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Central mechanisms of Pain Flashcards

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1
Q

what is the Localization and intensity of pain

A

the Sensation of pain

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2
Q

what is the Emotional response (Psychological component) of pain

A

Affective component

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3
Q

what is short term pain with an identifiable source

A

Acute

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4
Q

what is long term pain with a frequently non-identified source

A

Chronic pain

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5
Q

what meidates Normal pain

A

A-delta and C-fibers

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6
Q

what mediates Pathological pain (hyperalgesia

A

Pheripheral and central sensitization

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7
Q

where is oral and facial pain processing done

A

Caudalis (part of the spinal trigeminal nucleus)

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8
Q

what is the sensory portion of the spinal cord

A

Medullary dorsal horn

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9
Q

pain vs non-pain senations of the medullary Dorsal Horn

A

Pain is more on the outer surface (supperficial)
non-pain is found deeper
But there is some overlap

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10
Q

what do Nociceptive specific neurons respond to

A

to only painful stimuli

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11
Q

what do Wide Dyanmic range neurons respond to

A

Both painful and non-painful stimuli

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12
Q

Does the PNS have something like wide dynamic range neurons

A

NO

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13
Q

Cell types found in the medullary dorsal horn

A

Nociceptive specific neurons

Wide Dynamic range neurons

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14
Q

REceptive fields of the Wide Dynamic Range Neurons in the medullary dorsal horn

A

HAve large Receptive fields

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15
Q

how is the receptive fields of wide Dynamic range neurons different from that of the PNS

A

PNS can’t be in 2 different branches

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16
Q

where do Nociceptive specific neurons tuerminate in the medullary dorsal horns

A

In superficial layers I and II

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17
Q

where do Non-nocicpetive neurons terminate in the medullary dorsal horn

A

In deeper layers III, IV, and V

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18
Q

where does OVerlap occure in the medullary dorsal horn

A

In layers II and V

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19
Q

Convergence in the medullary dorsal horn

A

High degree of convergence

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20
Q

what Afferents converge in the MDH

A

Nocicpetive and Non-nociceptive afferents

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21
Q

what types of things converge in the MDH

A

Submodality convergence

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22
Q

what emerges in the MDH

A

wide dynamic range neurons emerge

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23
Q

what happerents to peripheral affernets of different receptive fields

A

they converge

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24
Q

what peripheral affernts converge their receptive fields

A 
Cutaneous
Joint
Muscle
Tooth pulp (max and Mandibular)
other nerves (SLN: superior laryngeal nerve)
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25
Roll of MDH and referred pain
MDH is the neural substrate for referred pain
26
spread of pain from the teeth
Spread all along the head due to refered pain
27
how does MDH help to explain referred pain
Pain and non-pain afferents converge on "pain-signaling" neurons
28
why can't convergence on the MDH explain Referred pain alone
Because pain only occures under pathological conditions ( not a normal sensation)
29
what may cause the MDH to start doing referred pain under pathological conditions
something is preventing the activation of convergent input in MDH under "normal" conditions
30
Does Peripheral sensitization explain referred pain
Not entirely: peripheral sensitization mostly increases with C-fiber sensitivity - does not explain larger areas of Pain (increased receptive fields)
31
How could peripheral sensitization explain the larger areas of pain due to referred pain
following severe nerve injury there could be ephaptic connections between pain and non-pain fibers that could enlarge receptive fields
32
what fibers are used to Induce central sensitization
A-beta fibers
33
evidence for central sensitization
- Injected Capsacian to Activate TRPV1 giving a burning sensation - pressure block done near capsaicin, so can't feel light touch, so no allodynia - on hand with no pressure block, could feel light touch so there was allodynia - light touch neuron must communicate with pain nueron to give allodynia when pain is already pressent
34
what does the pressure block block in the central sensitization test
blocks A-beta and A delta fibers
35
Steps of Central Sensitization
1. C fiber afferent barrage (acute pain, inflammation) 2. MDH Neuron response - Depolarization by substance P (tachykinin) - modification of NMDA receptor (removal of Mg++ block) - Increase in conductance NMDA receptor 3. previously ineffective A-fiber now effective - A-diber release of glutamate effective at NMDA receptor - larger receptive field - response to innocuous stimuli by A-beta fibers now induces pain
36
Pain threshold of normal teeth
Very high pain threshold
37
Pain threshold in inflamed teeth
much lower pain threshold
38
what teeth tend to have lower pain thresholds in the mouth when the tooth is inflammed
Lower pain threshold also in healthy contralateral heathy teeth
39
why do teeth contralateral to inflammaed teeth expereince low pain thresholds
Inflamed teeth are sensitizing central neurons with input from healthy contralateral side to make them more sensitive
40
is pain confined to the MDH
Not confined
41
Effects of trigeminal tractotomy (Cut C1-C3)
Anesthesia (no sensation: C1-C3) Analgeais (no pain on face) Hypalgesia (diminished mucosal pain) Pulpal pain still intact
42
why do a trigeminal tractotomy
Intractable facial pain from cancer
43
what is done in a trigeminal tractomy
Descending Vth tract tract cut at level of obex (C1-C3 cut at all afferents)
44
what happens to stroke patients with lesion in pons
Intraoral touch, thermal, and pain all diminished
45
what proves that pain is not confined to MDH
TRigeminal tractomy in humans ( intraoral mucosa still shows pain sensations and tooth pulp pain intact) Lesion in pons (diminishes intraoral and perioral pain)
46
Afferent pain fibers projecting from the MDH go to the:
Oral Motor N (Pons and Mdeulla N. submedius VPM
47
what is the sensory pain pathway
Afferent fibers MDH VPM (thalamus) S1 (Cortex)
48
what is the emotional pain pathway
Afferent fibers MDH N. Submedius Cingulate cortex
49
Roll of the oral motor N in the pain pathways
reflex function: Jaw opening sweating Increased HR and BP
50
receptive field in the VPM
small
51
response time of the VMP
Onset/offset of stimulus
52
what si the response to stimulus of the VPM
linear
53
receptive field of the submedius
LArge
54
response time of the N. submedius
outlasts stimulus
55
what does the N. submedius neurally respresent
NEgative emotion to outlast stimulus
56
Peripheral changes of phantom pain
``` Sprouting (neuroma) Ectopic impulses Ephaptic transmission Sympathetic-afferent coupling Down/upregulation og transmitters Down/upregulation of channels and transduction molecules ```
57
Central changes for phantom pain
``` Sprouting Central sensitization (unmasking of synpases ```
58
receptive field and why of VPL and Somatosensory cortex in pain processing in the forebrain
Small receptive field nad localization of pain
59
neural response time of VPL and Somatosensory cortex in pain processing in the forebrain
Neural response track pain stimulus onset and offset
60
how does the VPL and somatosensory cortex mediate phantom pain
Somatosensory reorganization
61
Neural response of the N. submedius and Cingulate cortex
Outlasts stimulus (poor localization)
62
what part of pain does the N. submedius and cingulate corteex involve
the emotional component of pain
63
effect of anxiety on pain perception
Increases pain perception
64
empathy and pain
Empathy for another in pain activates some cortical areas
65
placebo and pain
Suppresses pain perception
66
How did scientist create a low vs High anxiety condition
Low: Visual cues to indicate whether subject would receive a moderate pain High: visual cue indicated may receive high pain
67
results of low and high anxiety test
pain to same stimulus was rated higher in high anxiety state
68
what happens in the brain following induction of anziety
Increased activity in anerior cinguate cortex
69
what does Empathy do to the brain
Activates the anterior cingulate and insula
70
how did they test for empathy
couples get cue for pain only one person gets pain both showed pain activity in cinguate cortex
71
Does empathy also activate SI or SII
Does not activate SI or SII
72
what does the lack of SI or SII activation for empathy show
separates anatomical difference between emotional and somatosensory component of pain
73
what does the placebo effect activate
The anterior cingulate cortex like that of opioids
74
what mediates the placebo effect
endogenous opoids
75
Roll of Nalxone with testing the placebo
bloacks endogenous opioids so the placebo effect does not work
76
what do the multiple CNS sites for modulation of pain contain
Endogenous opioids to suppress pain
77
what are the Multiple CNS sites to modulate pain
Forebrain: ACC Midbrain: PAG Rostral ventraomedial medulla
78
what are the Descending projections from medulla
excitatory | inhibitory
79
steps of Presynaptic inhibition
Descending projection to local enkephalinergic interneurons Enkephalins work both pre- and postsynapticall pre-synaptic suppression of Ca++ channels suppresses neurotransmitter release Postsynaptic effect of opening K+ channels

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