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Flashcards in Pain Deck (135):
1

What is the function of the anterolateral system?

- Pain and temperature
- Gross touch
- Light touch

2

What is the definition of pain?

Unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

3

What are the 2 duration classifications of the pain?

- Acute
- Chronic

4

What causes nociceptive pain?

- Stimulation of peripheral nerve fibers or their receptors that only respond to stimuli approaching or exceeding harmful intensity

5

What are the 3 modes of noxious stimulation to nociceptors?

- Thermal
- Mechanical
- Chemical

6

What 3 terms are used to describe the perception of pain?

- Visceral
- Deep somatic
- Superficial somatic

7

What type of pain is dull, aching, and poorly localized?

- Deep somatic

8

What type of pain is sharp, well-defined, and clearly located?

- Superficial somatic

9

What type of pain is diffuse, difficult to locate, and often referred?

- Visceral pain

10

Why are somatic and visceral pain sometimes confused?

- They share afferent pathways

11

What is neuropathic pain caused by?

- Damage or disease that affects any part of the nervous system involved in bodily feelings

12

How is neuropathic pain typically described?

- Burning
- Tingling
- Electrical
- Stabbing
- Pins and Needles
- Funny bone

13

What is phantom pain?

- Pain felt in a part of the body that the brain no longer receives signals from

14

Phantom pain is a subtype of which type of pain?

- Neuropathic

15

What is psychogenic pain caused by?

- Mental, emotional, or behavioral factors

16

Why are psychogenic pain sufferers sometimes stigmatized?

- Medical professionals and general public think the pain isn't real

17

Is psychogenic pain real?

Yes

18

What is referred pain?

- Pain occurs in an area away from the damaged/ pain site

19

What are the 2 types of referred pain?

- Myofascial
- Sclerotomic & Dermatomic

20

What is myofascial pain?

- Trigger points
- Nerve impulses bombard CNS and expresses as referred pain

21

What is sclerotomic/ dermatomic pain?

Pain in the pattern of a spinal nerve root

22

Where may the heart refer pain to?

- Upper chest
- Left shoulder
- Jaw
- Arm

23

Where may the diaphragm refer pain to?

- Lateral tip of either shoulder

24

Where may the gallbladder refer pain to?

- Right shoulder
- Inferior angle of right scapula

25

What referred pain may result from a ruptured spleen? What is this called?

- Pain on tip of shoulder
- Kerr's sign

26

What may sclerotomic pain of L5 and S1 present as?

Lateral leg and foot pain

27

What is paresthesia?

- Abnormal spontaneous sensations such as burning, tinging or pins and needles

28

What is dyesthesia?

- Unpleasant sensation produced by a stimulus that is usually painless

29

What is anestheisa?

Loss of sensation

30

What is hypoesthesia?

Partial loss of touch and pressure sensations

31

What is hyperesthesia?

Increased sensitivity to touch and pressure sensations

32

What is analgesia?

Loss of pain and temperature sensations

33

What is hypoalgesia?

Partial loss of pain and temperature sensations

34

What is hyperalegsia?

- Increased sensitivity to pain sensations

35

What is myalgia?

Tenderness or pain in the muscles

36

What is malaise?

General discomfort/ uneasiness

37

What is causalsia?

Intense, severe burning pain

38

What is allodynia?

Non-painful stimuli evokes pain

39

What nerve fibers carry fast pain?

Myelinated a-delta

40

What nerve fibers carry slow pain?

Unmyelinated C fibers

41

What neuron transmits pain info to the spinal cord?

Nociceptive neurons

42

Which type of pain is more localized?

Fast

43

Is fast or slow pain aching, throbbing, burning?

Slow

44

What time frame is considered acute pain?

< 6 months

45

Which type of pain typically has more actual tissue damage?

- Acute

46

Which type of pain can have no actual damaging or threatening stimulus?

- Chronic

47

What time frame is considered chronic pain?

> 6 months

48

What type of nerve fibers is typically responsible for acute pain?

Group III

49

What are the 2 aspects of the pattern of pain?

- Frequency (firing rate of neuron)
- Intensity (frequency of stimuli acting on neuron)

50

What types of pain does the specific/ anatomic theory of pain not hold true for?

Neurogenic
Neuropathic

51

What are the 4 underlying aspects of the neuromatrix?

- Body self
- Sensory
- Affective
- Cognitive

52

What is the sensory aspect of the neuromatrix?

The actual stimulus

53

What is the affective aspect of the neuromatrix?

- Emotional or personality influence

54

What is the cognitive aspect of the neuronmatrix?

Frontal lobes remember pain

55

What role does the insular cortex play in pain perception?

- Distinguishes pain from other homeostratic emotions (itch, nausea_

56

What role does the anterior cingulate cortex play in pain perception?

- Motivation

57

What role does the sensory cortex play in pain perception?

Localizes pain

58

Do type IV or III fibers react more quickly to pain stimulus?

- IV

59

What is volume transmission?

Dumping of neurotransmitters

60

What do the primary afferents of pain synapse on?

- Tract cells
- Inhibitory interneurons that regulate ascending flow of nociceptive input
- Facilitory interneurons that regulate ascending flow of nociceptive input
- Interneurons that mediate local refelxes

61

What method of communicaiton is used by primary afferents of pain?

- Volume transmission

62

Which type of pain is more discriminitive? (fast or slow)

Fast

63

What laminae do fast pain fibers synapse on?

- Lamina 1 and 5 (marginal nuceleus)

64

What 2 areas do fast pain fibers synapse on in the higher centers?

- Lateral thalamus (VPL)
- Post central gyrus of parietal cerebral cortex

65

On which laminae do most slow pain neurons synapse?

Laminae 2 and 5

66

What chemical mediators may cause a slow pain response?

- Histamine
- Prostaglandin
- Substance P
- Other inflammatory mediators

67

Which type of pain projects laterally? (fast or slow)

Fast pain

68

Which type of pain projects medially? (fast or slow)

Slow pain

69

Which type of pain has more interneurons? (fast or slow)

- Slow pain

70

Which type of pain deals with the affective components of pain? (fast or slow)

Slow pain

71

Which type of pain gives information regard perception of sharpness, intensity, location of pain? (fast or slow)

Fast pain

72

Where do the fast and slow pain fibers split during their ascent to higher centers?

- At the brain stem

73

What is the axon reflex (Why does the skin become red and flare up around the area of the injury)?

- Pain receptors transmit impulses in orthdromic and antidromic directions to neighboring skin, where free nerve endings release substance P binding to arteries, and causing dilation, and also binds to mast cells releasing histamine resulting in fluid accumulation

74

What is the triple response (in relation to inflammation)?

- Red line
- Flare
- Weal

in response to skin stretching

75

Which autonomic nervous system causes the redness of inflammation?

Sympathetic

76

What is peripheral sensitization of primary afferents?

- Nerves become inflamed and fire without reason or stimulus

77

What are the aspects of peripheral sensitization of primary afferents?

- Receptor sensitivity
- Membrane threshold lowered
- Ectopic firing (random firing)

78

Why is it so difficult to treat central sensitiization?

- There are so many causes

79

How may neuronal receptive fields be changed in central sensitization?

- Expanded so that more stimuli acts on one field

80

How can neuronal activity be altered in central sensitization?

- Increased response to noxious stimuli

81

How can the glia affect central sensitization?

- Release chemical mediators

82

How can interneurons affect central sensitization?

- Inhibit neurotrasmission

83

What is long-term potentiating?

- Stimulation of a cell over time increases it excitability/ and its duration of action

84

How can central sensitization affect membranes?

Lower thresholds

85

What is wind-up?

- Dorsal cells activated a lot, they'll fire more often

86

What is the origin of the lateral spinothalamic tract?

- Laminae I and V - VII in dorsal horn (nucleus proprius)

87

Do the fibers of the lateral spinothalamic tract cross?

Yes, at the level of the dorsal horn

88

What is the extent of the lateral spinothalamic tract?

- Throughout the cord

89

What does the lateral spinothalamic tract synapse on?

- Lateral thalamus

90

What is the function of the lateral spinothalamic tract?

- Concious pain and temperature

91

What is the origin of the anterior spinothalamic tract?

- Laminae III and V/ dorsal horn

92

Do the fibers of the anterior spinothalamic tract cross?

- Yes, at the level of the dorsal horn

93

What is the extent of the anterior spinothalamic tract?

- Throughout

94

What is the termination of the anterior spinothalamic tract?

- Medial thalamus

95

What is the function of anterior spinothalamic tract?

- Gross touch and pressure
- Maybe pain

96

What is the origin of the spinotectal tract?

- Laminae I and V

97

Dot he fibers of the spinotectal tract cross?

Yes

98

What is the termination of the spinotectal tract?

- Tectum of midbrain

99

What is the function of the spinotectal tract?

Tectum: Reflexive responses to pain and temperature
Locomotor center/ PAG: Aversise behavior and algesia

100

What is another name for the spinotectal tract?

Mesencephalic

101

What is the origin of the spinoreticular tract?

Laminae VI and VII

102

What is another name for the spinoreticular tract?

- Hypothalamic
- Limbic

103

Do the fibers of spinoreticular tract cross?

Yes

104

What is the extent of the spinoreticular tract?

Throughout cord

105

What is the termination of the spinoreticular tract?

Reticular formation

106

What is the origin of the spinocervical tract?

- Laminae III and IV

107

Do the fibers of the spinocervical tract cross?

No

108

What is the extent of the spinocervical tract?

Throughout cord

109

What is the termination of the spinocervical tract?

Lateral cervical nucleus

110

What is the function of the spinocervical tract?

Possibly a secondary tract for Pain and temperature to cerebral levels

111

What is the function of the spinoreticular tract?

- Reflexive response and state of conciousness

112

What is the origin of the posterior synaptic dorsal column?

- Laminae X

113

Do the fibers of the posterior synaptic dorsal column cross?

No

114

What is the extent of the posterior synaptic dorsal column?

Throughout the cord

115

What is the termination of the posterior synaptic dorsal column?

The gracillis

116

What is the function of the posterior synaptic dorsal column?

Visceral pain

117

Where do the group III and IV afferents of the lateral spinothalamic tract enter the spinal cord? What is their pathway from entrance of the cord to their ascending pathway?

- Enter by the lateral division
- Go up or down 2 segments in Lissauers tract (dorsal-lateral fasciculus)
- Enter dorsal horn
- Synapse on projection cell
- Projection cell crosses over cordl through anterior white commisure
- Ascend as lateral spinothalamic tract

118

How are fibers added to the lateral spinothalamic tract as it ascends the spinal cord?

- From lateral to medial due to its contralateral - projection
- Arranged from lateral to medial:
- Sacral
- Lumbar
- Thoracic
- Cervical

119

Where do the two spinothalamic tracts split?

At the brain stem

120

Which spinothalamic tract is the phylogenetically older?

Anterior spinothalamic

121

Which spinothalamic tract has more synapses?

Anterior spinothalamic

122

Which tract constitutes the neo spinothalamic tract? Which tract consitutes the paleo spinothalamic tract?

Neo: Lateral spinothalamic
Paleo: Anterior spinothalamic

123

Where are phylogenetically newer structures located in the spinal cord?

On the lateral portion

124

What pathway does visceral pain take up the spinal cord?

Post-synaptic dorsal column

125

Why is meant by the "post-synaptic" in post-synaptic dorsal column?

A projection cell extends from the neuron in the dorsal horn to the pathway in the dorsal funniculus

126

What is the Melzak and Wall theory?

The gate theory.

Mechanoreceptor/ group II fibers synapse on the projection cell, inhibiting it
- There requires a stronger stimulus to activate pain projection fibers

127

What is the origin of descending modulatory sytems?

Periaqueductal gray

128

What nuclei are stimulated by the periaqueductal gray in the descending modulatory system?

- Lateral tegmental nucleus
- Nucleus raphe magnus

129

What does the nucleus raphe magnus synapse on in the descending modulatory system?

- Inhibits projection neuron that travel to the dorsal horn
- Excites endorphin interneuron that inhibits a projection cell to the dorsal horn and a-delta fiber

130

What does the lateral tegmental nucleus synapse on in the descending modulatory system?

- Excites an endorphin interneuron which inhibits projection neuron to dorsal horn and a-delta fiber

131

What neurotransmitter does the nucleus raphe magnus pathway use? What is the name of the pathway?

- Serotonin

132

What neurotransmitter does the lateral tegmental nucleus pathway use?

- Norepinephrine

133

What is the overall effect of the descending modulatory system?

If stimulated, it inhibits pain/ causes analgesia

134

What is the spinomesencephalic tract?

- Projections of the lateral spinothalamic tract to the periaqueductal gray

135

Review slides 24 - 27 possibly

24 - 27