Term
| What is nociceptive pain? |
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Definition
| caused by activation or sensitization of peripheral nociceptors. Usually bone, muscle, or visceral insult |
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Term
| What is neuropathic pain? |
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Definition
caused by injury or acquired abnormalities of peripheral or central neural structures.
burning, tingling, "pins and needles" sensation |
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Term
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Definition
| term used to describe the recognition and transmission of painful stimuli |
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Term
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Definition
| Free, **afferent nerve endings of myelinated A-delta and unmyelinated C fibers that transduce noxious stimuli (heat, mechanical, chemical tissue damage) |
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Term
A) mechanonociceptors
B) silent nociceptors |
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Definition
A) type of nociceptor that responds to pinch and pin-prick
B) type of nociceptor that responds to inflammation |
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Term
| polymodal mechanoheat nociceptors |
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Definition
most prevalent type of nociceptor;
responds to excessive pressure, extremes of temp. (>42C and <18C), and alogens |
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Term
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Definition
| Pain producing substances |
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Term
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Definition
| perception of an ordinarily non-noxious stimulus as pain |
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Term
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Definition
| absence of pain perception |
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Term
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Definition
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Term
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Definition
| pain in an area that lacks sensation |
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Term
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Definition
| unpleasant or abnormal sensation with or without a stimulus |
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Term
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Definition
| diminished response to noxious stimulation |
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Term
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Definition
| increased response to noxious stimulation |
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Term
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Definition
| increased response to mild stimulation |
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Term
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Definition
| presence of hyperesthesia, allodynia, and hyperalgesia usually associated with overreaction, and persistence of the sensation after the stimulus. |
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Term
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Definition
| reduced cutaneous sensation (e.g. light touch, pressure, or temperature) |
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Term
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Definition
| pain in the distribution of a nerve or a group of nerves |
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Term
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Definition
| abnormal sensation perceived without an apparent stimulus |
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Term
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Definition
| functional abnormality of one or more nerve roots |
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Term
| What is protopathic sensation? |
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Definition
noxious (pain)
subserved by high-threshold receptors
conducted by A-delta and C fibers |
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Term
| What is epicritic sensation? |
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Definition
Non-noxious
Light touch, pressure, proprioception, and temp. discrimination
characterized by low-threshold receptors
conducted by large myelinated fibers (A-beta) |
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Term
| What 3 nerve fibers are involved in pain? |
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Definition
| A-beta, A-delta, and C fibers |
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Term
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Definition
large, myelinated fibers
transmit impulses quickly
transmit sensations of touch, pressure, and proprioception
Carry sensations described as EPICRITIC |
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Term
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Definition
Small, myelinated fibers
transmit impulses fast
Sense sharp and well localized sensations
**First pain or "Acute" pain**
Carry protopathic sensations
Warns you to react quickly |
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Term
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Definition
Very small, unmyelinated fibers
Transmit impulses slowly
sense dull, poorly localized sensations
**second or "chronic" pain**
transmits protopathic sensations of pain, temp., and touch |
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Term
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Definition
pain transmission to brain is blocked by gates located at the spinal cord level and the thalamus.
They open or close either allowing or blocking pain impulses from registering in the brain.
Large diameter fibers CLOSE gates (A-beta fibers)
Small diameter fibers OPEN gates (A-delta and C fibers) |
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Term
| What is the difference between acute and chronic pain? |
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Definition
Acute is caused by noxious stimulation and is almost always nociceptive.
Chronic pain persists beyong the usual course and may be nociceptive, neuropathic, or a combination |
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Term
| What are the two types of acute pain? |
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Definition
| Somatic (deep or superficial) and visceral |
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Term
| Acute superficial somatic pain |
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Definition
Due to nociceptive stimuli from skin, subQ tissue, and mucous membranes
Well localized
Described as sharp, pricking, throbbing, and burning |
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Term
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Definition
Arises from muscles, tendons, joints, or bones.
Dull aching quality
Less well-localized than superficial pain. |
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Term
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Definition
Due to disease process or abnormal function of an internal organ
Presents as aching, dull, and diffuse.
Poorly localized. |
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Term
| **REVIEW PG. 362 M&M TABLE 18-2 FOR PATTERNS OF REFFERED PAIN (VISCERAL)** |
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Definition
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Term
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Definition
Neuropathic pain.
Caused by an injury to the CNS that transmits pain.
Injury can be central or peripheral.
Described as burning, electrical, and shooting.
Example: post-herpetic pain, diabetic neuropathy, or post surgical procedure |
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Term
| What are the two types of sympathetically maintained pain/complex regional distrophy? |
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Definition
| reflex sympathetic dystrophy (CRPS I) and causalgia (CRPS II) |
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Term
| reflex sympathetic dystrophy (CRPS I) |
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Definition
Nerve disorder that occurs at site of injury (usually extremities)
Chronic condition characterized by severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch |
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Term
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Definition
burning pain that typically follows high velocity injuries to large nerves (i.e. gunshot).
anything that increases sympathetic tone (fear, anxiety, noise) exacerbates the pain.
Treatment is sympathetic block |
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Term
| What are the four processes for pain perception and response? |
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Definition
| Transduction, transmission, interpretation, and modulation |
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Term
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Definition
Nociceptors are stimulated in skin and muscle.
A noxious, painful or tissue-damaging stimuli affects a peripheral sensory nerve ending.
Nerve is depolarized.
Generates electrical impulse. |
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Term
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Definition
| The impulse is transmitted or carried throughout the nervous system. |
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Term
| **What is the most important pathway for transmission of pain? |
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Definition
| The spinothalamic tract** |
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Term
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Definition
A subjective interpretation of pain by the patient.
behavioral, psychological, and emotional factors are involved, which create an individualized perception of pain. |
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Term
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Definition
Can either inhibit or facilitate pain.
It is a neural response.
peptides, amino acids, and other mediators released.
chemical messages are released. |
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Term
T/F. Pain is conducted along three-neuron pathways from cortex to periphery.
What are they? |
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Definition
FALSE. It is from peiphery to cortex.
First, second, and third order neurons |
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Term
| **Where are first, second, and third order neurons located? |
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Definition
First- in the dorsal root ganglia
Second- in the dorrsal horn
third- in the inner chamber of thalamus |
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Term
| What is a dorsal rhizotomy? |
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Definition
| transection of the dorsal nerve root |
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Term
| Why do patients still experience pain after dorsal rhizotomy? |
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Definition
| Because there are some unmyelinated fibers that have been shown to enter the spinal cord via the ventral root |
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Term
| Where do first order neurons (FON) synapse with second order neurons (SON)? |
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Definition
| In the gray matter of spinal cord |
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Term
| Spinal cord gray matter is made up of _____ laminae, of which the first ____ make up the dorsal horn |
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Definition
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Term
| T/F. Laminae 1-6 are where all efferent stimuli comes into the spinal cord. |
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Definition
| FALSE. It is where all AFFERENT stimule comes into the spinal cord |
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Term
| **Lamina II (substantia gelatinosa) |
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Definition
Contains many interneurons (aka association/relay/connector/local circuit neurons).
These interneurons are multipolar and connect afferent neurons and efferent neurons in neural pathways.
Plays a major role in processing and modulating nociceptive input from the periphery.
**MAJOR SITE OF ACTION FOR OPIODS** |
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Term
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Definition
| receive non-nociceptive sensory input (doesn't hurt) |
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Term
| lamina VII (intermediolateral column) |
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Definition
| contains pre-ganglionic sympathetic neurons |
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Term
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Definition
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Term
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Definition
very small neuron surrounding the central canal.
involved in pain, temp. and visceral sensations. |
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Term
| T/F. SON are either nociceptive or wide dynamic range (WDR) neurons. |
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Definition
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Term
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Definition
respond only to noxious stimuli.
Primarily located in lamina I |
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Term
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Definition
respond to noxious (protopathic) and non-noxious (epicritic) stimuli.
most abundant in lamina V |
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Term
| What type of neurons are associated with "spinal wind up?" |
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Definition
| Wide dynamic range neurons |
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Term
| T/F. The spinothalamic tract is divided into lateral and medial. |
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Definition
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Term
| In spinothalamic tracts, where do the axons cross over? |
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Definition
| In the spinal cord around the level of the stimulus. AFTER crossing they form the spinothalamic tract. |
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Term
| lateral spinothalamic tract |
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Definition
carries pain (location, intensity, and duration) and temperature sensations up to brain.
project into the posterolateral portion of the thalamus |
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Term
| medial spinothalamic tract |
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Definition
mediates the autonomic and unpleasant emotional perceptions of pain.
projects into the medial portion of the thalamus. |
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Term
| Ascending sensory pathway (DCML or PCML) |
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Definition
| Sensory pathway responsible for transmitting fine touch, pressure, vibration, and conscious proprioceptive info from the body to the cerebral cortex via the cuneatus and gracilis tracts. |
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Term
| With the ascending sensory (DCML) pathway where does cross over occur? |
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Definition
| In the brainstem to the contralateral thalamus |
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Term
| What pathway is monitored with SSEP? |
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Definition
| The ascending sensory pathway (DCML) |
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Term
| T/F. Opioids must be avoided during SSEP monitoring because they will hinder the results. |
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Definition
| FALSE. They do not affect SSEP monitoring |
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Term
| What are the two major groups of descending tracts from the brain? |
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Definition
| The corticospinal (pyramidal) tracts and the extrapyramidal tracts |
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Term
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Definition
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Term
| How would a posterior left-sided rhizotomy affect a patient? |
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Definition
| sensations carried in the spinothalamic tract (pain&temp.) would be lost on the RIGHT side at the level of the dermatome and DOWN. |
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Term
| If the right dorsal lemniscal tract was severed how would it affect the patient? |
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Definition
| touch, pressure, and vibratory senses would be lost from the ipsilateral side, in this case the RIGHT side at that level and down |
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Term
| Where do SON's synapse with TON's? |
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Definition
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Term
| Where do TON's terminate? |
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Definition
| At somatosensory areas of the cortex |
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Term
| What are the two most important excitatory pain modulating peptides? |
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Definition
| Substance P and Calcitonin gene related peptide (CGRP) |
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Term
| What is the most important excitatory amino acid? |
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Definition
| glutamate: transmits pain impulses. Binds to receptors and causes changes in sodium ion channels. |
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Term
| T/F. CGRP causes a major increase in SVR? |
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Definition
| FALSE. It is a powerful arteriolar vasodilator |
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Term
| T/F. Substance P can be an excitatory or inhibitory pain modulator. |
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Definition
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Term
| What are the inhibitory pain-modulating neurotransmitters? |
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Definition
| Enkephalins, endorphins, substance P (can also be excitatory), and somatostatin. |
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Term
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Definition
Synthesized and released by FON's both peripherally and in the dorsal horn.
facilitates ascending transmission in pain pathways.
sensitizes nociceptors.
causes release of histamine from mast cells.
Causes a release of serotonin (5-HT) from platelets.
Potent vasodilator.
chemoattractant for leukocytes. |
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Term
| Where does modulation of pain occur? |
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Definition
Can occur peripherally at the nociceptor.
Can occur in the spinal cord.
Can occur in supraspinal (brain) structures.
Modulation can either inhibit or facilitate pain |
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Term
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Definition
| nociceptors become oversensitized after repeated stimulation and eventually pain remains after stimulus removed. |
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Term
| READ ABOUT PRIMARY AND SECONDARY HYPERALGESIA SLIDES 77-84 |
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Definition
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Term
| READ ABOUT CENTRAL MODULATION |
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Definition
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Term
| What is preemptive analgesia |
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Definition
Supplying analgesia before the circuit of pain begins.
This blocks the effects of sensitization.
Decreases amount of narcotics needed both intraoperatively and postoperatively. |
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Term
| what effects are attributed to mu-1 receptors? |
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Definition
| supraspinal analgesia, decreased HR, euphoria, and itching |
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Term
| What effects are attributed to Mu-2 receptors? |
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Definition
| Spinal analgesia, respiratory depression, and addiction |
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