Term
| What are the main modulations of nociception? |
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Definition
| peripheralspinaldynamic modulation = neuroplasticitysupraspinal |
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Term
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Definition
| the detection, transduction, and transmission of noxious stimuli |
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Term
What are nociceptors?
What are they activated by? |
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Definition
free afferent nerve endings of A-delta (myelinated) and C (unmyelinated) fibers
activated by mechanical, chemical or thermal stimuli |
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Term
| What are nociceptors in close approximation to? |
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Definition
| small blood vessesl and mast cells with which they operate as a functional unit |
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Term
| List the fiber type from the most myelinated to the least. |
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Definition
| A alpha - motor proprioceptionA beta and gamma - cutaneous touch, pressureA delta - painB - postgang. sympathetics, visceral afferentsC - pregang. autonomics, pain (no or thinly myelinated) |
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Term
| Where is the cell body of first-order neurons?Where do the axons project? |
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Definition
| cell body in dorsal root ganglionaxons project to dorsal horn and other areas, where they synapse with second-order neurons |
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Term
| Where is the cell body of second-order neurons?Where do the axons project? |
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Definition
| dorsal hornaxons project to contralateral hemisphere of SC and ascend in spinothalamic tract to thalamus where they synapse wtih thrid-order neurons |
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Term
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Definition
| send axonal projections into sensory cortex |
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Term
| What does peripheral modulation occur by? |
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Definition
| occurs either by release of or elimination of endogenous mediators of inflammation in the vicinity of the nocioceptor |
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Term
What does tissue injury cause the release of?
These substances _____ activate nocioceptors |
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Definition
Glutamate
Substance P
- directly activate nocioceptors |
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Term
What do damaged cells, mast cells, plasma and platelets release?
Which further _____ & _____ nocioceptors and produce _________. |
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Definition
K and H ions
Lactic acid
Serotonin
Histamine
Bradykinin
Prostaglandins PGE1>PGE2
which further sensitize and excite nocioceptors and produce inflammation |
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Term
What do the analgesic effect of ASA, NSAIDs and COX-2 inhibitors result from?
Which prostaglandins are responsible for sensitization of peripheral nocioceptors? |
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Definition
inhibition of prostaglandin synthesis
PGE1 & PGE2 mediate sensitization of peripheral nocioceptors |
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Term
What are excitatory ion channels of peripheral nocioceptors involved in?
What do these channels do? |
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Definition
| involved in pain sensation and hypersensitivity to noxious stimulithese channels modulate pain hyperexcitability following inflammation |
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Term
| What does spinal modulation result from? |
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Definition
| action of NT in the dorsal hornspinal reflexes which convey efferent impulses back to the peripheral nocioceptors |
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Term
| Opioids produce their effects by interacting with receptors that are: |
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Definition
saturable
membrane bound
non-uniformly distributed throughout the CNS
(and periphery) |
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Term
| Why is Ketamine useful as an adjunct in pain management? |
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Definition
| due to antagonism of NMDA-reduces central sensitization-may attenuate opioid tolerance |
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Term
| Low dose infusion of Ketamine |
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Definition
| 20mcg/kg/mindon't seem to cause cognitive impairment or hallucinationsSE comparable to that seen with opioids |
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Term
| Is a small periop dose of Ketamine safe?Avoid use in? |
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Definition
| small periop dose is safe and useful adjunct to pain control<2mg/kg IM<1mg/kg IVuse remains controversialavoid use in central neuraxis, as concerns about neurotoxicity exist |
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Term
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Definition
| titanium rod implant containing sufentanyl providing up to 90 days supply |
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Term
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Definition
| electrically stimulated transcutaneous fentanyl reservoir can deliver up to 80 40mcg doses of drug over 24 hrs |
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