Topic 5: Pain1: Intro

Question 1

Define pain according to the international Association for the study of pain

Answer 1

And unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 2

Can pain exist without tissue damage and without detection by current diagnostic methods?

Should it be excepted as pain?

Answer 2

Strong evidence suggest YES pain can exist without tissue damage.

YES, If people report pain in the same way as pain caused by tissue damage, it should be accepted as pain.

Question 3

The bio psycho social model of pain

Answer 3

Pain does not consist simply of biological factors but also psychological and social factors.

i.e.: thoughts, emotions and behaviours such as psychological distress, fear/avoidance believes, current coping methods and social economical, social environmental, and cultural factors contribute

Question 4

Acute pain

Answer 4

• sudden onset usually sharp in quality
• warning of disease or threat to the body
• mostly does not last longer than six months, and disappears when underlying cause of pain has been treated or healed.

Question 5

Can unrelieved acute pain lead to chronic pain?

Answer 5

Yyyyyeah

Question 6

Chronic pain

Answer 6

• pain persists despite the fact the injury has healed

- pain signals remain active in the nervous system for weeks, months, or years

Question 7

Physical effects of chronic pain

Answer 7

Tense muscles

Limited mobility

Lack of energy

Changes in appetite

Question 8

Emotional effects of chronic pain

Answer 8

Depression

Anger

Anxiety

Fear of re-injury

Question 9

How is pain classified?

Answer 9

Adaptive or maladaptive

Question 10

Adaptive pain

Answer 10

Serves as an early warning system of potential injury from damaging stimulus

Question 11

Maladaptive pain

Answer 11

Persists and becomes even more intense after healing apparently is complete

Question 12

Pains adaptive role in healing:

Answer 12

Forces us to rest and reduce the likelihood of further injury

Question 13

What is nociceptive pain?

Answer 13

AKA: acute pain

• detection of potentially tissue damaging noxious stimuli
• Early warning system to detect and minimize contact with damaging or noxious stimuli

Question 14

When nociceptive pain is engaged what does it overrule? and what reflex does it initiate?

Answer 14

Over rules most other neural functions

Initiates withdrawal reflex, demand immediate attention in action

Question 15

What can congenital insensitivity to pain result in?

Answer 15

Self-mutilation

Bone fractures

Multiple scars

Joint deformities

Amputations and early death

Question 16

Peripheral neuropathy leads to_____________.

Answer 16

A sensory denervation of joints.

Example: Charcot arthropathy

Question 17

What is Charcot Arthropathy?

Answer 17

Charcot foot occurs in patients with peripheral neuropathy resulting from the adverse conditions including diabetes, mellitus, leprosy, syphilis, poliomyelitis, chronic alcoholism.

Question 18

Inflammatory pain

Answer 18

Caused by activation of the immune system by tissue injury or infection.

Question 19

Inflammatory pain is________ and ________.

Answer 19

Adaptive and protective

Question 20

After tissue damage inflammatory pain heightens ___________.

Answer 20

Pain sensitivity

Question 21

How does inflammatory pain assist in healing?

Answer 21

Discourages contact and movement

Question 22

Pathological pain

Answer 22

Maladaptive pain/. Pain that is not protective.

Question 23

Pathological pain is a result of_______.

Answer 23

Abnormal functioning of the nervous system

Question 24

pathological pain a disease state of the_______.

Answer 24

Nervous system

(It is not a symptom of some disorder).

Question 25

Pathological pain can be evoked when there is no_________, ________.

Answer 25

Damage to the nervous system (Neuropathic pain), No inflammation

Question 26

Examples of conditions that can evoke maladaptive pain:

Answer 26

Fibromyalgia, irritable bowel syndrome, tension type headache, temporomandibular joint disease, interstitial cystitis And other syndromes in which there exists substantial pain but no noxious stimuli and no or minimal peripheral inflammatory pathology

Question 27

Pathological pain is a consequence of_____.

Answer 27

Amplified sensory signals in the CNS (Allodynia)

Question 28

Neuropathic pain can be from and coexist with_____.

Answer 28

Nociceptive pain

Question 29

Pain modulation regulated by ______ and __________ circuits in the CNS

Answer 29

Excitatory and inhibitory

Question 30

The CNS can either diminished or exaggerate pain depending on...

Answer 30

Mood, cognitive function, and memories.

Question 31

Genetic and epigenetic component of pain modulation

Answer 31

Susceptibility, hypersensitivity, and conversion from acute to chronic pain

Question 32

What is epigenetics?

Answer 32

The study of changes in organisms caused by modification of gene expression rather than alteration of genetic code itself.

Question 33

Phenotype

Answer 33

How genetic and environmental influences come together to create an organism's physical appearance and behaviour.

Question 34

Genotype

Answer 34

Genetic code

Question 35

Epigenetic change can be influenced by...

Answer 35

Age, the environment and lifestyle, and disease state.

Question 36

Three neuron tract of pain

Answer 36

NEO SPINOTHALAMIC TRACT: First order in the dorsal horn, second order in the Thalamus, third order in the primal somatosensory cortex

Question 37

Multi Neuron tract of pain

Answer 37

PALEOSPINOTHALAMIC TRACT It goes through the limbic system and gives affective (emotional) component

Question 38

Axoplasmic transport Aka axonal transport Is??

Answer 38

As cellular process responsible for movement of mitochondria, lipids, synaptic vessels, proteins, and organelles to and from a multi polar neurons cell body through the cytoplasm of its axon. (Anterograde and retrograde)

Question 39

What is necessary for cell division and for axonal transport?

Answer 39

Microtubules Pic: pg 7 of 17

Question 40

Neurotransmitters released by the peripheral axon of the C fibre

Answer 40

substance P and glutamate

Question 41

Mast cells

Answer 41

Immune cells release histamine

Question 42

Released by mast cells activated by substance P

Answer 42

Histamine

Question 43

Small protein hormones that have many normal cell functions and regulates cells involved in nonspecific and immune responses

Answer 43

Cytokines

Question 44

Released by damage cells that intensify and prolong the pain associated with inflammation

Answer 44

Prostaglandins

Question 45

A group of organic compounds found in high concentrations in meat products, especially internal organs such as liver and kidney, in general, plant-based diet are low in these

Answer 45

Purines

Question 46

Extremely potent mediators of immediate hypersensitivity reaction's and inflammation, producing smooth muscle contraction especially bronchoconstriction, increase vasculature probability, and migration of leucocytes two areas of inflammation

Answer 46

Leukotrines

Question 47

Algogenic substances released into the ECF when cells are injured or destroyed, affecting C fibres in very low concentrations:

Answer 47

``` Substance P and glutamate Histamine Cytokines Prostaglandins Purines Leukotrines ```

Question 48

Central sensation or plasticity

Answer 48

Changes in levels of neurotransmitters and APs that occur in the CNS in response to repeated nerve stimulation

Question 49

Glutamate receptors

Answer 49

NMDA (N-methyl-D-aspartate)

Question 50

Glutamate acts in the spinal cord and in brain sites to amplify_________.

Answer 50

Sensory input from the periphery. | NMDA receives glutamate

Question 51

Increasing response and expansion of receptive fields to repeated input from C fibres

Answer 51

"Windup"

Question 52

Repeated or prolonged application of noxious stimuli and non-noxious stimuli result in ....

Answer 52

Enhanced CNS excitability and sensation.