Ch. 7 Somatosensation: Clinical Application

Question 1

Somatosensation contributions to function

Answer 1

1. contribute to smooth coordinated movement
2. help protect from injury
3. contribute to understanding environment

Question 2

Quick Screening

Answer 2

1. vibration (A-beta: DC/ML)
2. Conscious Proprioception (Ia, Ib, II: DC/ML)
3. Fast pain (A-delta: anterolat column)

Question 3

Threshold

Answer 3

minimal detectable touch that can still be sensed

Question 4

2 problems of sensation

Answer 4

• Nn fail to transmit signals (not enough sensation)

- Nn transmit inappropriate sensory messages (too much sensation)

Question 5

Anesthesia

Answer 5

lack of sensation

Question 6

Paresthesia

Answer 6

• extra sensation: painless, abnormal, tickling/tingling

- sign of NS irritation

Question 7

Analgesia

Answer 7

lack of pain

Question 8

hypalgesia

Answer 8

less pain

Question 9

dysesthesia

Answer 9

• extra sensation: unpleasant, abnormal, burning, shooting

- sign of NS irritation

Question 10

Allodynia

Answer 10

Normally nonpainful stimulus causes pain

Question 11

Sensory ataxia

Answer 11

• uncoordinated movement due to disorder of sensation

- (specifically loss of unconscious proprioception)

Question 12

Hyperalgesia

Answer 12

normally painful stimulus causes greater pain than expected

Question 13

Pain

Answer 13

• an unpleasant sensory and emotional experience

- Multifaceted (sensory/physical, limbic/autonomic, cortical)

Question 14

fast pain function

Answer 14

• withdraw/escape from pain
• Acute: A-delta, superficial
• alert to danger

Question 15

peripheral sensitization

Answer 15

• by products of inflammation can sensitize free nerve endings
• decrease threshold (easier to elicit pain)

Question 16

Components of testing somatosensation

Answer 16

• Discriminative Touch (A-beta; skin/subQ)
• Conscious proprioception (Ia; spindles)
• Fast Pain (A delta)
• Discriminative Temp (A-delta)

Question 17

Complete Eval

Answer 17

(Quick eval plus:)

• threshold (monofilaments)
• Sensitivity (2 point discrim)
• higher (cortical) sensation (perception: stereognosis)

Question 18

return of sensation order

Answer 18

• slow pain
• heat
• fast pain
• cold
• conscious proprioception (Ia, A-beta)

Question 19

Order of loss of sensation

Answer 19

• Conscious sensation (Ia, A-beta)
• cold
• fast pain
• heat
• slow pain

Question 20

Small diameter affected first by:

Answer 20

anesthetics, toxins, metabolic insufficiency

Question 21

Hypesthesia

Answer 21

less sensation

Question 22

Slow pain function

Answer 22

• rest damaged tissue

chronic: C, deep

Question 23

3 Aspects of pain to treat

Answer 23

• sensory discriminative
• motivational/affective
• cognitive/evaluative

Question 24

antinociception

Answer 24

• pain relief
• turn down pain
• pain control

Question 25

Top-down response to pain

Answer 25

- antinociception | - pronociception

Question 26

Pronociception

Answer 26

- turn up pain | - increase perception of pain

Question 27

5 levels of pain control

Answer 27

``` I-periphery II-dorsal horn III-brain stem, descending IV-Subcortical (hormone) V-cortical ```

Question 28

Level II pain control

Answer 28

- dorsal horn - counter irritant - presynaptic inhibition of pain neurons - activate A-beta Nn in same area to decrease pain signal at synapse

Question 29

Level III pain control

Answer 29

- brainstem descending - presynaptic inhibition from above - activated by level IV pain control

Question 30

Level IV pain control

Answer 30

- Subcortical - hormone level - hypothal, pig gland and adrenal medulla release endogenous opiates into blood to decrease pain - from aerobic exercise - can outlast pain stimulus

Question 31

Level V pain control

Answer 31

- cotrical - mind over matter - perception, attn, distraction, placebos, stress-induced analgesia etc - thinking can turn on level III and IV

Question 32

Level I pain control

Answer 32

- periphery | - remove stimulus/irritant

Question 33

Chronic Pain

Answer 33

- nociceptive (continuing pain stimulus)=pain neurons functioning normally - neuropathic=NS/pain neurons malfunctioning, no continuing stimulus

Question 34

Level II pronociception

Answer 34

LTP of pain pathway and other malfunctions

Question 35

Level I Pronociception

Answer 35

peripheral sensitization can turn on nociception

Question 36

Level V pronociception

Answer 36

psychological stress can amplify pain perception