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Physiology III > Lecture 12: Pain and Vestibular Control > Flashcards

Lecture 12: Pain and Vestibular Control Flashcards

1
Q

Describe pain from stimulus to perception

A
  1. Transduction
  2. Transmission
  3. Modulation
  4. Perception
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2
Q

What is involved in transduction of pain

A

Translation of noxious stimulus into neural activity

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3
Q

What is involved in modulation of pain stimulus

A

Facilitation of inhibition of neurons and interneurons in spinal cord

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4
Q

What is involved pain perception

A

Result of the integration of projection pathways with modulation, to produce final conscious subjective and emotional response

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5
Q

What is mechanical deformation in pain perception

A

Stretches or damages the receptor membranes and opens ion channels

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6
Q

What is the result of application of chemicals in pain perception

A

Opens ion channels in chemoreceptors

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7
Q

What is the result of the change in temperature in pain perception

A

Alters permeability of the membrane of thermoreceptors

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8
Q

Pain is detected through ___

A

Free nerve endings

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9
Q

___fibers detect immediate, sharp pain

A

A-delta fibers

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10
Q

__fibers detect dull, burning pain

A

C- fibers

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11
Q

Are free nerve endings myelinated or non-myelinated

A

Non-myelinated

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12
Q

Where are pain free nerve endings located

A

Skin, joints, internal organs, and bones

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13
Q

T or F: pain occurs in brain

A

False, no pain free nerve endings in brain

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14
Q

What do transient receptor potential channels detect

A

Detect temperature

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15
Q

__ receptors increase AP frequency with an increase in temperature or certain chemicals

A

Warm receptors

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16
Q

Where are warm receptors located

A

C- nerve fibers

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17
Q

___ receptors increase AP frequency with decrease in temperature

A

Cold receptors

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18
Q

Where are cold receptors located

A

Alpha-delta nerve fibers with non-myelenated endings

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19
Q

What is the resting skin temperature

A

30 degrees Celsius

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20
Q

At what temperature are heat nociceptors activated at

A

> 45 degrees Celsius

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21
Q

Which fibers have mechanical nociceptors and noxious thermal nociceptors

A

Alpha-delta fibers

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22
Q

Which receptors respond to mechanical damage- cutting, crushing, pinching

A

Mechanical nociceptors

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23
Q

What receptors respond to extreme heat and cold

A

Noxious thermal nociceptors

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24
Q

What fibers contain thermal nociceptors and polymodal nociceptors

A

C-fibers

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25
Q

What do receptors respond to thermal gradients

A

Thermal nociceptors

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26
Q

What receptors respond to various noxious, damaging stimuli- thermal, mechanical and chemical

A

Polymodal nociceptors

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27
Q

How many pathways are required to transmit pain to the brain and what are they

A

3
1. First order sensory neuron
2. Second order sensory neuron
3. Third order sensory neuron

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28
Q

What is the first order sensory neuron

A

Afferent neuron in the periphery that first detects pain signal

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29
Q

Where is the cell body for first order sensory neuron located

A

DRG

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30
Q

Where is the cell body of second order sensory neuron located

A

Soma in spinal cord or brain stem

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31
Q

Where is the third order sensory neuron located

A

Located in thalamus, synapses in cortex (layers 2-6)

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32
Q

What pathway does pain travel on

A

Spinothalamic, specifically lateral spinothalamic

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33
Q

Where does the 2nd order synapse occur

A

Thalamus

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34
Q

What does the 2nd order synapse relay

A

Perception of pain

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35
Q

Where does the 3rd order synapse occur

A

Somatosensory cortex

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36
Q

What does the 3rd order synapse relay

A

Location of pain

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37
Q

Are nociceptors adaptive or non-adaptive

A

Non-adaptive- nociceptors are activated as long as lesion is present

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38
Q

Tissue damage causes hyperalgesia which is

A

Increased sensitivity to pain

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39
Q

What fibers are activated on initial/acute pain stimulation

A

Alpha-delta fibers

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40
Q

Which fibers are activated over time, dull pain sensation that increases in intensity

A

C fibers

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41
Q

Inflammatory response to pain over time releases…

A

Bradykinins, prostaglandins, substance P, K+, and H+

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42
Q

___ in the ECF stimulate polymodal nociceptors and contribute to tissue inflammation

A

Bradykinins

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43
Q

____stimulates mast cells to release histamine

A

Substance P

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44
Q

___enhances pain sensitivity beyond the somatosensory circuit

A

Substance P

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45
Q

Describe the pathway/mechanism of action of substance P

A
  1. Substance P binds a neurokinin 1 receptors in neurons and numerous other non-neuron cell types
  2. Initiates vasodilation and inflammation
  3. Sensitizes afferent pain fibers to increase pain perception
46
Q

Repeated stimulation of ___ fibers enhances pain

A

C fibers

47
Q

Repeated stimulation of dorsal horn neurons causes ____

A

Central sensitization

48
Q

Central sensitization results in the recruitment of additional ___ receptors that make C fibers more sensitive

A

Glutamate receptors

49
Q

Central sensitization, recruitment of glutamate receptors to make C fibers more sensitive results in ____ of C-fiber nociceptors

A

Memory

50
Q

Where is pain modulated

A

CNS

51
Q

What is the endogenous opioid mechanism

A

Pain relieving pathway, activate opiate receptors that block release of substance P in the spinal cord and periaqueductal gray matter of the mid brain

52
Q

The pain afferent neuron releases ___ as NT. Another neuron releases ___ at presynaptic synapses to inhibit release of ___ and alleviate pain

A

Pain neuron: substance P
Another neuron: enkephalin
Inhibit release of: substance P

53
Q

What NT is released to counteract the pain initiated by substance P

A

Enkephalin

54
Q

What are the endogenous opioid substances

A

Endorphins, enkephalins (met-Enk and Leu-EnK) and dynorphins

55
Q

What are endogenous opioids synthesized by

A

Nerve cells

56
Q

What drugs mimic actions of endorphins at synapses in pain modulating networks

A

Morphine, Demerol and perocdan

57
Q

What drug blocks the pain modulating/relieving action

A

Naloxone- mu-Opiod receptor competitive antagonist

58
Q

Where are mu-receptors concentrated

A

Dorsal horns in spinal cord

59
Q

What is the preferred receptor for B-endorphin

A

Mu/delta

60
Q

What is the preferred receptor for endomorphin-1 and 2

A

Mu

61
Q

What is the preferred receptor for met-enk and leu-enk

A

Delta

62
Q

What is the preferred receptor for dynorphin A and B

A

Kappa

63
Q

Describe the descending pathway of pain regulation

A
  1. Noxious stimulus on nociceptor
  2. Travel on afferent pain fiber
  3. Release substance P
  4. Signal periaqueductal gray matter
    4a. Periaqueductal gray matter acts on medulla and reticular formation to activate inhibitory inter neuron in DH
    4b. Periaqueductal signals to active enkephalin releasing neurons
  5. Enkephalin releasing neurons act on raphe nucleus in brain stem
  6. Raphe nucleus release serotonin on inhibitory neuron
  7. Inhibitory neuron releases endogenous opiate to counteract substance P
64
Q

How does an epidural nerve block work with opioids and other drugs

A

Epidural blocks somatic and visceral pain by blocking transmission of pain without interfering with sensory and motor function or depressing SNS.

Opioids bind opioid receptors

65
Q

How do serotonin and NE modulate pain

A

Act by stimulating enkephalin releasing interneurons or pain modulating nuclei in brainstem

66
Q

How do NSAIDS affect pain control

A

Block COX2, critical enzyme to synthesize prostaglandins, this decreases sensitization to pain

67
Q

How do endocannabinoids modulate pain

A

Modulate pain following sustained physical activity

68
Q

How do exogenous opioids modulate pain

A

Agonize endogenous opioid receptors

69
Q

The ___ system measures orientation, position and movement of head

A

Vestibular

70
Q

What does the vestibular system measure

A

Static tilt of head, linear acceleration, and rotary acceleration

71
Q

What movements are facilitated by vestibular system

A

Correction of posture and balance, maintain focus of the eyes and head moves

72
Q

__bone houses the vestibular system and cochlea

A

Temporal bone

73
Q

The vestibular system is composed of 3 ___ and 2 ___

A

3 semicircular canals and 2 ampullae

74
Q

Which structure contains ridge of hair cells

A

Ampulla, Crista ampullaris

75
Q

2 ampulla are connected to a ___ and ___

A

Utricle and saccule

76
Q

What fluid are the utricle and saccule coated in

A

Endolymph

77
Q

Hair cells synapse with a ___ at the base

A

Sensory neuron

78
Q

sensory neuron in a hair cell leads into the ___nerve

A

CN VIII

79
Q

Bending towards the large cilia causes ___ channels to open

A

K+

80
Q

Membrane depolarization of the hair cells causes __channels to open

A

Ca2+

81
Q

Opening of Ca2+ channels within the hair cells causes exocytosis of ___ and __

A

Glutamate and aspartate

82
Q

Bending the hair cells in the opposite direction of large cilia results in ___

A

Hyperpolarization

83
Q

___detect rotational acceleration and deceleration

A

Semicircular canals

84
Q

___ causes a bend in the cupola in the opposite direction

A

Deceleration

85
Q

Canals on opposite side of the head provide ___information

A

Directional

86
Q

Ex: if you rotate head clockwise the direction of flow would be ___ in each canal, providing information on direction

A

Opposite

87
Q

___ and ___ detect linear acceleration and deceleration

A

Utricle and saccule

88
Q

__ detects horizontally oriented macula

A

Utricle

89
Q

___ detects vertically oriented macula

A

Saccule

90
Q

___ and ___ detect head tilt

A

Utricle and saccule

91
Q

When the head tilts the ___ pull down causing the firing rate to change

A

Otoliths

92
Q

___ and ___ cause cilia to bend in opposite direction than the movement of the head

A

Otoliths and endolymph

93
Q

Utricle and saccule otolith organs project to the ____ to facilitate alpha-gamma co-activation

A

Vestibulospinal tracts

94
Q

Crista ampulla of the semicircular canals feed the ____ to provide compensatory eye movements in response to rotation

A

Medial longitudinal fasciculus

95
Q

___ receives and returns input to fine tune coordination of postural and oculomotor reflexes

A

Flocculonodular node of the cerebellum

96
Q

What are the 3 targets of CN VIII via the vestibular nuclei

A
  1. Vestibulospinal tracts
  2. Medial longitudinal fasciculus
  3. Flocculonodular node of the cerebellum
97
Q

What is the vestibuloocular reflex

A

Eyes rotate to head movement to allow unchanged visual perception of a target

98
Q

What is the goal of the vestibuloocular relfex

A

Move extraoccular eye muscles to maintain visual contact with the target

99
Q

When the head is rotated what structures are activated

A

Canals and otoliths

100
Q

What nerve and nucleus are activated with head rotation

A

Vestibular nerve and nuclei

101
Q

What tracts are activated when you rotate the head

A

Lateral and medial vestibulospinal tracts

102
Q

What side are extensors and flexors activated on when the head is rotated

A

Extensors are induced on the side to which the head is rotated and the flexors are induced on opposite side

103
Q

During VSR the vestibular sensory nerves synapse on the nerves in ___ nuclei

A

Vestibular

104
Q

During VSR the neurons in the vestibular nuceli act on ___ muscles via the ___ tract, facilitating several vestibular reflexes

A

Axial muscles, vestibulospinal tracts

105
Q

What does the extrapyramidal tract do during VSR

A

Control the eye and head position to maintain eyes on target while head or body is in motion

106
Q

What is the vestibulo-colic reflex

A

Head and neck muscles adjust to maintain head position

107
Q

What is peripheral vestibular syndrome

A

Labyrinth within petrosal bone affected, associated with head tilt

108
Q

What is central vestibular syndrome

A

Brain stem is affected, associated with paresis, hemiparesis, gait and posture effects

109
Q

How can a middle ear infection cause vestibular signs

A

Infection leads to pressure on the round/oval window of the cochlea and leads to head tilt.

Pressure difference causes unbalanced AP frequency

110
Q

What are 4 very common signs of vestibular syndrome

A

Head tilt, nystagmus, ataxia, loss of balance

Physiology III (34 decks)

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