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A/P > Lecture 14: 9/30 - Pain > Flashcards

Lecture 14: 9/30 - Pain Flashcards

Test 2

1
Q

What pathway does fast pain go up?

A

Lateral spinothalamic tract

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2
Q

What pathway does slow pain go up?

A

Anterior spinothalamic tract

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3
Q

Where are the fast pain synapse?

A

Laminae I

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4
Q

What type of fibers do fast pain travel on?

A

Heavily mylinated A-Delta fibers

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5
Q

What is a pain neuron called?

A

Nociceptor

Free nerve ending

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6
Q

What are the neurotransmitters on for fast pain?

A

Glutamate

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7
Q

Where is fast pain sent to?

A

Parietal Lobe (post central gyrus)

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8
Q

What pathway slightly mimics the fast pain pathway?

A

DCML

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9
Q

Describe Glutamate in fast pain

A

Fast to release and bind to receptor
Fast to generate AP

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10
Q

If there is fast pain on your LE, what part of the parietal lobe is that sent to?

A

Midline/Top

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11
Q

If there is fast pain on your face, what part of the parietal lobe is that sent to?

A

Lateral

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12
Q

Why can you localize fast pain better than slow pain?

A

Fast pain mimic the DCML and terminates in the parietal lobe vs slow pain that does always reach that far. The parietal lobe controls your senses

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13
Q

What are the neurotrasmitters in slow pain?
What is the main one?

A

Glutamate
Substance P
Calcitonin Gene-related peptide (CGRP)

Substance P

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13
Q

Where are the synapse for slow pain?

A

Laminae II, III, and V

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14
Q

Describe Glutamate in slow pain vs fast

A

Glutamate acts slower in slow pain

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15
Q

What is a Neospinothalamic tract?

A

New pain pathway that has branched off of slow pain pathway. More sophitocated

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16
Q

What is a paleospinothalamic tract?

A

older tract that hasnt been developed much

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17
Q

T/F: Slow pain transmitters are slow to release and bind to receptor and generate an AP

A

T

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18
Q

Where does crossover happen in pain?

A

Anterior White Commisure (AWC)

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19
Q

T/F: Pain goes up the spinal cord on the same side the pain went into the spinal cord

A

F

Pain crosses over at the AWC before going up

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20
Q

Describe the pathway of fast pain

A

Dorsal root/rootlets -> Dorsal horn -> Laminae 1 (Laminae marginalis) -> Crossover at AWC -> Lateral spinothalamic tract -> ascends through the spinomesencephalic tract -> thalamus -> ventrobasal and intralaminar nuclei of the thalamus -> internal capsule -> Parietal lobe / cortex

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21
Q

Where are the somatosensory areas?

A

Parietal lobe

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22
Q

What areas do the DCML and fast pain have in common?

A

Ventrobasal complex in the thalamus and the internal capsule

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23
Q

Where do slow pain signals normally terminate?
Where is this?

A

Reticular formation

Tissue at the top of the brainstem

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24
If slow pain does go pass the reticular formation, where does the signaling usually go?
Limbic system
25
Describe extrapyramidal tract: Olivospinal
Descending motor pathway only needs to know it exists
25
Describe extrapyramidal tract: Vestibulospinal
Descending motor pathway Balance; focuses eyes when body is moving
26
Describe extrapyramidal tract: Reticulospinal
Maintains muscle tone
27
Describe extrapyramidal tract: Rubrospinal
Monitors involuntary movements from the brain
28
DIC =
Descending Inhibitory Complex
29
T/F: DIC can completely suppress pain
T DOES NOT USUALLY DO THIS but it can
30
What activates the DIC pain suppression system?
Pain
31
What receptors do opiods act on?
Enkephalin receptors
32
In the DIC: where are the initial neurons located?
The periaqueductal gray (superior to the 4th ventricle) or The periventricular nuclei (anterior to 3rd ventricle)
33
In the DIC: what does the 1st order neuron release? Where is this released?
Enkephalin On the 2nd order cell body (Serotenergic neuron) locate at the Nucleus raphe
34
In the DIC: where is the synapse for the 1st and 2nd order neuron?
Nucleus raphe in the center of the pons
35
In the DIC: what is the 2nd order neuron?
Serotonin neuron
36
What is Serotonin called?
5-HT
37
In the DIC: what is the 3rd order neuron? Is it excitatory or inhibitory? What does it do?
Enkephalin neuron Inhibitory Releases enkephalin on the synapse/laminae in the grey matter where pain is before crossover
38
Deep brain stimulation of the periventicular nuclei and periaqueductal gray does what?
activate DIC pathway decrease pain...
39
What are things that can be perceived as pain?
Damage to the receptor Increase in H+ Increase in lactic acid (ex. exercise) Increase in K+ (think about dialysis pts) Histamine (ex. mosquito bites) 5-HT in periphery Ach in periphery PGs in periphery Bradykinin
40
T/F: taking antidepressants will increase pain
F They help pain by increase the bioavailability of serotonin in the cord
41
What are antidepressants that can help with chronic pain?
SSRIs Tricyclic antidepressants
42
What neuron runs parallel to pain neuron?
pressure neurons
43
What is lateral inhibition?
Pressure sesnor inhibiting pain senses
44
What is a negative SE associated with tricyclic antidepressants?
Drowsy But will give them if depressed, with chronic pain, and cant sleep... negative side effects are not helping
45
How does accupuncture works?
Lateral inhibition
46
What type of receptor is an opiate receptor? What type of ion channel is it linked to?
GPCR K+ ion channel
47
Volatile anesthetics increase ____ conductance
K+
48
T/F: Cox 2 decreases pain
F COX2 increases PG which increase pain sensitivity
49
What is an AMPA receptor linked to?
Na+ ion channel
50
What is an NDMA receptor linked to?
Primarily Ca++ ion channel Na+ gets through here as well
51
What are the differences between the AMPA and the NDMA receptors?
NDMA receptor is much slower to open/react after AP NDMA receptor also needs to be depolarized FIRST
52
What ion blocks the NDMA receptor? How do we unblock it?
Magnesium Depolarizing the cell and Glutamate binding to the receptor
53
What happens to our NDMA receptors after we are born?
We develop more
54
What happens when we block the NDMA receptors? What can block them?
Decrease pain Ethanol Lead Ketamine Magnesium Nitrous Tramodol
55
What happens to the AMPA and NDMA receptors when we have chronic pain?
More AMPA and NDMA receptors appear at the synapse
56
What are the 3 glutamate receptors? What type of receptors are these?
AMPA NDMA Kanate Ionotropic
57
Where are metabotropic glutamate receptors found?
In the brain
58
What is a SE of taking alot of magnesium for pain?
GI disturbances - pooping
59
Which is better for pain; Ca++ or Mg++?
Mg++
60
What type of fiber for slow pain travel on?
Non-myelinated C-fibers
61
T/F: None of the slow pain signals make it to the parietal lobe
F Some do; but most dont. Most terminate in the reticular formation. some make it to the limbiic system. some make it to the parietal lobe
62
How does COX2 contribute to pain?
Increased pain activates the release of COX2 COX2 increases PG which increase pain sensitivity
63
What is iNOS? What does it do?
Induceable form of NOS (nitric oxide synthase) Increases pain signaling/sensitivity
64
What does Alpha 2 agonist do in the CNS?
Suppress pain and increase relaxation **help increase K+ permeability**
65
What are some examples of Alpha-2 agonists?
Xylazen (horse tranquilizer) Precedex (most specific) Clonidine

A/P (33 decks)

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