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140 Cards in this Set

  • Front
  • Back
What is a sensory pathway UP spinal cord to the brain?
Anterolateral Pathway
Does the anterolateral pathway require high discrete local. of signals?
Does the Anterol.Pathway require fine discrimination?
What signals are included in the pathway of Anterolateral?
Pain, heat and cold, crude, tactile,tickle,itch and sexual sensations
What is another name for the Anterolateral Pathway?
Spinothalamic Pathways
How many Spinothalamic pathways is there and what are they?
1)lateral-pain and temp
2)anterior(ventral)-crude touch,tickle, press and itch
For both spinothalamic tracts for does the first- order neuron enter?
Dorsal Gray
What happens after the enter of the dorsal horn on the anterol pathway-spinoth?
Immediately synapses with the second order neuron
The Axon of 2nd order neuron in the Spino.pathway decussates through where?
Gray commissure
After the 2nd order neuron decussates and enters the gray commissure, what happens?
it enters lateral or anterior tract depending on modality being carried.
Each spino. tract passes though where?
the brainstem
Where does the signal go after it leaves the brainstem?
it then travels to the thalamus
Where does the 3rd order neuron synapse on the spinoth tract?
the thalamus is where the axon synapses
What does the 3rd order neuron pass through on the spino.pathway?
the internal capsule and then to somatosensory cortex
After going through the somatosensory cortex what happens to the 3rd order neuron?
synpases with the appropriate cortical neuron so perception of modality occurs
When does pain occur?
when tissue is damaged
What is pain?
protective mechanism for the body
Pain causes individuals to what?
withdraw or remove from the painful stimuli
How many types of pain is discussed?
What are the 2 types of pain?
fast pain
slow pain
How fast is the stimulus felt in fast pain?
0.1 sec
what type of character is the fast pain?
sharp, prickling, acute, electric
What is the speed of the slow pain's stimulus?
a second or more
What are some characteristics of slow pain?
throbbing,aching, slow burning, nausea, chronic pain
What is slow pain associated with?
tissue destruction
Where is fast sharp pain generally not felt?
deeper tissues of the body
What is an increase in the sensitivity of the pain receptors called?
Which pain receptors are free nerve endings?
all are free nerve endings
What are 3 pain receptor stimuli's?
1. mechanical
2. thermal
3. chemical
What is a chemical stimuli and what is released?
injury or inflamm. that releases bradykinin,serot., histamine,K ions,acids,ACh,prote.enzymes
In a chemical response what enhances sensitivity of pain endings?
Prostoglandins and substance P
Does Prostaglandin and Subs.P directly excite the pain endings?
What are the 2 stimulus of fast pain?
mechanical and thermal
Which stimuli can slow pain be elicited by?
all 3, chem., mech. and thermal
Do pain receptors adapt to the stimulus?
What is the cause of pain ?
the rate of tissue damage
At what temp. do most people feel pain?
45 degress C
Which of the 3 stimulus is import. in slow, suffering type of pain after tissue damage?
Where are some pain receptors located?
superfical layers of skin, internal tissues, periosteum, arterial walls, joint sufaces, cranial vault
What part of the cranial vault contains pain receptors?
falx and the tentorium
What causes the most pain and possibly single agent for causing tissue dmg type of pain?
What are some other factors that could contribute to pain?
local increase in K ions and action of enzymes (proteolytic)
by attacking n.endings and excite pain
Pain from heat is correlated with what?
rate at which dmg to tissue is occurring and not total amt already occured.
What is intensity of pain?
rate of tissue dmg from causes other heat, such as bacterial infect, tissue isch.,and contusion
How are fast pain transmitted in the dual pathway?
type A delta myelineated
What is the velocity of the fast A delta myel. fibers?
How is slow pain transmitted?
type C unmyelinated
What is the velocity of the slow pain?
0.5-2 m/sec
Where are the fast pain fibers transmitted in the dual pathway?
neospinothalamic tract
Where are the slow pain fibers transmitted in the dual pathway?
paleospinothalamic tract
Where are the fast and slow pain pathways activated?
in the periphery
Cell bodies of A delta and C afferent fibers are where?
dorsal root ganaglion

(lect.notes: posterior cord)
When the fibers enter the dorsal spine what do they do?
the divide and ascend or descend
The pain fibers divide and ascend or descend where?
1-3 segments in the tract of lissauer
After the FAST SHARP Pain leaves the tract of Lissauer where do they go?
Axons of the A delta enter the dorsal horn
After the fast sharp pain enters the dorsal horn where do they terminate?
Rexed's lamina I and V
What neuron is leaving Lamina I and V?
2nd order neurons (fast sharp pain)
What side does the A delta fibers (fast) cross?
to the Contralateral spinothalamic tract
After crossing the contralateral side what happens to the a delta fibers?
ascends to the brain
Where do Slow-Chronic C fibers terminate?
primarily in Lamina II and III (substantia gelatinosa)
What kind of fibers transmit impulses to Lamina V?
The C fibers
The C fiber is transmitted to the Lamina V and from where?
from Lamina II and III
(substantia gelantinosa)
What neuron is leaving Lamina V in slow pain pathway?
2nd order neuron
What side of the tract does the 2nd order neuron cross to before ascending to the brain?
contralateral lateral spinothalamic tract
In the brainstem termination of pain where does the fast pain fibers terminate?
Ventrobasal complex in the thalamus
Where is the ventrobasal complex located?
the thalamus
Where are impulses transmitted after the ventrobasal complex in thalamus?
somatosensory cortex of the brain
Where do slow pain fibers terminate on the brainstem pain pathway name two of the 3?
Reticular nuclei of medulla, pons, and mesencephalon and tectal area of mesencephalon near the super. and infer. colliculi.
Where is the last place that slow pain fibers can terminate in the brain stem?
periaqueductal gray region (PAG) of aqueduct of sylvius
what plays an importanat role in intrepreting pain quality, pain perception principally in lower centers?
The cortex
What is the major neurotransmitter released from A delta fibers?
What does glutamate do?
it is an excitatory pain transmitter
How fast do the glutamate act?
acts immediately, duration few milliseconds
What is the major neurotransmitter released from C. fibers?
Substance P
How is Subtance P released?
and what does it do?
released more slowly
builds up concentrations over period of seconds or mins.
Does the removal of the somatic sensory area destroy the ability to perceive pain?
Pain impulses to lower areas can cause what?
conscious perception of pain
Stimulation of what causes widespread arousal of the nervous system?
reticular areas of the brainstem and intralaminar nuclei of the thalamus.
What is responsible for the modulation of pain?
analgesia system of the brainstem
What are 3 major descending spinal tract components?
1.periaqueduct. gray and periventricular areas
2. raphe magnus nucleus
3.pain inhibitory complex in dorsal horns of the spinal cord.
What higher brain areas can activate the periaquetal gray region and supress pain?
(anagesia syst of the brain and S.C.)
periventricular nuclei of the hypothalamus and the medial forebrain bundle
What nerve fiber secrete enkephalin at their nerve endings?
periventricular nucleus and periaquet. gray
Nerve fibers from raphe magnus secrete what at their nerve endings?
Serotonin causes the local neurons to secrete what?
What is believed to cause pre and post synaptic inhibition of type C and A delta pain fibers where they synapse in the dorsal horn?
Impulses from perivent/periaquad gray matter of brainstem transmit. thru nucleus raphe magna to where and via of what?
substantia gelantinosa via of the descending dorsolateral funiculus
What happens when an action potential arrives at the substantia gelantinosa?
They activate enkephalin neurons
The release of enkephalin increases or decreases what neurotransmitter?
it decreases the release of Substance P
A decrease in substance p from the release of enkephalin results in what?
a reduction in number of pain impulses ascending in the later spino. tract
Action potentials descending in the dorsolateral funiculus hyperpolarize 2nd neuron in pain pathway by what?
decreasing the number of action potentials in the ASCENDING lateral STT
What helps inhibit or modulate pain but does not completely get rid of pain?
The descending dorsolateral tract
How do IV opioids produce analgesia?
in part by initiating action potentials in the descending dorsolateral funiculus
What sites in the brain do opioids act on?
limbic system. hypothalamus, and thalamus
The supraspinal analgesia is mediated by what receptors?
Mu-1, kappa and delta receptors
What is the dominant receptor mediating supraspinal analgesia is?
Mu-1 receptor
With IV administration of opioids with supraspinal analgesia what is the patients response to pain?
it is altered
" I feel pain, but I don't care"
Spinal analgesia is mediated primarily by what receptors?
Mu-2 receptors
What receptors mediate spinal anesthesia?
Mu-1, Mu-2, kappa and delta
What are the dominante receptors for mediating spinal analgesia?
Mu-2 receptors
What happens to patients pain when receiving spinal analgesia?
The pain is diminished
What occurs when spinal analgesia is administered in relation to action potentials?
fewer action potentials are relayed to the brain
How many spinal nerves are there?
31 pairs
Each spinal nerve innervates a segmental of skin known as what?
What is a dermatome map useful in determining?
1.level of S.C. injury or 2.Level of sensory anesth prod by regional anesth.
Do segments overlap?
Yes, there is overlap b/w segments
How many dorsal roots need to be interrupted to produce complete denervation of a dermatone?
Where is the clavicle dermatone landmark?
Where is the nipples dermatone landmark?
Where is the xiphoid dermatone landmark?
Where is the umbilicus dermatone landmark?
Where is the Tibia dermatone landmark?
Where is the perineum dermatone landmark?
In the 1970's the inject of morphine produced a profound and prolonged anesthesia?
into the area around the 3rd venticle
Opiate-like substances all breakdown into what 3 molecules?
In the endogenous opiate syst what are the major opiate substances?
B-endorphin, met-enkephalin, leu-enkephalin, dynorphin
Where are the enkephalins and dynorphin of the endogenous opiate syst found?
brain stem and spinal cord
Where in the endogenous opiate syst is the B-endorphin found?
hypothalamus and the pituitary
What type of people get the euphoric opiate feeling?
long distance runners
Function of the internal opiate system?
pain suppression during times of stress
What happens in an organisms response to emergency?
a reduction in the responsiveness to pain
"think superhuman"
Pain from an internal organ that is perceived to originate from where?
a distant area of the skin
Viscera have few of what and what is the exception?
few sensory fibers except for pain fibers.
Highly localized damage to an organ may result in what?
little pain
Widespread damage to an organ can lead to what?
severe pain
Where does heart pain localize to ?
neck, shoulder, and arm
Where does the stomach localize to ?
above the umbilicus
Where does the colon localize to?
below the umbilicus
What are the causes of visceral pain (4)?
1.ischemia, 2.chemical irrit.
3.spasm of hollow viscus
4. overdistention of a hollow viscus
Does the brain have pain receptors?
No, brain tissue itself is insensitive to pain
Where are the pain sensitive structures of the brain?
1. membranes that cover the brain
2. blood vessels
What specific brain membranes and blood vessels are pain sensitive?
dura, blood vess of dura, venous sinuses, middle meningeal artery
What is the inflammation of the meninges resulting in a severe headache and stiff neck called?
meningitis- intracranial h/a
What happens in a intacranial h/a referred to as a migraine?
abn vascular phenomemon
vasospasm followed by prolonged vasodil. and vasodil. causes stretching of the coverings of blood vessels
How much CSF can cause intracranial h/a?
as little as 20 ml can cause pain
What is it called when there is irritation of the meninges by alcohol breakdown products and additives?
called a "HANGOVER"
What causes an extracranial h/a in muscle spasms or "tension headache"?
emotional tension, causes tension on neck,scalp muscles which causes irritation of scalp coverings
What kind of extracranial h/a is caused from an irritation of nasal structures?
sinus headache
An excessive contraction of the ciliary muscle in an attempt to focus and contraction of facial muscles cause what type of extracranial h/a?
eye strain
What are 4 examples of intreacranial headache?
meningitis, low CSF, migraine, and hangover
What are 3 examples of extracranial headaches?
muscular spasm(tension h/a), sinus h/a, eye strain