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Flashcards in Pain Deck (47):
1

What does capsaicin activate

Polymodal nociceptors; TRPV1

2

What is nociception

The physiological process by chick information on actual/potential tissue damage is conveyed to the CNS

3

What are nociceptors

Specialized ion channels on sensory nerve endings that respond to noxious stimuli

4

What is nociceptive pain

pain resulting from activation of nociceptors as a result of actual or potential tissue damage and processing by the CNS

5

What is neuropathic/neurogenic pain

abnormal sensory processing which does not signal actual or potential tissue damage
does not promote healing or repair.
May be considered a disease.

6

What is analgesia

Selective reduction of pain perception, w/o affecting other sensory modalities

7

What is anesthesia

Absence of any sensation due to suppression of CNS function

8

What are thefour physiologic processes of noceception

Transduction
Transimission
Modulation
Perception

9

What are four types of nociceptors

Mechanical
Thermal
Chemical
Polymodal

10

What is TRP

Transient receptor potential

11

What is released from lysed cells that can activate nociceptors

ATP

12

What is sensitization

Increased sensitivity and response to stimuli in and near the inured area

13

What is hyperalgesia

Increases perception of pain in response to painful stimuli

14

What is allodynia

Pain evoked by normally non painful stimuli

15

What produces sensitization

Chemical messengers that do not directly activate nociceptors.

16

What are two agents that cause sensitization

Substance P from nerve endings
Prostaglandins from damaged cells.

17

How does a PG work

PG receptor stimulation results in activation of specific Na- channels making the nociceptive nerve ending more excitable

18

What does COX-1 do

I is constitutive, it generate PGs for physiologic reg go
GO cytoprotection
Platelet aggreagation
Renal electrolyte homeostasis
Renal blood flow maintenance

19

What does COX-1 do with COX-2

Renal electrolyte homeostasis
Renal blood flow maintenance
CARDIOVASCUAR PROTECTION

20

What does COX-2 (inducible) do

Pain
Fever i
Inflammation

21

COX-1 is inhibited by

NSAIDs
Which is the basis for the basis of the adverse effects of NSAIDs such as aspirin and Ibuprofen.
Bleeding
Stomach irritation.

22

People that use COX-2 inhibitors are at risk of developing

heart problems

23

What is COX-2 induced by

Hormones
GFs
Inflammatory mediators

24

COX-2 inhibitors

NSAIDs
CELEBREX

25

how doe NSAIDs work

they inhibit the synthesis of PGs involved in sensitization.

26

Nociceptors in the viscera are normally activated by

mechanical stimulation such as:
distention
contractions

27

Nociceptive transmission of pain to the spinal cord is carried by ---- axons

A-delta
- myelinated, fast and sharp

28

C axons are associated with

Polymodal nociceptors
small, slow conducting

29

Dental nociception is accomplished via

Sub-odontoblastic plexus/ plexus of Raschkow
- sensory afferents of trigeminal nerve and synpathetic branches form superior cervical ganglion

30

Projection neurons travel

Across midline
ascend in spinothalamic tract.
Thalamus as major somatosensory relay

31

Where are nociceptive input heavily modulated and subject to central sensitization

dorsal horn, both facilitatory and inhibitory.
sensitization by prostaglandins can lead to hyperalgesia and allodynia.

32

Dorsal horn is a major site of action for what drugs

NSAIDs; anti-nociceptive action inhibit the synthesis of PGs.
Opioids

33

What does gate control refers to

Inhibition of pain by touch due to convergence of inputs from A ß and A delta and C fibers

34

How does referred pain occur

Visceral afferent noceceptors converge on the same pain-projection neurons as the afferents from the somatic structures in which the pain is perceived. Pain can't distinguish origin.

35

Modulation is considered the

endogenous pain suppressant neural system

36

What are the endorphins

Endogenous opioid peptides

37

If it is an endorphin, it will contain

Methionine and/or lucine

38

Enkephalin

Miu and delta; 5 amino acids

39

B-endorphin

Agonist to both miu and Delta
91 amino acids

40

What are dynorphins

A and B, primarily Kappa
Kappa; antagonistic to miu and delta receptors
block opioid reward/addictive properties.
disphoria properties

41

Drugs that enhance _____ and ____ have anti-nociceptive effects

NE
5HT

42

Opioids act in

PAG
dorsal horn; they inhibit release of pain transmitters

43

What are the features of neuropathic pain

Continuous; burning or aching
Periodic; Lancing or electric
Occurs w/o activation of nociceptors
Hyperalgesia and allodynia common/dramatic
Can be innitiated by triggers

44

What are some examples of neuropathic pain

phantom limb
Diabetes neurophaties
Shingles
Trigeminal neuralgia/tic douloureux
Fibromyalgia

45

Neuropathic pain tx

No response to NSAIDs
Antidepressants; Cymbalta
Anticonvulsants; Lyrica, gabapentin
Corticosteroids; work on 5HT and NE systems
Avoid triggers

46

What are possible mechanisms of neuropathic pain

Persistent peripheral sensitization
Spontaneous firing of damaged nociceptive nerves
Prolonged input from hyper excitable fibers
Decreased activity of endogenous pain suppressant neural system.

47

How does a placebo work

Endogenous analgesia elicited by suggestion.
Release of endorphins