Mechanisms of Pain

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Which step of pain involves converting a noxious stimulus to an electrical impulse in sensory nerve endings?

Transduction

Where does modulation of pain occur?

In the dorsal horn of the spinal cord

Which component of pain processing is responsible for altering pain transmission?

Modulation

In which case does pain occur in the absence of transduction of a chemical stimulus at a nociceptor?

Pain from trigeminal neuralgia

What phenomenon occurs in the absence of nociception or nociceptors?

Phantom limb pain

Which type of nociceptors typically respond to thermal, mechanical, and chemical stimuli?

A-fiber nociceptive afferents

Which nociceptor type is referred to as polymodal nociceptors?

A-fiber nociceptive afferents

What is the primary cause of sensitization of nociceptors?

Release of endogenous chemicals

Which outcome is associated with chronic pain due to unresolved inflammation?

Hyperalgesia

What contributes significantly to the process of nociception and neuronal sensitization during peripheral inflammation?

Release of endogenous chemicals

In chronic pain conditions, what leads to the sensitization of both peripheral and central pain signaling pathways?

Unresolved inflammatory conditions

Which step involves the adaptation of signaling pathways in primary sensory neurons induced by noxious stimuli?

Peripheral sensitization

Which of the following chemical mediators can directly activate nociceptors and induce sensitization to painful stimuli?

Prostaglandin E2

Which chemical mediator leads to sensitization by activating inflammatory cells that release cytokines during inflammation?

Histamine

What term is used to describe enhanced pain in response to a noxious stimulus following tissue injury and inflammation?

Hyperalgesia

Which type of hyperalgesia occurs at the site of the original tissue injury?

Primary hyperalgesia

What differentiates primary hyperalgesia from secondary hyperalgesia in terms of pain response?

Primary hyperalgesia responds to heat and mechanical stimuli.

What is believed to be the cause of primary hyperalgesia following tissue injury?

Activation of nociceptor receptors by proinflammatory mediators

Which brain region functions as a relay center for nociceptive and other sensory activity?

Spinal Dorsal Horn

Which system may either depress or facilitate the integration of painful information in the spinal dorsal horn?

PAG–RVM System

Which region of the spinal cord is primarily responsible for the integration of peripheral nociceptive information?

Lissauer tract

Where do afferent C fibers primarily synapse on second-order neurons in the spinal cord?

Lamina I

What is the main function of inhibitory interneurons in the dorsal horn?

Integrate and modulate incoming nociceptive information

What is the function of descending axons that terminate in the dorsal horn of the spinal cord?

Modulate integration of nociceptive information

What is the principal transmitter used by inhibitory cells in the dorsal horn?

GABA and/or glycine

Which region of the spinal cord receives relatively large numbers of projection neurons?

Lamina I

Which theory was proposed by Melzack and Wall in 1965 to illustrate the neuronal network underlying pain modulation?

Gate Control Theory of Pain

What type of fibers are activated by rubbing the skin of a painful area according to the Gate Control Theory of Pain?

Ab fibers

What behavioral phenomenon can be observed in humans that mirrors wind-up in the dorsal horn neurons?

Increased pain with each successive stimulus

Which neuropeptides are co-released with glutamate from nociceptor central terminals during central sensitization?

Substance P and CGRP

After peripheral nerve injury, what phenomenon occurs where light touch produces pain?

Allodynia

What effect does repeated light touch have after peripheral nerve injury?

Increasing pain progressively

What form of central sensitization can cause low-threshold sensory fibers to activate high-threshold nociceptive neurons?

Heterosynaptic central sensitization

What is the term for the phenomenon where peripheral noxious stimuli lead to transcriptional changes in proteins involved in pain transmission?

Transcription-dependent sensitization

Which factor contributes to nerve injury-induced tactile allodynia?

Sprouting of injured myelinated Ab fibers

From which spinal dorsal horn neurons do the fibers traveling in the spinothalamic tract (STT) primarily originate?

Lamina I, IV, and V

In which spinal cord laminae do neurons receiving input primarily from large-diameter Ab fibers from the skin reside?

Lamina IV and V

On which side of the body are about 85% to 90% of neuronal cells with projections extending through the spinothalamic tract (STT) found?

Contralateral side

From which laminae do the anterior STT cells predominantly originate?

Lamina V

Where do ascending spinobulbar projections mainly terminate to provide homeostatic feedback?

Brainstem

What is the primary function of spinal projections to the brainstem?

Integration of nociceptive activity with homeostasis and behavior

What is the function of the descending inhibition pathway (DI) from supraspinal regions?

Suppressing nociceptive transmission

Which brain regions are established as critical for descending pain modulation?

PAG and RVM

Which physiological response is associated with urinary retention during the surgical stress response?

Reflex inhibition of visceral smooth muscle

What is a key factor contributing to the risk for perioperative infection following cancer resection?

Reduced cytotoxicity of killer T cells

Which factor plays a major role in the prevention vs. treatment approach in attenuating the surgical stress response?

Pre/intraoperative techniques

How does general anesthesia typically impact the neuroendocrine response during the surgical stress response?

Has no significant impact on the neuroendocrine response

What is a notable benefit associated with regional anesthesia in attenuating the surgical stress response?

Reduced postsurgical complications

At what gestational age does pain perception develop in a human fetus?

23 weeks

What is a characteristic of neonates and infants regarding pain threshold compared to adults?

They have a significantly lower pain threshold

What are the potential consequences of untreated pain during early childhood?

Long-lasting consequences

What effect can increased catecholamines have on expected pain sensation?

Increase sensitization of nociceptors

Which response is characteristic of myocardial ischemia in the context of surgical stress response?

Coronary vasoconstriction

What can lead to hypercoagulability in the context of the surgical stress response?

Increased blood viscosity

What effect does pain-induced increased skeletal/accessory muscle tension have on ventilation?

Causes hypoventilation

Which factor inhibits gastrointestinal (GI) function in the surgical stress response?

Sympathetic hyperactivity

What is a potential consequence of increased pulmonary extracellular fluid in the context of the surgical stress response?

Atelectasis

What is a proposed mechanism for the transition from acute to chronic pain?

Sensitization of peripheral and central nocisponsive neurons

Which syndrome is more common, CRPS I or CRPS II?

CRPS I

What is a characteristic of neuropathic pain?

Reduced nociceptive threshold

Which factor is responsible for causing visceral pain?

Activation of nociceptors

What is the hallmark of CRPS I (Reflex Sympathetic Dystrophy)?

Allodynia/hyperalgesia disproportionate to the inciting event

What is a feature of CRPS II (Causalgia)?

'Causalgia' is limited to the territory of the injured nerve

What differentiates visceral pain from somatic pain?

'Visceral pain' is associated with autonomic reactions, unlike 'somatic pain'

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