Anatomy And Physiology Of Pain

Question 1

What is pain

Answer 1

Pain is an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage

Question 2

What is the purpose of immediate pain

Answer 2

Immediate pain warns of imminent tissue damage and we should withdraw from the source of the injury

Question 3

What is the purpose of persisting pain

Answer 3

Persisting pain encourages us to immobilise the injured area so we can give damaged tissue the best chance to heal and recover

Question 4

What is nociception

Answer 4

The neural processes involved in producing the sensation of pain

Question 5

What is the nociceptive pathways

Answer 5

The nociceptive pathways is the transduction in the periphery through transmission to the dorsal horn of the spinal horn and then onto the brain

Question 6

What is acute pain

Answer 6

Pain that lasts for less than 12 weeks in duration

Question 7

What is chronic pain

Answer 7

Pain that persists for more than 12 weeks
Pain that persists for longer that the tissue healing time

Question 8

What is nociceptive pain

Answer 8

Pain that arises from the actual or threatened damage to non-neural tissue and is due to the activation of nociceptors

Question 9

What is neuropathic pain

Answer 9

Pain that is caused by a lesion or disease of the somatosensory nervous system

Question 10

What is nociplastic pain

Answer 10

Pain that arises from the altered nociception despite no clear evidence of actual of threatened tissue damage causing the activation of peripheral nociceptiors or evidence for disease or lesion of the somatosensory system causing the pain

Question 11

What are examples of neuropathic pain

Answer 11

Glossopharyngeal neuralgia
Complex regional pain syndrome
Phantom limb pain
Pain due to Spinal cord damage or stroke

Question 12

What is allodynia

Answer 12

Pain due to a stimulus that does not normally provoke pain

Question 13

What is dysethesia

Answer 13

An unpleasant abnormal sensation, whether spontaneous or evoked

Question 14

What is hyperalgesia

Answer 14

Increased pain from a stimulus that normally provokes pain

Question 15

What is hypoalgesia

Answer 15

Diminished pain in response to a normally painful stimulus

Question 16

Describe the pain pathway

Answer 16

The peripheral receptors detect the relevant stimulus. The 1st order neuron then takes the signal from the periphery to the ipsilateral spinal cord. The 2nd order neuron which crosses to the contralateral cord, ascends to the thalamus which is a relay station within the brain. The 3rd order neuron then runs from the thalamus to the midbrain and higher cortical centres.

Question 17

What are nociceptors

Answer 17

They are free nerve endings of primary afferent neurons found in any area of the body which can sense pain eith externally or internally

External examples- skin or cornea
Internal examples- joints, muscles

Question 18

Where do the cell bodies of the nociceptors reside

Answer 18

Dorsal root ganglia
Trigeminal ganglion

Question 19

Where are dorsal root ganglion present

Answer 19

On the dorsal root

Question 20

What is the dorsal root made up of

Answer 20

Composed of cell bodies of nerve fibres that are sensory

Question 21

What is the spinothalmic tract

Answer 21

This is a sensory pathway that carries pain, temperature and crude touch information from the body

Question 22

Where does the spinothalmic tract originate

Answer 22

The spinal cord

Question 23

What does the lateral spinothalmic tract carry

Answer 23

Pain and temperature

Question 24

What does the anterior spinothalmic tract carry

Answer 24

Crude touch

Question 25

Where does the spinothalmic tract terminate

Answer 25

It terminates in the thalamus

Question 26

What sensations does the thalamus not get

Answer 26

The thalamus receives all sensations apart from olfactory

Question 27

What is the function of the insula

Answer 27

The insula is where the degree of pain is judged
The insula contributes to the subjective aspects of pain perception
It plays a role in perception, motor control, self awareness and interpersonal experience
Play part in the addiction

Question 28

What is the function of the amygdala

Answer 28

Plays a key role in learned emotional responses such as fear anxiety and depression.

Question 29

Why is the amygdala important

Answer 29

The amygdala is important for the emotional-affective dimension of pain and for pain modulation

Question 30

What does hyperactivity in the amygdala account for

Answer 30

Hyperactivity in this brain centre accounts for pain-related emotional responses and anxiety like behaviour

Question 31

Where is the cingulate cortex located

Answer 31

The medial aspect of the cerebral hemispheres

Question 32

What is the cingulate cortex linked with

Answer 32

The limbic system

Question 33

What is the function of the cingulate cortex

Answer 33

Maintains reciprocal connections with other pain processing areas

Question 34

How can we treat pain

Answer 34

Stimulate descending inhibitory pathway
Gate control
Pharmacotherapy

Question 35

What is involved in the management of pain

Answer 35

MDT approach
Biological target
Psychology
Physiotherapy

Question 36

What medications are usually used in pain medicine

Answer 36

NSAID’s
Paracetamol
Opioids

Question 37

What are opioids good at treating

Answer 37

Acute pain
Eg-after surgery

Question 38

What are the problems with long term use of opioids

Answer 38

Tolerance
Immunosupression

Question 39

What are causes of cancer pain

Answer 39

Pain associated with direct tumour
Pain associated with cancer therapy
Pain unrelated to cancer