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TSM 18
Pain mechanisms
14
Medical
Undergraduate 2
01/08/2013

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Term
Describe the structure of nociceptors.
Definition
Bare nerve endings.
Term
What are the 2 main types of nociceptor?
Definition
1) Mechanical nociceptors
2) Polymodal nociceptors
Term
How are mechanical nociceptors innervated?
Definition
Thinly myelinated Ad fibres. These produce sharp, highly localised pricking pain.
Term
How are polymodal nociceptors innervated?
Definition
Unmyelinated C fibres. These receptors produce dull, poorly localised burning pain.
Term
Explain how tissue reacts to inform nociceptors of damage.
Definition
1) Injury or tissue damage releases bradykinin and prostaglandins both of which activate and sensitise nociceptors
2) Nociceptor activation leads to the release of substance P and other peptides
3) Substance P acts on mast cells in the vicinity of sensory endngs to evoke degranulation and the release of histamine which directly excites nociceptors
4) Substance P also produces dilation of peripheral blood vessels and the resultant oedema causes a further liberation of bradykinin.
Term
Where are the cell bodies of nociceptors?
Definition
1) Dorsal root ganglia (pain from body)
2) Trigeminal ganglion (facial pain).
Term
Where do nociceptor afferents terminate?
Definition
Laminae II and V of the spinal cord and the spinal V nucleus.
Term
Describe the ascending pathway for facial pain.
Definition
CNV- Spinal V nucleus- Ventral trigeminothalamic tract- VPM nucleus of the thalamus- Primary somatic sensory cortex
-This is a contralateral pathway.
Term
What is the main ascending tract for ascending body pain?
Definition
Spiothalamic. Contralateral.
Term
Describe the endogenous analgesia system.
Definition
1) Electrical stimulation in the midbrain periaqueductal grey matter activates the raphespinal tract (5-HT)
2) This tract inhibits pain transmission in the dorsal horn (substantia gelatinosa) of the spinal cord
3) Interneurones containing opioid are involved in the system at each level.
Term
What are the 3 main classes of naturally occuring opioids?
Definition
1) Enkephalins
2) Dynorphins
3) Endorphins.
Term
Describe the gate control theory of pain control.
Definition
1) Dull pain mediated by C fibres can be suppressed by simultaeneoous stimulation of AB fibres from light touch receptors in skin of the same region
2) This occurs in the dorsal horn and spinal V.
Term
How does referred pain work?
Definition
It arises when skin and visceral nociceptors synapse on common spinothalamic tract organs.
Term
Where does general anaesthesia have it's effect?
Definition
At the reticular formation.
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