Pain

Question 1

A sign that causes an excessive discharge of stimuli

Answer 1

Pain

Question 2

Pain is both a

Answer 2

sensation and emotion

Question 3

When can pain transmission occur?

Answer 3

When one has an intact spinothalamic system

Question 4

A gate that receives pain stimuli from receptors

Answer 4

Substantia Gelatinosa

Question 5

Transmitters of pain (excitatory)

Answer 5

Substance P
Calcium
Enzymes: Histamine
Prostaglandins

Question 6

Inhibitory neurotransmitters of pain

Answer 6

Serotonin
GABA
Opioid peptides
Endorphins
Enkephalin
Dynorphin

Question 7

What inhibitory neurotransmitter inhibits at the dorsal horn?

Answer 7

Opioid peptides

Question 8

Pain pathway and interconnections

Answer 8

Receptors
Substantia Gelatinosa
Spinothalamic tract
Lateral/Anterior White mater
Tegmentum
VPL
Primary sensory area

Question 9

subserve
the emotional aspect
of pain at the level of the brainstem

Answer 9

Spinoreticular pathway

Question 10

Spinoreticular pathway

Answer 10

Pain to reticular fromation
To midbrain and pons tegmentum
to the hypothalamus
to the amygdala

Question 11

Where is the Periaqueductal Gray (PAG) located?

Answer 11

gray matter of the tegmentum of the brainstem

Question 12

What does the PAG do?

Answer 12

Regulates substantia gelatinosa; decides how much the substantia gelatinosa opens

Question 13

What lobe is the core of emotions?

Answer 13

Limbic

Question 14

Where is the Substantia Gelatinosa located?

Answer 14

Dorsal Spinal Cord

Question 15

What does increased pain do to the RAS?

Answer 15

Activates RAS in the RF found in MB & Pons to activate the cortex resulting in alertness.

Question 16

Central Modulation of Pain Perception acts on

Answer 16

Dorsal horn of the SC

Question 17

What can the central modulation of pain do?

Answer 17

can enhance or inhibit pain depending on the emotional framework

Question 18

Subserved by diffuse projections of pain fibers to the limbic and frontal lobes

Answer 18

Affective motivational aspect of pain

Question 19

What does the affective motivational aspect of pain do?

Answer 19

It is the main factor of how pain is perceived by the brain

Question 20

What neurotransmitter brings pain stimuli across the SGR?

Answer 20

Substance P

Question 21

Pain from skin, bone, organs, ligaments, and muscles

Answer 21

Nociceptive pain

Question 22

Pain from the dysfunction of the nervous system

Answer 22

Neuropathic pain

Question 23

Protective role of nociceptive pain

Answer 23

Elicits reflex and behavioral responses that keep tissue damage to a minimum

Question 24

Pain that originates or comes from cutaneous nociceptors

Answer 24

Somatic pain

Question 25

Pain that originates or comes from nociceptors found in hollow organs

Answer 25

Visceral pain

Question 26

Neuropathic pain may be

Answer 26

central or peripheral

Question 27

pain that occurs without identifiable nerve or tissue damage.

Answer 27

Central sensitization or dysfunctional pain

Question 28

Duration of Central sensitization or dysfunctional pain

Answer 28

long-lasting duration

Question 29

Scope of dysfunctional pain

Answer 29

Extends beyond the receptive field (widespread)

Question 30

Examples of dysfunctional pain

Answer 30

Fibromyalgia Irritable bowel syndrome

Question 31

Types of nociceptive pain

Answer 31

ischemic inflammatory traumatic metabolic toxic

Question 32

A type of nociceptive pain that results from lack of blood flow to the cells

Answer 32

Ischemic

Question 33

A type of nociceptive pain that results from infections

Answer 33

Inflammatory

Question 34

A type of nociceptive pain that is caused by external forces

Answer 34

Traumatic

Question 35

An example of this type of pain is uric acid that creates gouts.

Answer 35

Metabolic

Question 36

Examples of central neuropathic pain

Answer 36

Stroke Tumor Demyelinating diseases

Question 37

How much pain does nociceptive pain inflict?

Answer 37

Proportionate to the stimulus.

Question 38

How much pain does neurologic pain inflict?

Answer 38

Disproportionate to the stimuli

Question 39

PNS Lesions

Answer 39

Diabetic neuropathy Phantom limb pain Trigeminal neuralgia LBP Carpal tunnel syndrome

Question 40

CNS Lesions

Answer 40

Lesions in the VPL Stroke Myelopathic pain due to MS

Question 41

Type of pain present in neuropathic pain

Answer 41

Burning Shooting Stabbing Vice-like Electric shock-like

Question 42

A neuropathic pain that comes and goes

Answer 42

Paroxysmal

Question 43

A neuropathic pain that does not need any noxious stimuli

Answer 43

Spontaneous

Question 44

A neuropathic pain that is tolerable

Answer 44

Paresthesia

Question 45

A neuropathic pain that is no longer tolerable

Answer 45

Dysesthesia

Question 46

Onset of neuropathic pain

Answer 46

Immediate or delayed

Question 47

Pain stimulus in neuropathic pain

Answer 47

Allodynia Hyperalgesia Hyperpathia

Question 48

Clinical features associated with neuropathic pain

Answer 48

Insomnia Anxiety Depression Weight loss Decreased quality of life

Question 49

Burning, shock-like pain

Answer 49

Spontaneous pain

Question 50

Abnormal, unpleasant sensations

Answer 50

Dysesthesia

Question 51

Abnormal, not unpleasant sensation

Answer 51

Paresthesia

Question 52

Painful response to a non-painful stimulus

Answer 52

Allodynia

Question 53

Heightened response to a painful stimulus

Answer 53

Hyperalgesia

Question 54

Delayed, explosive pain to a painful stimulus

Answer 54

Hyperpathia

Question 55

decreased sensitivity & a raised threshold to painful stimuli

Answer 55

Hypoalgesia

Question 56

3 General Mechanisms of Neuropathic Pain

Answer 56

Ectopic focus Peripheral and General Sensitization Loss of Local and Central Inhibition

Question 57

damage in the CNS or PNS that will fire by itself with pain stimuli

Answer 57

Ectopic focus

Question 58

Does neuropathic pain need noxious stimuli?

Answer 58

No

Question 59

Why does neuropathic pain still illicit pain despite not having any stimulus?

Answer 59

Spontaneous firing of axons at once

Question 60

Regenerating sprouts

Answer 60

Neuromas

Question 61

What do neuromas express

Answer 61

Na+ channels

Question 62

What does damage in the PNS do?

Answer 62

Enhances pain; makes receptors very sensitive to stimulus

Question 63

Where is diabetic neuropathy more common?

Answer 63

Lower extremities than upper extremities

Question 64

Viral infection of the peripheral nn that presents with sharp burning pain in the involved dermatome

Answer 64

Herpes Zoster

Question 65

Inadequate relief of herpes zoster may lead to

Answer 65

Post herpetic neuralgia

Question 66

An injury in the msk system that gets worse with time

Answer 66

Complex Regional Pain syndrome

Question 67

Complex regional pain syndrome often result in

Answer 67

impairment of motor function

Question 68

Conditions that lead to CRPS

Answer 68

reflex sympathetic dystrophy causalgia shoulder hand syndrome acute bone atrophy post-traumatic OP

Question 69

refers to burning pain

Answer 69

causalgia

Question 70

local treatments to neuropathic pain

Answer 70

thermotherapy, electrotherapy, anesthesia, capsaicin

Question 71

what nerve block treatments are there for neuropathic pain?

Answer 71

peripheral nerve, roots, plexus; sympathetic ganglia

Question 72

Anti-convulsant for neuropathic pain

Answer 72

Caramazepine Gabapentine Pregabalin Valporic Acid Lamotrigine

Question 73

Opioids for neuropathic pain

Answer 73

Oxycodone Tramadol

Question 74

Topical prep for neuropathic pain

Answer 74

Capsaicin Lidocaine 5%

Question 75

Anti-depressants for neuropathic pain

Answer 75

TCAs - lines SSRIs - tines SNRI - xines

Question 76

make you tell the px that the pain will get better

Answer 76

Placebo

Question 77

tell the patient that they will feel more pain

Answer 77

Nocebo

Question 78

aware that they are given the drug

Answer 78

Open analgesic

Question 79

not aware that they are given the drug

Answer 79

Hidden analgesic