Anesthesia- EXAM 1: Intro to Pain Management LEC1

True or False- Pain & nociception are the same.

False

_______ is a neural process of encoding noxious stimuli.

Nociception

Pain encompasses which 3 of the following?

Nociception, perception, emotions/responses

Under the strictest definition, pain _____ occur during unconsciousness.

does not

True or False- Noxious stimuli can be mechanical, thermal, or chemical.

True

Place the following steps of the pain pathway in order from beginning to end.

Transduction -> Transmission -> Modulation -> Projection/Perception

_______ is the detection of noxious stimuli by nociceptors and conversion into action potentials.

Transduction

_________ is the conduction of action potential to the spinal cord in the pain pathway.

Transmission

________ is the alteration (amplification or suppression) of action potentials in the pain pathway.

Modulation

_______ is the conveyance of nociceptive information to the brain through the spinal cord.

Projection

_____ is the integration, processing, and recognition of nociceptive information by the cortex of the brain.

Perception

Which 3 of the following are nociceptive neurons?

A delta fibers, C fibers, A beta fibers

Which nociceptive neurons are responsible for rapid transmission of sharp, localized, and/or transient pain?

A delta fibers

A delta fibers are lightly myelinated and have a ________ receptive field.

small

C fibers have a ______ diameter than A delta fibers.

smaller

C fibers are ________ and have a large receptive field.

unmyelinated

True or False- C fibers have slow transmission of pain, causing burning, throbbing, persistent and/or generalized pain.

True

Which nociceptive neurons have large diameters, and are heavily myelinated, and have specific receptive fields?

A beta fibers

True or False- A beta fibers are sensory and have dynamic interplay (non-aversive to aversive pain stimuli).

True

Hitting your thumb with a hammer would primarily trigger which nociceptive neurons?

A delta fibers (immediate pain), C fiber (throbbing)

Lowering your hand to hot stove would primarily trigger which nociceptive fibers?

A beta fibers

A scalpel cutting through tissue would primarily trigger which nociceptive neurons?

A delta fibers

True or False- Acute, high intensity pain stimuli triggers A delta fibers and C fibers.

True

True or False- Tissue injury and inflammation triggers C fibers.

True

Injury to specific or all peripheral sensory nerves triggers which 2 nociceptive neurons?

C fibers & A beta fibers

Neuropathic pain has which pain phenotype?

Injury to sensory nerves

_______ describes the absence of pain in response to stimuli that would normally be painful.

Analgesia

________ describes an increased response to a normally painful stimulus.

Hyperalgesia

_______ describes pain due to a stimulus which does not normally provoke pain.

Allodynia

True or False- Allodynia often occurs due to neuropathic pain.

True

______ describes pain (or amplification of) caused by a primary lesion/dysfunction in the somatosensory nerves.

Neuropathic pain

True or False- Neuropathic pain is classified as either central or peripheral.

True

Which 4 of the following are signs of neuropathic pain?

hyperalgesia, allodynia, chronicity, failure of traditional analgesics

Which 3 of the following are causes of peripheral neuropathic pain?

Alteration in Na+ channels (main one), direct nerve injury, peripheral nociceptor sensitization

In peripheral neuropathic pain, Na+ channels may have a _______ threshold for activation.

lower

True or False- Inflammatory mediators can cause peripheral nociceptor sensitization.

True

Central neuropathic pain can be caused by which 2 mechanisms?

central sensitization and glutamate activity

In normal physiologic function, AMPA receptors for glutamate are _______, and NMDA receptors are ________.

active; inactive

In neuropathic pain, NMDA receptors for glutamate are _______, due to sensitization of AMPA receptors.

active

In normal physiological function, which molecule is responsible for "plugging" glutamate NMDA receptors?

Mg2+

Central neuropathic pain originates in which location?

dorsal horn neuron

Which 4 of the following are reasons why pain should be treated?

1. Promotes healing 2. Reduces co-morbidity 3. Promotes physical rehab/movement 4. Professional obligation

True or False- All animals experience pain the same way, and a gold standard for assessing pain exits.

Hell nah

Endorphins, catecholamines, and corticosteroids may be ______ during pain.

increased

True or False- Physiological, behavioral, and postural changes can be used to assess pain.

True

True or False- Grimace scoring, AAHA pain scale, and Glasgow pain scale, can be helpful in assessing pain in animals.

True

True or False- Preventative analgesia requires a multimodal approach.

True

Which 3 of the following can be used to treat incisional pain?

opioids, local/regional anesthetics, A2 agonists

Which of the following can be used to treat inflammatory pain?

NSAIDS

Which 2 of the following can be used to treat peripheral neuropathic pain?

Lidocaine CRI and Na+ channel blockers

Ketamine is an NMDA receptor antagonist and can be used to treat ________ neuropathic pain.

central

Gabapentin is a selective _______ channel blocker and can be used to treat central neuropathic pain.

Ca

True or False- When treating central neuropathic pain, there may be a delay in treatment response.

True

Which 5 of the following could possibly be used in the future to treat pain?

1. Targeted toxins to specific pain receptors

2. Gene therapy

3. Oxytocin

4. Transient receptor potential (TRP) receptor antagonist

5. Cannabinoids

True or False- Pain afferent fiber specific Na channel blockers are potential future therapy for pain.

True