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PHYSL 372 > Lecture 7 - Pain Part 1 > Flashcards

Lecture 7 - Pain Part 1 Flashcards

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1
Q

what is pain?

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

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2
Q

what is nociception?

A

physiological processing of tissue damaging information (ex: stubbing your toe and knowing you stubbed your toe)

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3
Q

pain is a protective mechanism to prevent:

A

tissue injury and permit recovery from injury

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4
Q

heightened pain; often a more robust response to something that already hurts

A

hyperalgesia

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5
Q

pain arising from gentle touch (painful response to a stimulus that would not normally be painful)

A

allodynia

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6
Q

in the somatosensory component, specific pain pathways allow:

A

the localization, intensity, and quality of pain

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7
Q

the affective component of pain allows for:

A
  • production of negative emotion
  • arousal
  • initiation of stress responses
  • interruption of ongoing procedures
  • learning
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8
Q

stress, anxiety, and anticipation can:

A

make pain worse

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9
Q

what is first pain?

A

the initial response to tissue damage sensed by free nerve endings and transmitted by sensory A-delta fibres (feels like a ‘pricking’ pain)

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10
Q

what is second pain?

A

an ongoing pain response caused by the release of bradykinin, histamine, acid metabolites, and prostaglandins at the site of lesion, and transmitted by C-fibres (feels like a ‘burning’ pain)

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11
Q

musculoskeletal and other ‘mild’ pain have two main phases:

A
  • first pain
  • second pain
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12
Q

what is deep pain?

A

a deep aching pain, felt as deep to the body surface, and poorly localized (highly diffuse)

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13
Q

how is deep pain treated?

A

with opioids

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14
Q

how is deep pain initiated?

A

by major trauma (post-operative pain, injury, or childbirth)

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15
Q

both deep pain and mild pain have been referred to as ‘good pain’ because:

A

it prevents overuse of damaged tissue and allows healing to occur

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16
Q

pain resulting from nerve injury or infections (there is some change in the nervous system)

A

neuropathic pain

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17
Q

list five examples of neuropathic pain:

A
  • phantom limb pain
  • trigeminal neuralgia
  • diabetic neuropathy
  • post herpetic neuralgia (shingles caused by herpes Zoster)
  • HIV-AIDS neuropathy
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18
Q

true or false: neuropathic pain responds poorly to opioids

A

true

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19
Q

how do you treat neuropathic pain?

A

antidepressants, cannabanoids, or anticonvulsants (like pregabalin or gabapentin)

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20
Q

why does shingles appear in a striped pattern?

A

it runs along the dermatomes

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21
Q

why do we treat neuropathic pain with antidepressants?

A

adds inhibition to the pain pathways

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22
Q

why do we treat neuropathic pain with anticonvulsants?

A

the physiology of epilepsy is similar to pain

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23
Q

why is neuropathic pain known as ‘bad pain’?

A

there is no obvious biological function

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24
Q

type of pain characterized by allodynia, hyperalgesia, causalgia, and spontaneous pain

A

neuropathic pain

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25
type of pain that has a slow onset, outlasts the original injury, and is stimulus independent
neuropathic pain
26
primary sensory neurons reside in the:
dorsal root ganglia (DRG)
27
innervates the target tissue (ie: skin) and sends projections into the spinal cord
primary sensory neurons
28
different subtypes of sensory neurons mediate:
different sensations
29
what type of neurons are primary sensory neurons?
pseudo-unipolar neurons
30
- myelinated and rapidly conducting - carry innocuous information - convey touch, pressure, muscle afferent information (important for movement, balance, and proprioception) these are all characteristics of:
Aa and Ab fibres
31
are Aa and Ab fibres responsible for pain sensation?
no
32
ion channels that open with mechanical force (mechanosensors)
Piezo 2 channels
33
- thinly myelinated - carry first pain - slow conduction velocity (<40 m/s) - high threshold mechanoreceptors these are all characteristics of:
A-delta fibres (nociceptors)
34
A-delta fibers terminated primarily in:
spinal lamina I, lamina II, lamina V
35
- unmyelinated - carry second pain - very slow conduction velocity (0.2-1 m/s) these are all characteristics of:
C fibres (nociceptors)
36
C fibres terminate primarily in:
spinal laminae I and II (marginal zone and substantia gelatinosa)
37
peptidergic C fibres are:
high-threshold mechanoreceptors and polymodal nociceptors, and mechanical cold nociceptors
38
isolectin B4 positive (IB4+) C fibers are:
low-threshold mechanoreceptors (gentle mechanical stimulation)
39
peptidergic C fibers express:
sensory neuropeptides
40
what is the main neurotransmitter for Ab fibers?
glutamate
41
what are the main neurotransmitters for A-delta fibers?
glutamate, substance P, and CGRP
42
thermoreceptors on A-delta fibers
TRPV1 and TRPM8
43
nociceptor specific sodium channels on A-delta fibers
Nav1.8/1.9 and Nav1.7
44
growth factor (NGF) dependent channels on A-delta fibers
TrkA
45
people who don't feel pain don't express these channels
TrkA
46
what are the main neurotransmitters for peptidergic C fibers?
glutamate, substance P, and CGRP
47
what are the main neurotransmitters for non-peptidergic C fibers?
glutamate
48
in the dorsal horn, pain fibers project to:
lamina II (substantia gelatinosa), lamina I (marginal zone), and lamina V
49
in the dorsal horn, pain fibers make connections with:
- lamina I projection neurons - local circuit interneurons - dendrites of wide dynamic range neurons (lamina IV and V)
50
lamina I projection neurons project to the:
brainstem, parabrachial nucleus, hypothalamus, and thalamus
51
local circuit neurons are involved in:
local withdrawal and autonomic reflexes
52
pain exits the spinal cord in either ____ or ____ projection fibers
lamina I, lamina V
53
all types of primary afferent (sensory) fibres release:
glutamate
54
glutamate acts on:
excitatory NMDA and AMPA receptors
55
some pain fibers release ____ and ____ which generates ____
substance P, CGRP, slow excitation of dorsal horn cells
56
signal transmission in the dorsal horn is modulated by:
GABA/glycine interneurons
57
some inhibitory neurons release:
enkephalin and endorphin (endogenous opioids)
58
descending NA/5-HT inputs from the rostroventral medulla, locus coereleus and raphe nuclei modulates:
spinal processing of pain
59
type of neurotransmitter that has mixed excitatory/inhibitory effects
5-HT (serotonin)
60
type of neurotransmitter that has predominantly inhibitory effects
NA (noradrenaline)
61
descending pathways from the rostroventral medulla (RVM) release:
endogenous opioids
62
most axons of lamina I and lamina V projection neurons cross midline and:
ascend in anteriolateral quadrent of spinal cord
63
what are the five main pathways that pain takes from the spinal cord to the brain?
1) spinothalamic tract 2) spinoreticular tract 3) spinomesencephalic tract (spinoparabrachial tract) 4) cervicothalamic tract 5) spinohypothalamic tract
64
a phylogenetically old tract which projects to the intralaminar thalamic neurons
spinothalamic tract (medial division)
65
type of pain tract which is responsible for the affective and alerting aspects of pain, and is associated with slow (second) pain
spinothalamic tract (medial division)
66
the medial division of the spinothalamic tract lacks:
somatotopic organization (there is pain in an area but it's not very specific because the input from the dorsal cells have large receptive fields)
67
the medial division of the spinothalamic tract projects widely to the:
association and prefrontal cortex
68
known as the "gateway to the cortex"
thalamus
69
a phylogenetically recent tract which projects to the ventroposteriolateral (VPL) nucleus of the thalamus
spinothalamic tract (lateral division)
70
the lateral division of the spinothalamic tract is somatotopically organized, which allows for:
localization and discrimination of pain
71
what percent of ventroposteriolateral (VPL) neurons are nociceptive?
only 10%
72
the lateral division of the spinothalamic tract projects to the:
somatic sensory cortex and parietal lobe
73
tract associated with fast, first pain
spinothalamic tract (lateral division)
74
type of pain tract which lacks topographical organization and projects to the reticular neurons in the brain stem
spinoreticular tract
75
what kind of receptive field do reticular neurons have?
a wide receptor field
76
the spinoreticular tract is associated with:
general aspects of pain perception (ie: alerts onset of pain)
77
neurons in the reticular formation project to the:
thalamus (reticulothalamic tract)
78
the spinomesencephalic (or spinoparabrachial) tract projects to:
1) midbrain periaqueductal gray matter (PAG) 2) hypothalamus (lateral parabrachial area), nucleus of the solitary tract, and amygdala
79
responsible for interaction between ascending pain signals and descending analgesic information from 'emotional centres' such as the amygdala
the midbrain periaqueductal gray matter (PAG)
80
responsible for autonomic, affective, and neuroendocrine responses to pain
hypothalamus, nucleus of solitary tract, and amygdala
81
the amygdala adds ____ to sensory information
value
82
what are the four main cortical structures involved in pain?
- anterior cingulate cortex - prefrontal cortex - insular cortex - somatosensory cortex
83
the anterior cingulate cortex, prefrontal cortex, insular cortex, and somatosensory cortex are all a part of the:
pain matrix
84
part of the pain matrix responsible for attention
anterior cingulate cortex
85
part of the pain matrix responsible for evaluative, higher cognitive functions
prefrontal cortex
86
part of the pain matrix that acts as a hub for putting "value" on a sensation
insular cortex

PHYSL 372 (18 decks)

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