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Volume 1

Pain Pathways and Opiods

Describe A delta fibers. free, naked, nerve endings, myelinated, diameter = 1-4 micrometers
What type of pain do A delta fibers transmit? first pain or fast pain; well localized discriminative sensation (sharp, stinking, pricking), duration of pain coincides with duration of painful stimulus
Describe C fibers. free, naked, nerve endings, unmyelinated, diambeter = 0.4-1.2 micrometers
What type of pain do C fibers transmit? second pain or slow pain, diffuse and persistent burning, aching, throbbing sensation, duration of pain exceeds duration of stimulus
What are four types of pain? somatic, superficial, deep, and visceral
Where does superficial pain originate? cutaneous
Where does deep pain originate? from muscles, tendons, joints, and fascia
Does deep pain involve first or second pain? both
Where does visceral pain arise from? either parietal peritoneum or viscera itself
Visceral Pain: Second pain from ___ is carried by C fibers. viscera
Visceral Pain: first pain from ___- is carried by a delta fibers. parietal peritoneum
The fast and slow pathways are activated in the periphery when what happens? the free nerve endings of the A delta and C fibers are stimulated or damaged
The Where are the cell bodies of the A delta and C fiber afferents found? in the dorsal root ganglion
Describe the path of A delta and C fibers. The A delta and C fibers enter the dorsal cord, divide and ascend or descend 1-3 segments in the tract of Lissauer
Describe the pathway for fast sharp pain. After leaving the tract of Lissauer, the axons of the A delta fibers enter the dorsal horn and terminate in Rexed's lamina I and V. Second order neurons leaving lamina I or V cross to the contralateral spinothalamic tract and ascend to the brain
Describe the pathway for slow chronic pain. The C fibers terminate primarily in lamina II and III. Interneurons transmit C fiber impulses to lamina V from laminae II and III. Neurons leaving lamina V cross immediately to the contralateral lateral spinothalamic tract and ascend tot he brain.
Which lamina are the substantia gelatinosa? II and III
What is the major neurotransmitter released from A delta fibers? glutamate
What does glutamate bind to? AMPA and NMDA
Where are the AMPA and NMDA receptors located? the postsynaptic membrane
What is the major neurotransmitter released from C fibers? substance P
What does substance P bind to? NK-1 (neurokinin 1
Where are NK-1 receptors located? postsynaptic membrane
What is the ascending sensory spinal cord tract carrying pain and temperature? lateral spinothalamic tract
The lateral spinothalamic tract is a component of what sensory system? anterolateral sensory system
The dorsolateral funiculus is a (ascending/descending) tract? descending
What is the function of the dorsolateral tract? it modulates pain
The lateral spinothalamic tract carries __ and ___ modalities. pain and temperature
C fiber afferents enter the spinal cord via the __ ___. dorsal horn
The C fibers synapse just after entering the spinal cord with interneurons in lamina __ , __ , or lamina __. V, II, or III
The interneurons from lamina II and III synapse with what? second order neurons in lamina V
What happens to second order neurons leaving lamina V? they cross immediately to the opposite side in the spinal cord and then ascend on the contralateral side
There is no sensory component to __. C1
C1 is purely ___. motor
What is the site where pain impulses are attenuated? the substantia gelatinosa
What is another name for the substantia gelatinosa? Rexed's lamina II
The first neuron in the slow chronic pain pathway synapses with the interneurons in which two locations? substantia gelatinosa and lamina III of the spinal cord
When the first neuron in the slow chronic pain pathway synapses with lamina II and III, what is released? substance P
Is substance P excitatory or inhibitory? excitatory
What other interneurons also synapse on the substance P releasing nerve terminal? Enkephalin (E)-releasing interneurons
When enkephalin is released to the nerve terminal of the primary pain C fiber afferent, the release of substance P is increase or decreased? decreased
Describe the sequence of events that occurs when the release of substance P is decreased. the number of action potentials initiated in the interneuron of the pain pathway is reduced and, ultimately, the perception of pain is decreased.
Enkephalin may be considered the ___ in the __ control theory of pain. gate, gate
Opiods stimulate the same receptors that are stimulated by what? the body's endorphins and enkephalins
After an opiod such as morphine (Duramorph) is injected into the intrathecal or epidural space, where does it diffuse? substantia gelatinosa (Rexed's lamina II)
The opiod then unites with opiod receptors on the nerve terminal of the __ __ ___. primary pain afferent
When the opiod unites with the opiod receptor, is substance P reduced or increased? release of substance P is reduced
When happens when substance P is reduced? the transmission of impulses through the substantia gelatinosa is inhibited
Which receptors mediate spinal analgesia? mu-1, mu-2, kappa, and delta receptors
What is spinal opiod analgesia mediated by? primarily mu-2 receptors
Created by: valleyanesthesia