Neuroscience of Pain Perception

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Questions and Answers

What component of pain perception is affected by the integrity of the lateral pain system?

  • Discriminative component of pain (correct)
  • Affective component of pain
  • Emotional response to pain
  • Behavioral response to pain

Which area of the brain is primarily associated with the lateral pain system?

  • Prefrontal cortex
  • Anterior cingulate cortex
  • Lateral thalamic nuclei (correct)
  • Hippocampus

What type of stimulus was used in the clinical examination of the patient?

  • Mechanical pressure
  • Thermal stimulation
  • Electrical stimulation
  • Cutaneous laser stimulation (correct)

What is the dual pathway for pain perception mediated by?

<p>C-fibers and Aδ-fibers (A)</p> Signup and view all the answers

Which cortical areas are mainly involved in the lateral pain system?

<p>Primary and secondary somatosensory cortices (D)</p> Signup and view all the answers

What was the age of the male patient who suffered from the postcentral stroke?

<p>57 years old (A)</p> Signup and view all the answers

What is the primary function of the medial pain system?

<p>Emotional processing of pain (D)</p> Signup and view all the answers

What was the pain threshold measured for the right hand?

<p>200 mJ (D)</p> Signup and view all the answers

What effect does cutaneous laser stimulation have in the study?

<p>It selectively activates thermonociceptive afferents. (D)</p> Signup and view all the answers

What is a significant limitation in assessing human pain perception mentioned in the content?

<p>Use of non-selective pain-evoking stimuli. (D)</p> Signup and view all the answers

At what intensity did the patient describe a 'clearly unpleasant' sensation?

<p>350 mJ (B)</p> Signup and view all the answers

What was the mean reaction time for right index finger lift?

<p>300 ms (C)</p> Signup and view all the answers

What are the two components of pain perception that the study aimed to differentiate?

<p>Sensory-discriminative and motivational-affective (A)</p> Signup and view all the answers

What role does the lateral pain system play according to the study's findings?

<p>It is associated with the sensory-discriminative pain component. (A)</p> Signup and view all the answers

What was the initial health status of the patient presented in the case report?

<p>Was completely healthy with no previous issues. (D)</p> Signup and view all the answers

What type of stroke did the patient experience?

<p>Cardioembolic stroke (C)</p> Signup and view all the answers

What was observed in the patient's motor functions following the stroke?

<p>Stable left-sided sensory deficits with no further motor deficits. (C)</p> Signup and view all the answers

What does the phrase 'first and second pain' refer to in the context of this study?

<p>Initial sharp pain followed by a dull ache. (B)</p> Signup and view all the answers

What methodological approach was lacking evidence in humans based on the study?

<p>Direct correlation between sensory-discriminative pain and lateral pain system. (B)</p> Signup and view all the answers

What type of imaging was performed on the patient after the stroke?

<p>MRI (C)</p> Signup and view all the answers

Which area of the brain was affected by the stroke described in the case report?

<p>Right postcentral gyrus (A)</p> Signup and view all the answers

What type of sensation was absent when thermal stimuli were applied to the patient?

<p>Temperature sensation (C)</p> Signup and view all the answers

Which testing method indicated normal sensory function in the right hand?

<p>Graphaesthesia (C)</p> Signup and view all the answers

What was the score of the left hand in sharp-dull discrimination testing?

<p>0/5 (B)</p> Signup and view all the answers

Which area of the brain is crucially important for pain perception according to the content?

<p>Postcentral gyrus (B)</p> Signup and view all the answers

What does the table suggest about the patient's ability to perform sensory tests on the left hand?

<p>Sensation is completely impaired (C)</p> Signup and view all the answers

What technology was used for controlled, selective thermonociceptive stimuli?

<p>Tm:YAG Laser (B)</p> Signup and view all the answers

What sensory test showed a normal result in the patient's right hand?

<p>Stereognosia (C)</p> Signup and view all the answers

What was the method used to determine pain thresholds on the dorsum of feet and hands?

<p>Increasing and decreasing stimulus intensities (B)</p> Signup and view all the answers

What suggests an interaction between the medial and lateral pain system in the patient?

<p>Detection of and reaction to painful stimuli (D)</p> Signup and view all the answers

What was the criterion for defining the pain threshold during the study?

<p>Intensity that elicited painful sensations in at least three of five applications (C)</p> Signup and view all the answers

Which sensory test had the highest score for the left hand?

<p>Sharp-dull discrimination (C)</p> Signup and view all the answers

During clinical examination, the evaluation of the patient's sensory deficits was based on which technique?

<p>Extensive clinical examination (A)</p> Signup and view all the answers

What phenomenon was detected regarding the proprioceptively impaired left hand?

<p>Inability to participate in motor reactions (D)</p> Signup and view all the answers

What was the patient's score for two-point discrimination on the left hand?

<p>0 mm (B)</p> Signup and view all the answers

Which area of the brain was indicated to have a partial lesion, as suggested by the diminished long latency potentials?

<p>Somatosensory Area I (SI) (D)</p> Signup and view all the answers

What was the effect of stroke on the patient's sensory examination on the right side?

<p>Right-side examination was normal (C)</p> Signup and view all the answers

The reaction times to painful laser stimuli were measured in what intervals?

<p>10 to 14 seconds (C)</p> Signup and view all the answers

What sensory test involves the ability to discern sharpness or dullness?

<p>Sharp-dull discrimination (D)</p> Signup and view all the answers

What does graphaesthesia test assess?

<p>Ability to recognize shapes drawn on the skin (D)</p> Signup and view all the answers

What type of stimuli was used to evaluate the patient after the stroke?

<p>Controlled thermal stimuli (C)</p> Signup and view all the answers

Flashcards

Pain perception components

Pain perception involves separate sensory-discriminative and affective components.

Lateral pain system

A brain pathway involved in the sensory-discriminative component of pain, including the first pain sensation.

Medial pain system

A brain pathway involved in the affective component (emotional aspect) of pain.

Postcentral stroke

A stroke affecting the postcentral gyrus, a brain region that processes sensory information from the body.

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First pain

The initial sharp, immediate pain sensation.

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Sensory-discriminative component of pain

Part of pain perception related to identifying location and nature of pain.

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Affective component of pain

The emotional or unpleasant feeling associated with pain.

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What is the difference between first and second pain?

First pain is a sharp, initial pain sensation. Second pain is a dull, throbbing sensation experienced later.

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What brain system is responsible for sensory-discriminative pain?

The lateral pain system is responsible for identifying the location and type of pain.

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What brain system is responsible for motivational-affective pain?

The medial pain system handles the emotional and unpleasant aspects of pain.

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What is a possible consequence of a stroke in the right postcentral gyrus?

A stroke in the right postcentral gyrus can cause sensory deficits on the left side of the body.

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What is a unique characteristic of pain perception?

Pain perception involves distinct sensory-discriminative and motivational-affective components.

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What does the study of pain perception involve?

The study of pain perception explores the separation between sensory-discriminative and motivational-affective components, as well as between first and second pain.

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What is the significance of the lateral pain system?

The lateral pain system is crucial for experiencing the sensory-discriminative aspect of pain and first pain.

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What evidence suggests the crucial role of the lateral pain system?

A case study of a patient with a stroke affecting the lateral pain system showed a loss of pain sensation while preserving emotional response to pain.

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What is the implication of this study for understanding pain?

The study demonstrates a clear distinction between the roles of lateral and medial pain systems in the different aspects of pain perception.

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Tm:YAG Laser

A type of laser commonly used for pain studies. Emits infrared light with a wavelength of 2000 nm and a short pulse duration.

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Pain Threshold

The minimum intensity of a stimulus that causes a person to perceive pain. It's a measure of how sensitive someone is to pain.

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Laser Stimulation

A method of pain research that involves applying a focused laser beam to the skin, producing a controlled pain sensation.

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Reaction Time

The time it takes for a person to respond to a stimulus, like the pain of a laser.

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Interstimulus Interval

The time between two separate painful stimuli applied to the same person. Helps ensure the stimuli are separate experiences.

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Dorsum of the Hand

The back surface of the hand. Commonly used as a site for pain testing due to the presence of many nerve endings.

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Stimulation Site

The specific location on the skin where the laser is applied to produce pain.

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Contralateral

Refers to the opposite side of the body. A pain stimulus on one side of the body is processed by the contralateral hemisphere.

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Index Finger

The finger commonly used in pain studies as it's easy to lift for reaction time measurements.

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Somatosensory Evoked Potentials

Brainwaves that are generated in response to sensory stimuli, particularly touch. Used to assess the integrity of sensory pathways.

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Cutaneous Laser Stimulation

A method used to selectively activate pain afferents (nerve fibers) in the skin, minimizing contamination from touch pathways.

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SI and SII Involvement

The primary (SI) and secondary (SII) somatosensory cortices play a role in processing pain information.

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Functional Imaging Studies

Techniques like fMRI, showing increased blood flow in SI and SII during pain, support the role of these brain regions in pain processing.

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Contralateral SI and SII

Pain processing occurs in the SI and SII cortices on the opposite side of the body from the pain source.

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Proprioception

The sense of knowing your body's position and movement without looking. It involves joint receptors, muscles, and tendons.

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Two-Point Discrimination

The ability to distinguish between two closely spaced points on the skin. It measures how sensitive an area of skin is to touch.

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Graphaesthesia

The ability to identify a letter or number drawn on your skin without looking.

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Stereognosis

The ability to recognize an object by touch alone without seeing it.

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What is pallaesthesia?

Pallaesthesia is the sense of vibration. It is tested by using a tuning fork placed on a bony prominence.

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What is hypaesthesia?

Hypaesthesia is a decrease in sensitivity to touch or other sensory stimuli.

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What is the sensory-discriminative component of pain?

This involves the ability to locate, characterize (sharp, dull, etc.), and quantify the intensity of the pain.

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What is the affective component of pain?

This is the unpleasant emotional response to pain.

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What is the role of the postcentral gyrus in pain perception?

The postcentral gyrus in the brain processes sensory information from the body, including pain. Damage to this region can impact pain perception.

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What is the relationship between the medial and lateral pain systems?

Both systems likely cooperate for normal pain experience. The medial system processes the emotional aspect of pain, and the lateral system processes the sensory-discriminative aspect of pain.

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Study Notes

Pain Affect Without Pain Sensation

  • A 57-year-old male with a right-sided postcentral stroke exhibited a dissociation of pain perception components.
  • The patient demonstrated a separation between discriminative (sensory) and affective aspects of pain.
  • This case, for the first time in humans, showed a dependence of sensory-discriminative pain and first pain on the integrity of the lateral pain system.

Lateral and Medial Pain Systems

  • Cerebral pain processing involves two systems: lateral and medial.
  • The lateral system includes the lateral thalamic nuclei, SI (Primary), and SII (Secondary) somatosensory cortices.
  • The medial system involves the medial thalamic nuclei and anterior cingulate cortex.
  • These systems are anatomically distinct and likely function differently in pain perception.
  • The medial system is more strongly associated with the motivational-affective aspects of pain.

First and Second Pain

  • Pain is often experienced as two distinct sensations.
  • First pain is sharp and pricking, mediated by Aδ fibers.
  • Second pain is dull and persistent, mediated by C-fibers.
  • The lateral pain system seems to be involved in the representation of first pain.

Key Lesion and Imaging

  • The patient's lesion affected the right SI and SII cortices, particularly the hand area.
  • MRI confirmed the location of the lesion.
  • The location of the lesion in SI and SII supports a critical role for these areas in the sensory-discriminative aspects of pain perception for humans..

Cutaneous Laser Stimulation

  • Used to elicit controlled and selective thermonociceptive stimuli.
  • This technique is effective in evaluating sensory-discriminative pain components and distinguishing first pain from second pain.
  • By applying stimuli at varying intensities, pain thresholds were determined and reaction times were measured.

Sensory Deficits

  • The patient exhibited left-sided sensory deficits.
  • These included hypaesthesia (reduced sensitivity) and anesthesia (loss of sensitivity) in the foot, leg, face, hand, and left arm.
  • Thermal stimuli did not evoke any sensation, indicating a significant sensory impairment.
  • Other sensory functions (touch, two-point discrimination, etc) were also impaired on the left side, but pallaesthesia was nearly normal.

Motor Deficits

  • Marginal left-sided pronation impairment was noted during arm movement against gravity tests.
  • This suggests that other motor functions were mostly spared by the stroke.

Clinical Examination & Testing

  • The patient was comprehensively evaluated 5 and 12 days after the stroke.
  • Evaluations focused on sensory functions such as light touch, pain, temperature, two-point discrimination, stereognosis.
  • Various tools were used to test sensation (von Frey-hairs, test tubes, tuning forks etc.).
  • Reaction times to acoustic stimuli were also determined to assess possible delays affecting other functions.

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