Pain Pathways and Opiods
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| Describe A delta fibers. | free, naked, nerve endings, myelinated, diameter = 1-4 micrometers
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| 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
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| Describe C fibers. | free, naked, nerve endings, unmyelinated, diambeter = 0.4-1.2 micrometers
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| 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
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| What are four types of pain? | somatic, superficial, deep, and visceral
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| Where does superficial pain originate? | cutaneous
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| Where does deep pain originate? | from muscles, tendons, joints, and fascia
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| Does deep pain involve first or second pain? | both
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| Where does visceral pain arise from? | either parietal peritoneum or viscera itself
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| Visceral Pain: Second pain from ___ is carried by C fibers. | viscera
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| Visceral Pain: first pain from ___- is carried by a delta fibers. | parietal peritoneum
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| 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
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| The Where are the cell bodies of the A delta and C fiber afferents found? | in the dorsal root ganglion
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| 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
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| 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
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| 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.
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| Which lamina are the substantia gelatinosa? | II and III
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| What is the major neurotransmitter released from A delta fibers? | glutamate
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| What does glutamate bind to? | AMPA and NMDA
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| Where are the AMPA and NMDA receptors located? | the postsynaptic membrane
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| What is the major neurotransmitter released from C fibers? | substance P
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| What does substance P bind to? | NK-1 (neurokinin 1
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| Where are NK-1 receptors located? | postsynaptic membrane
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| What is the ascending sensory spinal cord tract carrying pain and temperature? | lateral spinothalamic tract
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| The lateral spinothalamic tract is a component of what sensory system? | anterolateral sensory system
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| The dorsolateral funiculus is a (ascending/descending) tract? | descending
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| What is the function of the dorsolateral tract? | it modulates pain
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| The lateral spinothalamic tract carries __ and ___ modalities. | pain and temperature
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| C fiber afferents enter the spinal cord via the __ ___. | dorsal horn
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| The C fibers synapse just after entering the spinal cord with interneurons in lamina __ , __ , or lamina __. | V, II, or III
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| The interneurons from lamina II and III synapse with what? | second order neurons in lamina V
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| 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
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| There is no sensory component to __. | C1
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| C1 is purely ___. | motor
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| What is the site where pain impulses are attenuated? | the substantia gelatinosa
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| What is another name for the substantia gelatinosa? | Rexed's lamina II
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| 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
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| When the first neuron in the slow chronic pain pathway synapses with lamina II and III, what is released? | substance P
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| Is substance P excitatory or inhibitory? | excitatory
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| What other interneurons also synapse on the substance P releasing nerve terminal? | Enkephalin (E)-releasing interneurons
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| 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
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| 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.
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| Enkephalin may be considered the ___ in the __ control theory of pain. | gate, gate
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| Opiods stimulate the same receptors that are stimulated by what? | the body's endorphins and enkephalins
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| 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)
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| The opiod then unites with opiod receptors on the nerve terminal of the __ __ ___. | primary pain afferent
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| When the opiod unites with the opiod receptor, is substance P reduced or increased? | release of substance P is reduced
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| When happens when substance P is reduced? | the transmission of impulses through the substantia gelatinosa is inhibited
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| Which receptors mediate spinal analgesia? | mu-1, mu-2, kappa, and delta receptors
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| What is spinal opiod analgesia mediated by? | primarily mu-2 receptors
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Created by:
valleyanesthesia
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