Pathophys 4.2

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Author:
Rx2013
ID:
36976
Filename:
Pathophys 4.2
Updated:
2010-09-23 21:20:16
Tags:
Pain
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Description:
Pathophysiology of pain
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  1. 1st order Neurons
    from periphery to CNS
  2. 2nd order neurons
    Spine to Thalamus
  3. 3rd order neurons
    thalamus to cortex
  4. General somatic afferent neurons
    • throughout body
    • pain
    • touch
    • temperature
  5. special somatic afferent neurons
    • muscles
    • tendons
    • joints
    • position
    • movement
  6. General cisceral affernt neurons
    • visceral structures
    • fullness
    • discomfort
  7. Ascending neural pathways
    • spinal column
    • discriminative pathway
    • anterolateral pathway
  8. Discriminative Pathway
    crosses at the base of the medulla
  9. Anterolateral pathway
    • crosses within the first few segments of entering the spinal cord
    • transmission of crude sensory info
    • no localization
    • no intensity
    • autonomic responses
  10. Neospinothalmic tract
    rapid transmission of sensory info to the thalamus
  11. 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
  12. List the chemical mediators involved in nociceptive pain impulses.
    • Bradykinin
    • histamine
    • seratonin
    • potassium
    • ATP
    • acetylcholine
    • leukotrienes
    • platelets
    • prostaglandins
    • glutamate
    • norepinephrine
    • substance p
  13. A delta fibers
    • Myelinated
    • Fast
    • Sharp discrimination
    • mechanical or thermal stimuli
    • discriminative pathway
    • neospinalthalamic pathway
  14. C Fibers
    • unmylenated
    • slow-wave pain
    • chemicals
    • persistent mechanical or thermal stimuli
    • neurogenic inflamation role in cronic pain
    • paleospinalthalamic pathway
  15. Periaqueductal gray region
    • pain modulator
    • analgesic center
  16. Nucleus raphe magnus
    • pain modulator
    • descending axon pathways from PAG
    • inhibit pain transmission by dorsal horn
  17. Pain modulating neurotransmitters
    • serotonin in NRM
    • norepinephrine in pons and medulla
    • these break down in chronic pain
  18. Endogenous opiod peptides
    • enkephalins
    • endorphines
    • dynorphins
    • stimulate opiod receptors in the CNS
  19. Dynorphins
    • found in primary afferent neurons
    • function as neurotransmitters
    • inhibit synaptic transmission of pain impulses
  20. 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
  21. Etiology of pain
    • Nociceptive pain - tissue injury
    • neuropathic pain - injury to nerves
  22. Acute Pain
    • pain < 6 mo
    • autonomic fight or flight responses
    • anxiety
    • may be nociceptive or neuropathic or both
  23. chronic pain
    • continuous or intermittent
    • > 6 Mo
    • no autonomic response
    • increased irritability
    • depression
    • usually neuropathic but may also include nociceptive pain
  24. Assesment of pain
    • Range of motion
    • muscle strenght test
    • deep tendon reflex tests
    • sensation tests
    • History of pain
    • quantify pain
  25. Non-pharmacologic therapy
    • surgery
    • physical therapy
    • heat
    • braces
    • TENS
  26. Pharmacologic Treatment
    • Analgesics
    • Adjuvants
    • -anticonvulsants
    • -antidepressants
  27. Allodynia
    pain produced by stimuli that do not normally cause pain
  28. Hyperpathia
    an unpleasant and prolonged response to pain
  29. Hyperesthesia
    abnormal increase in sensitivity to sensation
  30. Paresthesia
    abnormal touch sensation souch as tingling in the absence of external stimuli

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