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Pathophys 4.2
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1st order Neurons
from periphery to CNS
2nd order neurons
Spine to Thalamus
3rd order neurons
thalamus to cortex
General somatic afferent neurons
throughout body
pain
touch
temperature
special somatic afferent neurons
muscles
tendons
joints
position
movement
General cisceral affernt neurons
visceral structures
fullness
discomfort
Ascending neural pathways
spinal column
discriminative pathway
anterolateral pathway
Discriminative Pathway
crosses at the base of the medulla
Anterolateral pathway
crosses within the first few segments of entering the spinal cord
transmission of crude sensory info
no localization
no intensity
autonomic responses
Neospinothalmic tract
rapid transmission of sensory info to the thalamus
Paleospinothalamic tract
slow conducting tracts
transmission of signals that are not localized or discriminate
projects into the intralaminar nuclei of the thalamus
close connections with the limbic cortical systems
associates emotions
List the chemical mediators involved in nociceptive pain impulses.
Bradykinin
histamine
seratonin
potassium
ATP
acetylcholine
leukotrienes
platelets
prostaglandins
glutamate
norepinephrine
substance p
A delta fibers
Myelinated
Fast
Sharp discrimination
mechanical or thermal stimuli
discriminative pathway
neospinalthalamic pathway
C Fibers
unmylenated
slow-wave pain
chemicals
persistent mechanical or thermal stimuli
neurogenic inflamation role in cronic pain
paleospinalthalamic pathway
Periaqueductal gray region
pain modulator
analgesic center
Nucleus raphe magnus
pain modulator
descending axon pathways from PAG
inhibit pain transmission by dorsal horn
Pain modulating neurotransmitters
serotonin in NRM
norepinephrine in pons and medulla
these break down in chronic pain
Endogenous opiod peptides
enkephalins
endorphines
dynorphins
stimulate opiod receptors in the CNS
Dynorphins
found in primary afferent neurons
function as neurotransmitters
inhibit synaptic transmission of pain impulses
Epidemiology of pain
#1 reason pt seek medical attention
50 million americans partially or totally debilitated
75 million in serious pain
9% of U.S. adults suffer from chronic pain
Etiology of pain
Nociceptive pain - tissue injury
neuropathic pain - injury to nerves
Acute Pain
pain < 6 mo
autonomic fight or flight responses
anxiety
may be nociceptive or neuropathic or both
chronic pain
continuous or intermittent
> 6 Mo
no autonomic response
increased irritability
depression
usually neuropathic but may also include nociceptive pain
Assesment of pain
Range of motion
muscle strenght test
deep tendon reflex tests
sensation tests
History of pain
quantify pain
Non-pharmacologic therapy
surgery
physical therapy
heat
braces
TENS
Pharmacologic Treatment
Analgesics
Adjuvants
-anticonvulsants
-antidepressants
Allodynia
pain produced by stimuli that do not normally cause pain
Hyperpathia
an unpleasant and prolonged response to pain
Hyperesthesia
abnormal increase in sensitivity to sensation
Paresthesia
abnormal touch sensation souch as tingling in the absence of external stimuli
Author
Rx2013
ID
36976
Card Set
Pathophys 4.2
Description
Pathophysiology of pain
Updated
2010-09-24T01:20:16Z
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