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Exercise Prescription II > Week 4 - Pathophysiology of pain > Flashcards

Week 4 - Pathophysiology of pain Flashcards

1
Q

Is pain always from actual tissue damage?

A

No, can be potential damage or described in terms of damage

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2
Q

List structures from most to least sensitive to a noxious

A
  1. Periosteum and joint capsule
  2. Subchondral bone, tendons, ligaments
  3. Muscle and cortical bone
  4. Synovium and articular cartilage
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3
Q

“____” fractures produce little to no pain, while ____ fractures (tear away periosteum) are very painful

A

silent, aulvsions

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4
Q

Nociceptive pain is…?

A
  • Pain via stimulation of nociceptors (pain sensors)

- Something causing the pain (burn, bruise, fracture)

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5
Q

Neuropathic pain…?

A
  • Pain via direct nerve damage

- Crush injury, amputation –> damages nerve

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6
Q

A nerve ending is the termination of a …?

A

nerve fibre in a peripheral structure

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7
Q

Receptor nerve ending Meissners corpuscles ….?

A

skin, light touch

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8
Q

Receptor nerve ending Pacinian corpuscles…?

A

skin, deep pressure

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9
Q

Receptor nerve ending Merkels corpuscles…?

A

skin, deep pressure, hair follicle deflection

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10
Q

Receptor nerve ending Ruffini corpuscles…?

A

in skin, sensitive to touch, tension: in joint capsule, sensitive to position

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11
Q

Receptor nerve ending pain receptors…?

A

sensitive to extreme mechanical, thermal, or chemical energy. Respond to noxious stimuli

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12
Q

Meissners corpuscles, Pacinian corpuscles, Merkels corpuscles are all _______

A

mechanoreceptors (different responses to different stimuli)

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13
Q

Ruffini corpuscle’s are …?

A

mechanoreceptor/proprioceptor

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14
Q

Krause end bulbs are…?

A

Thermoreceptor (cold)

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15
Q

Pain receptor are…?

A

Nociceptors

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16
Q

Afferent/sensory nerve fibres transmit impulses ____ the brain

A

towards

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17
Q

Efferent/motor nerve fibres transmit impulses ____ the brain

A

(away) from

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18
Q

Type Ia receptors are in the …?

A

muscle spindle (therefore, detect change)

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19
Q

Type Ib fibres are…

A

golgi tendon organ (detect tension/force in muscle)

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20
Q

Type A-beta (II) fibres are…

A

all cutaneous mechanoreceptors

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21
Q

Type A-delta (III) fibres are…

A

Free nerve endings of touch and pressure. Cold thermoreceptors, nociceptors of neospinothalamic tract (—–sharp pain & primary pathway)

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22
Q

Type C (IV) fibres are…

A

Nociceptors of paleospinothalamic tract, warmth receptors

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23
Q

What are the primary nerve fibres associated with pain?

A

A-delta (III) & type C (IV)

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24
Q

A sharp pain is likely through what pathway?

A

A-delta (III)

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25
Q

A dull pain is likely through what pathway?

A

C (IV) fibres

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26
Q

A-delta fibres are fast or slow?

A

Fast

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27
Q

C-fibres fibres are fast or slow?

A

slow

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28
Q

Are A-delta fibres myelinated or unmyelinated?

A

myelinated

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29
Q

Are C-fibres myelinated or unmyelinated?

A

unmyelinated

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30
Q

Second order afferent fibres carry messages from the _______ to the _____

A

dorsal horn to thalamus

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31
Q

Third order afferents: Carry information to various _____ centers for _____/_____

A

brain, integration/interpretation

32
Q

_________ specific neurons receive input from A-delta and C-fibres only

A

Nociceptive

33
Q

Cortical processing of pain is very complex, there are lots of structures involved, and it is at the level of…?

A

The cortex in the brain

34
Q

The contact point between different neurons is called a _____

A

synapse

35
Q

A neuron only synapse with one neuron (T/F)

A

False, it may synapse with many more neurons

36
Q

Synaptic transmission is…

A

The movement of electrical signals between different neurons

37
Q

To pass information, a transmitter substance must be released from one neuron terminal (______________) and attach to the receptor site on the next neuron (______________)

A

pre-synaptic membrane, post-synaptic membrane

38
Q

Are neurotransmitters excitatory or inhibitory?

A

Can be both (turn it on or turn it off)

39
Q

Neurotransmitters are chemicals which….?

A

relay, amplify, and modulate signals between neurons

40
Q

Substance P is a…?

A

peptide believed to be the neurotransmitter of small-diameter primary afferents - the pain neurons

41
Q

Serotonin is …?

A
  • a neurotransmitter found in descending neurons

- Increased levels are associated with analgesia (pain relief)

42
Q

Glutamate Enkephalin is…?

A

Neurotransmitter proteins that block the passage of noxious stimuli from first to second order afferents, they also inhibit the release of substance P

43
Q

Norepinephrine is…?

A

Biogenic amine transmitter that inhibits synaptic transmission between first and second order nociceptive afferents

44
Q

GABA is…?

A

Inhibitory transmitter found at the spinal and cortical levels of pain modulation

45
Q

Nortriptyline is a tricyclic _______ that prevents the reuptake of…?

A

antidepressant, norepinephrine

46
Q

Nortriptyline reduces pain by inhibiting….

A

synaptic transmission between first and second order nociceptive afferents

47
Q

Nortriptyline increases ____ as it is a major catecholamine with epinephrine and dopamine

A

heart rate

48
Q

On the early onset of pain, local inflammatory substances are released. These include… (3)?

A

histamine, prostaglandins (NSAIDS target), bradykinin

49
Q

On the early onset of pain, there is a _____ depolarisation threshold of peripheral nociceptors

A

lower

50
Q

Lowers depolarisation threshold of peripheral nociceptors from immediate pain causes…

A
  • Primary hyperalgesia
  • nerves threshold to noxious stimuli is lowered
  • Increases the pain response
51
Q

After several hours of pain… ___ ____ occurs?

A

Secondary hyperagesia

52
Q

Secondary hyperagesia causes chemicals to spread…?

A

throughout surrounding tissue, increasing size of affected area and creating hypersensitivity of the receptors in the region.

53
Q

silent nociceptors don’t exhibit sensitivity to _____ stimuli

A

noxious

54
Q

silent nociceptors develop sensitivity to …?

A

the inflammatory response

55
Q

Key inflammatory mediator: bradykinin is and causes..

A
  • 9 amino acid peptide chain

- Causes blood vessels to dilate

56
Q

Key inflammatory mediator: Prostaglandins is..

A
  • Lipid compound derived from fatty acids

- Oxidation of various fatty acids by the COX-1 and -2 isoenzymes produces prostaglandin

57
Q

Prostaglandin functions (4)?

A
  • Constriction/dilation of smooth muscle
  • Aggregation or disaggregation of platelets
  • Sensitize spinal neurons
  • Regulate local inflammation
58
Q

The overall effect of primary sensitisation and activation of “silent” afferents is to _____ the total nociceptive barrage to the spinal cord

A

increase

59
Q

Remember silent nociceptors:

  • _____ exhibit sensitivity to noxious stimuli
  • Develop sensitivity to the inflammatory process
A

Don’t

60
Q

Increased afferent input (activity from the periphery) releases _____ ions and activates NMDA receptors (known as____)

A

magnesium, excito-toxin

61
Q

Increased activation of NMDA receptors increase the responsiveness of the _________ neurons

A

second order

62
Q

For single dorsal horn neurons, from ongoing activity, there is expansion of the receptive field and increased responsiveness by ….

A

lowering excitatory threshold (takes less stimuli to feel same pain)

63
Q

Each neuron can synapse with thousands more ____ and ____ neurons

A

spinal, supraspinal

64
Q

When there is an increase in cortical representation and activity in ‘pain pathways’, you can feel the ‘pain’ ______ actual pain receptors flaring (due to path already being so highly used)

A

without

65
Q

Dextromethorphan is a specific NMDA receptor antagonist that….?

A
  • is a cough suppressant

- When used in excessive dosages it can act as a psychedelic drug

66
Q

Nitrous oxide is a specific NMDA receptor antagonist that….?

A
  • commonly known as laughing gas
  • seems linked to endogenous opioid production
  • minimal metabolism -> retains potency when exhaled
67
Q

Methodone is a specific NMDA receptor antagonist that….?

A
  • also an opioid agonist
68
Q

Tramadol is a specific NMDA receptor antagonist that….?

A

-mild role as an opioid agonist

69
Q

Morphine is or is not NMDA antagonist

A

Is not

70
Q

Morphine is considered the prototype of…

A

opioid agonist

- and has high level of addiction

71
Q

Arthrogenic Muscle inhibition is the CNS response that leads to _______ voluntary activation (CNS drive to muscle) to a muscle that has been injured

A

decrease

72
Q

Allodynia means…

A

Pain due to a stimulus that does not normally provoke pain

73
Q

Hyperalgesia means…?

A

Increased response to s stimulus that is already painful

74
Q

Dysaesthesia means…

A

An unpleasant abnormal sensation (allodynia and hyperalgesia are specific examples)

75
Q

Hyperaesthesia means..

A

Increased sensitivity to stimulation

76
Q

Ways to work with chronic pain patients…?

A
  • Careful with wording (avoid harsh words)
  • Don’t focus on pain symptom to guide improvement
  • Educate client about chronic pain and healing
  • Focus on balance whole body program
  • Don’t keep asking for pain level or avoid things that cause any pain

Exercise Prescription II (11 decks)

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