- pain is subjective - unpleasant and linked to emotional experiences

- a type of pain - process by which information about a noxious (harmful) stimulus is conveyed to the brain

Exam 3 - Pathophysiology of CNS Disorders (Long) Flashcards by Cassie Kellogg

Pain physiology

pain is subjective
unpleasant and linked to emotional experiences

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Nociception

a type of pain
process by which information about a noxious (harmful) stimulus is conveyed to the brain

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Nociception is the sum of…

Neural activity prior to the cognitive processes to identify a sensation as pain (perception)

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Neural activity that identify a sensation as pain (perception)

Transduction
Transmission & conduction
Descending modulation

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Transduction definition

Process whereby a noxious stimulus activates sensory receptors to initiate an action potential (electrical impulse)

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Explain transduction

Noxious stimuli induce the release of chemicals

These bind to increase the excitability of the neuronal cell membrane and lead to generation of propagated action potentials (electrical impulse)

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Where does transduction occur

At nociceptors

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Conduction

Nociceptor activation leading to action potentials that continue along afferent fibers to the spinal cord

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Transmission: excitation

Na+ increases
K+ and Cl- decrease
Depolarization

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Define transmission

Action potentials (nerve impulses) conducted to the CNS from activation of Na+ channels at synaptic junctions of neurons

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Transmission: inhibition

Increased influx of K+ and Cl-
Polarization

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Perception

Process by which a noxious event is recognized as pain

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In transmission, where does the nerve impulse go after excitation and inhibition

Continues to the thalamus

Impulses are then relayed to multiple areas of the brain (eg somatosensory cortex = the processing center)

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Modulation

Descending input from the brain that affects nociceptive transmission in the spinal cord

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Migraine triggers: Limbic system

Affective emotional response to the noxious stimulus

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Perception: somatosensory cortex and insular cortex

Involved in sensory-discriminative component

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Pain physiology types: nociceptive

Due to noxious insult or injury of tissues (adaptive pain)

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Pain physiology types

Nociceptive
Neuropathic
Inflammatory

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Pain physiology types: neuropathic

Due to lesion or disease in the somatosensory nervous system (maladaptive pain)

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Pain physiology types: inflammatory

Activation and sensitization of the nociceptive pain pathway by mediators released at a site of tissue inflammation (eg. proinflammatory cytokines)

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Headache pathophysiology

most are either migraine or tension headaches
may be preceded by warning signs/symptoms (auras)
activation of trigeminal sensory nerves triggers release of proinflammatory neuropeptides (eg. Neurokinin A, substance P —> potent vasodilators) to induce manifestation

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Migraine epidemiology

Occurs more in women than men

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What do vasodilators do and give examples of them

Widen (dilate) blood vessels to decrease BP

Examples:
- Neurokinin A
- Estrogen
- Bradykinin
- Substance P
- Histamine
- Prostacyclin (PGI2)
- Prostaglandin E2 (PGE2)

(Never Ever Be Sucking Hairy PP)

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What do vasoconstrictors do and give examples of them

Narrow (constrict) BP to increase BP

Examples:
Serotonin
Caffeine
Angiotensin II
Neuropeptide Y
Testosterone
Epinephrine/norepinephrine
Cortisol
NSAIDs (non-salicylates)
Vassopressin

(She CANT Even Catch New Vag)

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Tension headaches are usually due to

Vasoconstriction

What is the most commonly reported trigger for tension headaches

Stress

How do tension headaches differ from migraines

- Not associated w/ visual disturbances or auras - Does NOT cause nausea/vomiting - Not intensified by physical activity - Not throbbing or pulsatile - Bilateral pain, on both sides of head

Cluster headache

- severe pain (worse than migraine) in the orbital, supraorbital, or temporal region of head - unilateral, pulsating pain - more common in men - associated w/ vasodilation

Are cluster headaches primary or secondary

Primary

What causes exercise headaches

Vasodilation

Pathophysiology of fever

- elevation of body temp - core body temp is controlled by the hypothalamus and regulated by feedback mechanisms - the thermostatic set point of the hypothalamus’ thermoregulatory center is set so that the core temperature is regulated within the normal range

Medication use headaches occur from

Medication overuse Aka “rebound headaches”

Core body temp is controlled by the _______ and regulated by ________

Hypothalamus Feedback mechanisms

What is a pyrogen

Any substance that causes fever

Where do most exogenous pyrogens come from

Microbes

Lipopolysaccharide endotoxin (LPS) is a pyrogen and is _______ bacteria

Gram-negatice

What does LPS initiate

Macrophage secretion of endogenous pyrogens (ie. Cytokines, prostaglandins, leukotrienes, thromboxane)

________ also produce pyrogens that activate macrophages

Gram-positive bacteria

Some strains of S aureus and S pyogenes also release superantigen

Fever occurs in _______, caused by S aureus and S pyogenes

Toxic shock syndrome

Fever pathogenesis

Pyrogens induce prostaglandin E2 (PGE2) formation, which increases the thermostatic set point in the hypothalamus Induces vasoconstriction, shivering, and increased metabolism can increase body temp

Pathogenesis of musculoskeletal pain: what is included in the musculoskeletal system

Muscles Tendons Ligaments Cartilage Bones

Pathogenesis of musculoskeletal pain: Somatic pain

Musculoskeletal, skin Due to noxious stimuli

Pathogenesis of musculoskeletal pain: What is tendonitis?

Tendon inflammation due to acute injury or from repetitive movements

Pathogenesis of musculoskeletal pain: Stains

Muscle or tendon injury due to hyperextension causing them to tear

Pathogenesis of musculoskeletal pain: Myalgia

Muscle pain Instigated by a variety of noxious stimuli

Pathogenesis of musculoskeletal pain: What are the types of tendonitis

Carpal tunnel syndrome Sports-related tendonitis Medication-related tendonitis

Carpal tunnel syndrome

Tingling or numbness of the first digits of the hand

Sports related tendonitis

Overuse of elbow, shoulder, or knee

Medication related tendonitis

Drugs that weaken tendons eg. Fluoroquinolones like cipro, levaquin

Pathogenesis of musculoskeletal pain: Bursitis

Inflammation of the fluid-filled pads (bursae)

Pathogenesis of musculoskeletal pain: Sprains

Most common problem with ligaments

Pathogenesis of musculoskeletal pain: Low back pain

May arise due to: - nerve compression (eg pinched nerve) - trauma related and degenerative disorders

Pathogenesis of musculoskeletal pain: Osteoarthritis

- degenerative joint disease - results in gradual softening and destruction of the cartilage between bones, leading to loss of space between joints - joint deformities

John is considering two types of local analgesics for sports related tendonitis. Both are numbing agents that block Na+ channels in rapid-firing neurons. What are the two analgesics? A. Camphor B. Lidocaine C. Hydrocortisone D. Capsaicin E. Diphenhydramine

Lidocaine and diphenhydramine

What physiological effects does aspirin have on the body? SATA A. Increases TXA2 synthesis B. Causes vasodilation C. Increases gastric acid secretion D. Increases the thermostatic set point E. Decreases PGI2 synthesis

Increases gastric acid secretion Decreases PGI2 synthesis

Which cytokine is primarily responsible for increasing the set point of hypothalamic thermoregulatory center to induce fever? A. PGI2 B. PGE2 C. TXA2 D. Arachidonic acid

PGE2

Which toxicity and medication is mismatched? Statin - myalgia Fluoroquinolone - tendonitis Tylenol - antithrombotic Advil - GI bleeding Bayer - gastric ulcer

Tylenol - antithrombotic

Tension type headaches are the result of cerebral vasoconstriction. Which two endogenous chemicals would be involved in the pathology of these headache types? A. Serotonin B. Substance P C. Neurokinin D. Norepinephrine E. Bradykinin F. Prostacyclin

Serotonin Norepinephrine

Which statements below are FALSE? A. Migraines are induced by vasodilators B. Cluster headaches are more common in females C. Auras are common w/ tension headaches D. Epinephrine is a vasoconstrictor

B and C B is wrong because cluster headaches are more common in men C is wrong because auras only occur with migraines

Which statement below is true? A. Nerve excitation is caused by polarization B. Nerve excitation is caused by increased potassium permeability C. Nerve excitation is caused by increased sodium permeability D. Nerve excitation is caused by increased chloride permeability

C. Nerve excitation is caused by increased sodium permeability

What bacterial species is implicated in toxic shock syndrome? A. Escherichia coli B. Enterococcus faecalis C. Streptococcus pyogenes D. Salmonella typhi E. Pseudomonas aeruginosa

Streptococcus pyogenes

Exam 3 - Pathophysiology of CNS Disorders (Long) Flashcards

(62 cards)