PATHO TWO: Stress and Pain

General Adaptation

_________ ________ Syndrome: Bodys three stage response system to persistent stressor

Alarm

_____ Stage: First GAS stage. SNS activation, HPA axis trigger, arousal of defences.

• SNS activation, HPA axis trigger, defense arousal

Resistance

________/Adaptation. Second GAS stage: Mobilization continues fight or flight response. Begins activation of adrenal hormones

Exhaustion

___________ Stage: Final GAS stage. Occurs only if stress continues and adaptation unsuccessful. Stress related disorders

Illness Factor

Stress is a proven _____ _______ in: Anxiety, Ulcers, Diabetes, Asthma, HIV, Depression, IBS, Infertility 

Hypothalamus

__________ Location of secretion of corticotroponin releasing hormone (CRH). Triggers ACTH release

Pituitary

______ gland: Location of release of Adrenocorticotropin hormone. 

Adrenal Medulla

ACTH triggers _______ _____ to release epi and norepi

Pituitary

ACTH triggers posterior _______ to release ADH and vasopressin to increase BP and HR

Adrenal Cortex

________ _______ site of Cortisol release

Cortisol

__________: Most important stress hormone. Increases BP, CO, and AA’s in blood

• Decreases cellular glucose uptake

• Lypolysis of extremities 

• Lypogenesis of face and trunk 

• Mobilizes energy and other substances needed for action 

• Reaches all tissues INCLUDING BRAIN

• Prolonged exposure linked to lymphoid atrophy 

Norepi

Adrenal medullary hormone ________:

• Increases BP

• Increases sweat gland action 

• Increases pupil dilation 

• Constricts peripheral vessels 

• Piloerection 

• FIGHT hormone

Epinephrine

Adrenal medulla hormone _________:

• FLIGHT hormone: Visible effects

• Bronchodilation- increases rate and force of cardiac contractions

• Increases lypolysis 

• Dilation of SM blood vessels 

Liver

Epinephrine impacts on _____: Decreases glycogen synthesis, increases glyconeogenesis

Pancreas

Epi action on ________: Decreases insulin, increases glucagon

Catecholamines

________ Both epi and norepi. Mimics sympathetic stimulation. Acts on both alpha and beta receptors.

Epi: Prepares body to act

Norepi: Constricts PV’s to aid of shifting of blood to dilated vessels 

• Increases blood flow and glucose metabolism to brain

• Increased renin from kidneys 

• Decreases peristalsis and sphincter tone 

Cytokines

Stress directly linked to presence of inflammatory ________ in the immune system. Stress linked to decreased T cell and B cell function

Endorphins

Stress induced hormne alterations ________:

• Proteins found in brain, pituitary, or hypothalamus 

• Released in response to stressor 

• Inflamed tissue activates endorphin receptors 

• In hemmorhage: Increased levels inhibit BP release and delay compensatory changes 

Individualized

Stress is __________: System of independent processes and influenced by personality charactersitics. Adverse consequences minimized by coping. 

Pain

____: Defined by international study as An unpleasant sensory and/or emotional experience associated with actual or potential tissue damage

Nociceptors

________: Free nerve endings in skin, muscles, joints, arteries, and viscera. Respond to chemical, mechanical, and thermal stimuli.

eg: A-delta and polymodal fibres

Afferent

Nociceptors send stimulus through ______ pathways to reach brain

Efferent

After brain recieves stimuli from nociceptors, _____ impulses are sent to dorsal horn of SC 

Transduction

________: First phase of nociception

Ion channels on nociceptors open → creating impulses that travel to SC, brain, thalamus, and cortex 

A-delta

_______ fibers: Larger, myelinated fibers that transmit fast, sharp, localized pain sensations.

• Activation causes reflex withdrawl away from stimulus. Eg: Hand on hot stove 

• Transmit along neospinothalmic tract to thalamus

C fibers

________: Smaller, unmyelinated fibers that transmit less localized, dull, burning sensations. Muscle, skin, tendons, and organs.

• Longer transmition leads to duller sensation 

• Transmit along paleospinothalmic tract to reticular formation of brainstem 

Transmission

Phase 2 of nociception __________: Conduction of pain impulses along brain fibers.

Perception

Phase 3 of nociception: Pain _________. Conscious awareness of pain from thalamus to somatosensory cortex. Three part pain matrix

Sensory Discrimintive

__________ ________ system: 1/3 pain matrix.

• Identify percise location and character of pain 

Cognitive Evaluative

_________ ______ system: 2/3 pain matrix. Modulates perception of pain as impacted by learned behaviour concerning pain experience

Affective Motivational

_________ ______ system: 3/3 pain matrix. Determines avoidance behaviours and emotional responses to pain 

Modulation

4th phase of nociception. Pain __________:

Neuromodulators modulate control over transmission of pain impulses in PNS, SC, and brain. 

Excitatory

______ signals for pain: Substance P, Glutamate, Histamine, Prostaglandins, Bradykinin. AFFERENT

Inhibitory

________ signals for pain: GABA, Serotonin, Endorphins. EFFERENT

Pathways activate opiod receptors and inhibit release of excitatory neurotransmitters. Facilitate release of inhibitory neurotransmitters

Threshold

Pain _________: Point at which stimulus percieved as pain

Perceptual Dominance

_________ ________: Pain at one location may cause an increase in threshold at another location 

Perceptual Dominance

_______ _______: Pain at one location may cause an increase in threshold at another location

Tolerance

Pain _________: Duration of time/intensity that a person will endure before initation of pain responses

Acute

_____ Pain;

• Can serve as a protection mechanism. Alerts individual to alteration in condition 

• Manifestations: Fear, Anxiety, fever, sweating, increase in glucose, decrease in gastric acid and motility

• Subacute: 3 weeks or so

Somatic

_________ Pain: Arises from skin/close to body surface. Sharp, localized pain (A fibers). Dull aching and throbbing

Visceral

________ pain: Pain in internal organs and abdomen. Poor localization due to decrease in number of nociceptors 

Referred

__________ Pain: Pain in an area removed from distant point of origin. Area supplied by same spinal segement

Chronic

_______ Pain: +3mos

• Persistent or intermittent. Response patterns can vary.

• Significant behaviour and psychological changes

• Do not usually see same physical signs as acute

Neuropathic

___________ pain: Often chronic. Results from trauma or disease of nerves. Peripheral or central. Injury to one or more sensory nodulating systems

PNS→ Trauma or disease to one or more peripheral nerves

CNS → Lesion or dysfunction of SC or brain

Neuronomas

Nerve sprouts that can form after amputation. Cause of phantom limb pain.

+1

__ WHO pain ladder: Pain persisting or increasing.

Treated with: Nonopiod, Adjuvant (Tylenol)

+2

__ WHO pain ladder: Pain still persisting. Mild opiate eg codiene

+3

____ on the WHO pain ladder: Opiod for moderate to severe pain such as morph or fent.

Cold

_____ Best for inflammatory injuries. Heat after 2-3 days