CNS Class 4 - Central Modulation, Sensitization, Disease & Terminology

Question 1

There are modifiers of ________ transmission as it travels from the tissues to the brain.

Answer 1

Afferent

Question 2

Local inhibition or gating in the dorsal horn and filtering in the thalamus are examples of _________ modulation.

Answer 2

Ascending Modulation

Question 3

T/F - Ascending modulation is often called central modulation.

Answer 3

False - DESCENDING modulation is often called central modulation.

Question 4

While __________ modulation is most often discussed in the context of pain, it can also be used to weaken or suppress sensory experience of other types of stimuli.

Answer 4

Descending Modulation

Question 5

T/F - The understanding of descending mechanisms is still incomplete.

Answer 5

True

Question 6

One of the first major commenters on the phenomena of descending modulation was ____ _______.

Answer 6

H.K. Beecher

Question 7

H.K. Beecher was a WW2 _________ who noted how frequently wounded ________ felt little or no pain, especially initially.

Answer 7

Physician
Soldiers

Question 8

__________ modulation has been observed of injured athletes in the heat of competition.

Answer 8

Descending Modulation

Question 9

The purpose of _______ experience is to bring attention to important matters, often because of a need for ________ or reflection.

Answer 9

Sensory
Response

Question 10

T/F - The sensory experience may be eliminated or weakened in the presence of other purpose or distraction.

Answer 10

True

Question 11

At the brain level, the following are all involved in __________ modulation:
- Parts of the cortex
- Thalamus
- Insula
- Amygdala
- Hypothalamus

Answer 11

Descending Modulation

Question 12

T/F - Exogenous opioids are chemicals released with descending modulation.

Answer 12

False - ENDOGENOUS opioids are chemicals released with descending modulation.

Question 13

__________ and ___________ are the body’s version of morphine or heroin. They are communicated to a group of nuclei in the ________ and brainstem.

Answer 13

Endorphins
Enkephalins
Midbrain

Question 14

T/F - Dopamine is also involved with endogenous opioids and descending modulation.

Answer 14

True

Question 15

Activation of the midbrain’s ______________ ____ area initiates a complex intercommunication process that results in the release of modulators from brainstem zones like the _____ ______.

Answer 15

Periaqueductal Gray Area (PAG)
Raphe Nuclei

Question 16

Modulators released from the PAG include neurotransmitters such as _________ (5-HT), norepinephrine (NE) and endocannabinoid substances such as __________, which is similar to THC.

Answer 16

Serotonin (5-HT)
Anandamide

Question 17

Modulators in turn act on neurons in the dorsal horn by directly inhibiting at the ________ where ___ fibres and ___ delta fibres are attempting to activate second order spinothalamic tract neurons.

Answer 17

Synapses
C Fibres
A Delta Fibres

Question 18

T/F - Modulators activate local inhibitory neurons to “open the gate.”

Answer 18

False - Modulators activate local inhibitory neurons to “CLOSE the gate.”

Question 19

Modulators also inhibit firing of the second order neurons themselves and these local neurons use ______ and _______.

Answer 19

GABA
Glycine

Question 20

T/F - Endorphins and enkephalins cannot produce effects in the spinal cord.

Answer 20

False - Endorphins and enkephalins CAN ALSO produce effects in the spinal cord.

Question 21

Because of the scale of the centres and pathways involved in the descending modulation mechanisms, they can be impaired by any number of traumatic and ____________ causes.

Answer 21

Pathological

Question 22

Types of pathological pain or sensation can result from aberrant ___________ or CNS analysis, or from failure of _______ modulation mechanisms, or both.

Answer 22

Nociception
Central Modulation

Question 23

T/F - Mood states, mental health, traumatic history and chronicity can all alter central modulation in ways that affect sensory experience.

Answer 23

True

Question 24

T/F - The more anxious a person is, the less intense their experience of pain.

Answer 24

False - The more anxious a person is, the MORE intense their experience of pain.

Question 25

Based on the neurochemistry of anxiety and stress, the predominance of ___________ nervous system activation enhances pain perception and pain distress (suffering).

Answer 25

Sympathetic Nervous System

Question 26

T/F - Central modulation is rendered less effective when people are stressed out.

Answer 26

True

Question 27

Central modulation is complex because of the number of individual physical and _______________ factors that come into play, especially if dysfunctional stress becomes entrenched and when _______ illness is present.

Answer 27

Psychoemotional Anxiety

Question 28

With central _____________, signals coming from sensory receptors along first order neurons are normal and should cause no pain. But at the ______ horn of the spinal cord, they are amplified, and by the time they reach the _____, what should have been a normal message has been turned right up to be a message of pain.

Answer 28

Central Sensitization Dorsal Horn Brain

Question 29

A term used to describe situations where a person's history of physical and/or emotional trauma creates hyperfacilitation of pain and other distressing symptoms along with reduced effectiveness of descending modulation.

Answer 29

Central Sensitization

Question 30

Over time, central _____________ becomes entrenched via causing altered neuron health and function, dysfunctional synapses and various changes in neurochemical production and function.

Answer 30

Central Sensitization

Question 31

_______ pain syndromes, such as fibromyalgia, are interwoven with central sensitization.

Answer 31

Chronic Pain Syndromes

Question 32

Central sensitization can be complicated by ____________, meaning that the person is expressing mental or emotional distress as physical symptoms.

Answer 32

Somatization

Question 33

Anxiety, central sensitization and depression are ______________ and often present in varying degrees in the same person over time.

Answer 33

Interconnected

Question 34

Anxiety, pain and distress cause __________ by depleting serotonin, dopamine, endogenous opioid and ______________ volumes in the CNS.

Answer 34

Depression Norepinephrine Mood

Question 35

T/F - Depression itself does not deplete neurochemicals that are used to restore and balance mood.

Answer 35

False - Depression itself DOES deplete neurochemicals that are used to restore and balance mood.

Question 36

Since neurochemicals like serotonin and norepinephrine are involved in __________ modulation, it means that their effectiveness in that role is reduced as an intrinsic aspect of depression. This results in the pain and other ________ discomfort symptoms that are part of the clinical presentation of depression.

Answer 36

Descending Modulation Physical

Question 37

The following are manifestations of depression that is ____________ in nature: - Agitation - Loss of appetite - Decreased libido - Suicidal ideation - Aggressive behaviour (verbal or physical) - Irritability

Answer 37

Serotonergic

Question 38

The following are manifestations of depression that is _____________ in nature: - Decreased concentration - Slowness - Loss of energy - Weakness - Tiredness - Reduced self-care (hygiene)

Answer 38

Noradrenergic

Question 39

_______ effects that reduce or suppress uncomfortable symptoms seem to work in large part by enhancing central modulation.

Answer 39

Placebo

Question 40

T/F - The effects of massage therapy have placebo components, especially via the therapeutic relationship and effects of touch on the brain.

Answer 40

True

Question 41

Neuron loss or ________ can lower firing rate, adding to the brain's interpretation difficulties.

Answer 41

Scarring

Question 42

____________, edema and chemicals released by damaged tissue can cause intense, irritable firing patterns.

Answer 42

Inflammation

Question 43

Abnormal firing patterns can occur anywhere along the pathways that carry transmission to the sensory cortex and often promote proximal ______________ confusion.

Answer 43

Proximal Depolarization

Question 44

________, compression and demyelination are additional factors that can cause interpretation challenges and also create transmission pattern __________.

Answer 44

Ischemia Asynchrony

Question 45

T/F - A cluster of demyelinated axons, such as in multiple sclerosis, will transmit faster than same-function neurons that are intact.

Answer 45

False - A cluster of demyelinated axons, such as in multiple sclerosis, will transmit MORE SLOWLY than same-function neurons that are intact.

Question 46

When it comes to multiple sclerosis, the information arrives in __________ batches, producing a more baffling interpretation challenge that often results in the assignment of dysfunctional _________ experiences.

Answer 46

Disordered Sensation

Question 47

T/F - Sensation can be activated without a stimulus when there is damage to a first order neuron's receptor or axon.

Answer 47

True

Question 48

A specific symptom caused by peripheral nerve damage occurring mostly with median, sciatic (tibial) and C8/T1 spinal nerve injuries. It reflects damage/irritation to the sympathetic vasomotor neurons within the affected nerve.

Answer 48

Complex Regional Pain Syndrome II (CRPS II/Causalgia)

Question 49

The primary symptom of CRPS II is an intense "_______" pain that usually has a "shooting" quality, often accompanied by ________ of the skin.

Answer 49

"Burning" Erythema

Question 50

___________ pain is a common phenomenon when there is irritation or damage in the sensory nervous system.

Answer 50

Neuropathic

Question 51

Neuropathic pain due to __________ nerve damage can be caused by: - Trauma - Neuralgias - Shingles (ex. Herpes Zoster) - Facet joint issues - Amputation (ex. Phantom Limb)

Answer 51

Peripheral

Question 52

Neuropathic pain due to _______ nerve damage can be caused by: - Transverse myelitis - Spinal stenosis - Multiple sclerosis - CNS infections - Stroke

Answer 52

Central

Question 53

__________, diabetes and chemotherapy can cause systemic damage in both the peripheral and central nervous system.

Answer 53

Alcoholism

Question 54

Possible mechanisms of ___________ pain include: - Sprouting of sympathetic post-ganglionic nerve fibres on first order afferent endings and first order sensory cell bodies - Lowered threshold for firing of c fibres and a delta fibres - Proliferation of alpha adranergic receptors on first order sensory afferent endings and first order cell bodies - Possible ephaptic afferent activation - Permanent hyperactivation of wide dynamic range neurons

Answer 54

Neuropathic Pain

Question 55

Possible mechanisms of ___________ pain include: - Glutamate excitotoxic cell death of inhibitory neurons - Inadequacy of central descending serotonin, norepinephrine, opioid peptide pathways to control nociception - Immobilization by pain decreases gating of nociceptive input, limiting physical therapy to initiate gate - Sprouting of c fibres in spinal cord - Extension of interneuron dendrites into additional spinal cord laminae

Answer 55

Neuropathic Pain

Question 56

The presentation of neuropathic pain can vary substantially as well, from numb, ________ sensations to "burning" or "electric shock" or "________" to more everyday types of pain.

Answer 56

Tingling "Stabbing"

Question 57

T/F - Neuropathic pain can often be triggered by non-nociceptive stimuli. It may be continuous or more episodic.

Answer 57

True

Question 58

T/F - Neuropathic pain is often mild and easy to live with.

Answer 58

False - Neuropathic pain is often SEVERE and VERY CHALLENGING to live with.

Question 59

Things like _______, illness, intense emotional states, anxiety and depression can make neuropathic pain _____.

Answer 59

Fatigue Worse

Question 60

There are a range of treatment approaches recommended for addressing ___________ pain, such as: - Anticonvulsant - Analgesic/antidepressant medications - Physiotherapy - Massage therapy - Psychotherapy - Acupuncture - Relaxation practices

Answer 60

Neuropathic Pain

Question 61

Absence of any sensation; the stimulus does not produce any of the expected sensation.

Answer 61

Anaesthesia

Question 62

___________ can be induced, for example by using nerve-blocking agent in dental work.

Answer 62

Anaesthesia

Question 63

Diminished sensation; the experience matches the nature of the stimulus, but is less strong than expected. Often referred to as numbness.

Answer 63

Hypoesthesia

Question 64

Heightened or exaggerated sensation; the experience accurately matches the stimulus, but produces an exaggerated or unexpectedly strong response.

Answer 64

Hyperaesthesia

Question 65

Hyperaesthesia can occur because of neuronal irritation or damage, but also for a range of _______________ reasons.

Answer 65

Psychoemotional

Question 66

Abnormal sensations, such as "pins and needles" or "bugs crawling on the skin"; the sensation experienced does not correlate with the stimulus.

Answer 66

Paraesthesia

Question 67

T/F - There is in fact reliable paraesthesia stimulus because it is a naturally produced sensation.

Answer 67

False - There is in fact NO reliable paraesthesia stimulus because it is NOT a naturally produced sensation.

Question 68

____________ can also occur when there is reduced blood flow to a nerve.

Answer 68

Paraesthesia

Question 69

When a paraesthesic sensation is painful, such as "hot pokers" or "electric burning"; dramatically strange and painful types of sensory experience.

Answer 69

Dysaesthesia

Question 70

Instead of the expected sensation, an innocuous or non-nociceptive stimulus results in pain, typically a "regular" sort of pain experience.

Answer 70

Allodynia

Question 71

T/F - Allodynia results in an increased pain threshold.

Answer 71

False - Allodynia results in A REDUCED pain threshold.

Question 72

_________ can be caused by local nerve damage/irritation, by problems in the CNS circulatory or appreciation centres and also by poor central modulation.

Answer 72

Allodynia

Question 73

The response to a nociceptive stimulus is weak; the sensation is not as strong as predictable because of the stimulus.

Answer 73

Hypalgesia

Question 74

Heightened sensitivity to painful stimuli; the person experiences an unexpectedly strong pain intensity as compared to the predicted response to the stimulus; may be accompanied by strong subjective/emotional response.

Answer 74

Hyperalgesia (aka. Hyperalgia)

Question 75

T/F - With hyperalgesia, often there is a continuation of the pain after the stimulation has ceased, sometimes for quite an extended period.

Answer 75

True