Pain

Question 1

What are 3 components of pain?

Answer 1

1-Sensory-descriminative
2-Cognitive
3-Emotional/affective

Question 2

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

Answer 2

Nociception

Question 3

Specialized Ion channels on sensory nerve endings that respond to noxious stimuli are called?

Answer 3

Nociceptors

Question 4

Pain resulting from activation of nociceptors as a result of actual or potential tissue damage and processing by the CNS is called?

Answer 4

Nociceptive Pain

-Somatic/visceral/inflammatory

Question 5

A pathophysiological process, resulting from abnormal sensory processing which does not signal actual or potential tissue damage, does not promote healing or repair and may be considered a disease is called?

Answer 5

Neuropathic/neurogenic pain

Question 6

Pain associated with musculoskeleton system that is well defined is called?

Answer 6

Somatic

Question 7

Pain associated with internal organs and associated tissues and is dull burning or poorly defined is called?

Answer 7

Visceral

Question 8

The selective reduction of pain perception without affecting other sensory modalities is called?

Answer 8

Analgesia

Question 9

The absence of any sensation due to suppression of CNS is called?

Answer 9

Anesthesia

*Local and General

Question 10

What are the 4 main steps of the nociceptive process?

Answer 10

Transduction
Transmission
Modulation
Perception

Question 11

What are the 4 types of ion channels that are on nerve endings?

Answer 11

1-Mechanical
2-Chemical
3-Thermal
4-Polymodal

Question 12

What compound found in spicy foods depletes substance P by activating the TRPV1 polymodal nociceptor?

Answer 12

Capsaicin

*numbness following pain

Question 13

Second messengers such as bradykinins are released from chemically activated nociceptor nerve endings and have what effect?

Answer 13

Further activate nociceptors by sensitizing them in a positive feedback

Question 14

Increased perception of pain in response to a painful stimuli is called?

Answer 14

Hyperalgesia

Question 15

Pain evoked by normally non painful stimuli is called?

Answer 15

Allodynia

Question 16

What are two major candidates for sensitization of nerve endings?

Answer 16

1-Substance p (SP) (nerve endings)

2-Prostaglandins (damaged cells)

Question 17

What affect to PGs have on nerve endings?

Answer 17

Activate Na channels making the cell more excitable

Question 18

Which protein is a constitutive in many tissues, generates PGs for regulation, is inhibited by classic NSAIDs and is the basis of some adverse effects of NSAIDs?

Answer 18

COX-1

*Aspirin blocks both COx1 and 2 but is more effective on 1

Question 19

GI cytoprotection, platelet aggregation, renal electrolyte homeostasis and blood flow, and some pain and fever are mediated by which protein?

Answer 19

COX-1

Question 20

Which protein is induced by hormones, growth and inflammatory mediators?

Answer 20

COX-2

*blocked by classic NSAIDs and selective Cox-2 inhibitors

Question 21

Renal electrolyte homeostasis and blood flow, Cardiovascular protection, pain, fever and inflammation are all mediated by what?

Answer 21

COX-2

Question 22

How do NSAIDs work?

Answer 22

Inhibiting the synthesis of prostaglandins that are involved in sensitizing the nociceptor nerve ending

Question 23

Which nociceptors are normally activated by mechanical stimulation (i.e. distention) but may be referred to somatic sites as well?

Answer 23

Nociceptors in the Viscera

Question 24

Which axons are the largest, myelinated, very fast and transmit touch, and proprioception?

Answer 24

A-beta axons

Question 25

Which axons are small, myelinatad, fast conducting and are associated with mechanical thermal nociceptors, transmitting fast or first pain?

Answer 25

A-delta axons

Question 26

Which axons are small, un-myelinated, slow conducting and are associated with polymodal nociceptors, transmitting slow or second pain?

Answer 26

C axons

Question 27

The plexus of nerves in the tooth are called what?

Answer 27

Plexus of Raschkow or Sub-Odontoblastic plexus

Question 28

Where do the nerves in the dentition come from?

Answer 28

- Sensory afferents of the trigeminal nerve | - Sympathetics from superior cervical ganglion

Question 29

What are the two types of nerve fibers in the tooth?

Answer 29

1-A-delta fibers (sharp localized pain when dentin is first exposed) 2-C-fibers (dull diffuse pain)

Question 30

Where do nociceptive fibers synapse with projection neurons?

Answer 30

Dorsal horn of the spinal chord *AB and Ad fibers synapse close together. mixing touch with pain

Question 31

What are the two important neurotransmitters in pain?

Answer 31

1-Glutamate | 2-Substance P

Question 32

After decussating, projection neurons ascend contra laterally in the spinothalamic tract to where?

Answer 32

Thalamus *Major somatosensory relay

Question 33

Where does the trigeminal nucleus input to?

Answer 33

Thalamus *Then goes to somatosensory cortex 1 and 2 (sensory) and limbic (emotional)

Question 34

When dorsal horn projection neurons become sensitized and hyper-respond to nociceptive input it is referred to as what?

Answer 34

Central sensitization *contributes to hyperalgesia and allodynia. Prostaglandins likely involved

Question 35

What area is the major site of action of analgesic drugs, a secondary mechanism for NSAIDs and a major site for opioids?

Answer 35

Dorsal horn of spine

Question 36

Inhibition of pain by touch is referred to as?

Answer 36

Gate Control *AB and Ad/C fibers converge

Question 37

When visceral afferent nociceptors converge on the same pain-projection neurons as the afferents from somatic structures causing pain it is called?

Answer 37

Referred pain *ie. sinusitis and dental pain

Question 38

What normally terminated nociceptive pain?

Answer 38

Healing

Question 39

Enkephalins/endorphins along with 5HT and NE act where to help modulate pain?

Answer 39

Mesencephalic Periaqueductal Gray

Question 40

What are the two types of enkephalins that are 5 amino acids long and stimulate u and d receptors?

Answer 40

1-Methionine | 2-Leucine

Question 41

Which molecules are 91 amino acids long and stimulate u and d receptors?

Answer 41

B-endorphins

Question 42

Which molecules are 17 amino acids long, stimulate k receptors are are not abused?

Answer 42

Dynorphins A and B *block pain but are not pleasant

Question 43

What are 3 features of Neuropathic pain?

Answer 43

1-1 or multiple damaged peripheral nerves 2-Continuous deep burning, aching and/or periodic shock 3-Triggers initiate the pain

Question 44

What two typical pain treatments do not work well for neuropathic pain?

Answer 44

1-NSAIDs | 2-Opioids (inconsistent)

Question 45

What types of drugs help with neuropathic pain?

Answer 45

1-Antidepressants (Cymbalta) 2-Anticonvulsants (Lyrica, gabapentin) 3-Corticosteroids

Question 46

What is an endogenous analgesia elicited by suggestion called?

Answer 46

Placebo *most likely causes release of endorphins