociresponsive neuron influenced by

A

Descending nerves, particularly those that release metenkephalin and beta endorphin.

42
Q

What do metenkephalin and beta endorphin do

A

They influence the transmission of neurotransmitters glutamate and substance P.

43
Q

Other than metenkephalin and beta endorphin, what else inhibits cord pain sensitivity

A

Noradrenaline, 5-HT (serotonin), GABA and glycine.

44
Q

What is spinal “wind up”

A

Spinal wind up is the chronic potentiation of depolarisation in spinal neurons due to repetitive activation of C fibres. There is a prolonged response to a stimulus. This leads to hypersensitivity/hyperalgesia.

45
Q

What is the gate theory of pain

A

Simple sensory input at the same level of the spinal cord as the pain input can dampen down pain sensation. This is why you may rub something if you have injured it - the rubbing sensation dampens down the pain sensation.

46
Q

How can the gate theory of pain be used in chronic pain patients

A

Transcutaneous electrical nerve stimulation can be used over the skin where pain is being sensed to reduce this pain.

47
Q

Where is spinal cord transmission of pain signals

A

The contralateral spinothalamic tracts.

48
Q

Where do pain impulses travel in the brain from the spinal cord

A

They travel to higher brain centres - first the thalamus and then the cerebral cortex to bring about an appropriate cognitive response. They also activate the limbic system to bring about an emotional response.

49
Q

Why is pain often an emotional experience

A

Because pain impulses from the spinal cord stimulate the limbic system as well as other areas of the brain. This brings about an emotional response.

50
Q

Where are opioid receptors found in the body

A

Opioid receptors are found throughout the nervous system.

51
Q

What do opioid receptors respond to

A

Opioid receptors respond to endogenous stimuli such as metenkephalin but also respond to exogenous opioids.

52
Q

What two things can affect pain impulses (the gate control theory of pain)

A
  • Descending nerve impulses from the thalamus and cerebral cortex
  • Other sensory input, e.g. from rubbing the painful area.
53
Q

Why do interventions such as imagery and distraction give some relief from pain

A

This provides nerve impulses from the brain which inhibit ascending nerve impulses.

54
Q

What are the excitatory neurotransmitters in the spinal cord

A

Substance P and Glutamate

55
Q

What are the inhibitory neurotransmitters in the spinal cord

A

GABA and glycine

56
Q

What are the inhibitory neurotransmitters if the descending pathway

A

Serotonin, noradrenaline, encephalin.

57
Q

What do inhibitory neurotransmitters of the descending pathway such as encephalin act as

A

Analgesics.

58
Q

What are algogens

A

Antagonists which block the substances which initiate pain.

The Locomotor System (13 decks)

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