What happens when the pain gate is open?
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Pain transmission is facilitated.
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What happens when the pain gate is open?
Pain transmission is facilitated.
What are the side effects of a prefrontal lobectomy?
Severe personality changes.
Where does enkephalin bind to opiate receptors in the central terminal of the 1st order neuron?
Enkephalin binds to opiate receptors in the central terminal of the 1st order neuron, leading to the opening of Cl channels.
How does anesthesia affect pain sensations?
It causes a loss of pain sensations.
What is local anesthesia?
Any technique to induce the absence of sensation in part of the body.
What is the potency of dynorphins as analgesics?
They are very potent analgesics
What is the site of contact between the presynaptic terminals carrying pain and SGR cells called?
The spinal gate.
What type of fibres does TENS activate to relieve pain?
Large diameter 'touch' fibres (Aβ).
What is the Convergence Projection Theory in the context of referred pain?
It is the theory that pain-carrying fibers from a diseased viscous and related somatic structures converge on the same SGR cells (Dorsal horn cells) and ascend to the same cortical neurons, causing the brain to perceive pain from the viscous as if it is coming from the somatic structure.
What role do the SGR cells (Dorsal horn cells) play in the Convergence Projection Theory?
They are the cells where pain-carrying fibers from the diseased viscous and related somatic structures converge before ascending to the same cortical neurons.
Where is the pain inhibitory complex located in the spinal cord?
In the substantia gelatinosa of Rolandi (SGR).
What is anesthesia?
Using some drugs as painkillers.
Where is pain from the esophagus usually felt?
In the lower neck and midline chest region.
What is the pharmacological method for pain relief?
Using drugs to relieve pain.
Where is the raphe magnus nucleus located?
In the lower pons and upper medulla.
Where are the spinal terminations of the descending fibers of the Pain Control System located?
In the dorsal horn of the spinal cord.
What is the result of opening Cl- channels in presynaptic inhibition?
Hyperpolarization.
What does anesthesia cause in terms of consciousness and memory?
Loss of consciousness and memory of the patient.
What are the receptors called that opioid peptides bind to?
Opioid receptors (morphine receptors).
What role do enkephalins play in acupuncture's mechanism of pain control?
They are involved in presynaptic inhibition.
Where is the Nucleus Reticularis Paragigantocellularis (NRPG) located?
In the medulla.
What are the neural connections involved in the Pain Control System?
Connections between the cerebral cortex, periventricular area, periaqueductal gray area, NRPG, NRM, and spinal cord.
Which system involved in emotions and memory can control the PAG?
Limbic system.
What type of neuron is involved in the Pain Control System at the spinal cord level?
Enkephalinergic neuron.
What is a natural (physiological) method for activating the Pain Control System?
Exposure to severe stress, particularly when associated with strong emotional excitement.
What temporary effect does anesthesia have on body muscles?
Temporary paralysis of the entire body muscles.
What are the three main types of anesthesia?
General anesthesia, Local anesthesia, Regional anesthesia.
Where are dynorphins present?
In the same sites as enkephalin
How does acupuncture inhibit pain transmission at the SGR?
Through collaterals.
How do endorphins act as neurohormones?
In stress conditions, Beta-endorphins are secreted from the hypothalamus and pituitary to general circulation, reaching all the opiate receptors in the body and causing analgesia.
Who are the core members of the interdisciplinary team in a PMP?
A Clinical Psychologist, a Physiotherapist, and a Medical Practitioner.
What is the function of the system consisting of certain areas in the brain and spinal cord?
When activated, it can reduce or abolish pain sensation.
Which part of the brain responsible for higher cognitive functions can control the PAG?
Cerebral cortex.
What is the final outcome of the process involving enkephalins, opioid receptors, Cl- channels, hyperpolarization, and Ca2+ channels?
Presynaptic inhibition.
Where does enkephalin bind to opiate receptors in the postsynaptic 2nd order neuron in the pain pathway?
Enkephalin binds to opiate receptors in the postsynaptic 2nd order neuron in the pain pathway, leading to the opening of K channels.
What is general anesthesia?
Medically induced coma and loss of protective reflexes resulting from the administration of one or more general anesthetic agents.
From what precursor are endorphins derived?
Pro-opi-melano-corten (POMC) in the anterior pituitary and hypothalamus.
What does PCS stand for in the context of pain management?
Pain Control System.
Where do the pain-carrying fibers from the diseased viscous and related somatic structures converge?
On the same SGR cells (Dorsal horn cells).
What does PAG stand for in the context of pain control?
Periaqueductal Gray.
What is the first step in postsynaptic inhibition?
Encephalin release.
What happens after encephalins bind to opioid receptors?
Opening of K channels.
What is the final outcome of the postsynaptic inhibition process?
Postsynaptic inhibition.
What is the sequence of events after enkephalin binds to opiate receptors in the central terminal of the 1st order neuron?
Opening of Cl channels -> Cl influx -> hyperpolarization -> block of Ca influx -> inhibit release of chemical transmitter from 1st order neuron.
What are the three classes of opioid peptides?
Enkephalins, Endorphins, and Dynorphins.
Which type of anesthesia affects the entire body and induces a state of unconsciousness?
General anesthesia.
Which type of anesthesia blocks pain in a larger area of the body, such as a limb or the lower half of the body?
Regional anesthesia.
What is believed about the role of dynorphins in addiction?
It is believed that they are responsible for addiction to opiates
What additional effects do Beta-endorphins have besides causing analgesia?
They increase the secretion of growth hormone and prolactin from the pituitary.
Which opiate receptors respond mainly to Enkephalins?
Delta receptors.
How does TENS relieve pain?
By activating large diameter 'touch' fibres (Aβ) without activating smaller diameter nociceptive fibres (Aδ and C).
Where is gall bladder pain usually referred to?
The epigastric region, and it may also be referred to the right shoulder and neck.
What are some surgical methods for pain relief?
Cutting of the peripheral nerves and prefrontal lobectomy.
What effect does a prefrontal lobectomy have on pain?
It abolishes the emotional and psychogenic effect of pain.
Where is the nucleus reticularis paragigantocellularis (NRPGC) located?
In the medulla.
What are the three main activators of the Pain Control System?
Electrical stimulation, application of opiates, and exposure to stress.
What is an example of pharmacological anesthesia used in the Pain Control System?
Local application of opiates such as morphine at particular regions in the nervous system.
What are the two types of enkephalins?
Leuenkephalin and metenkephalin
At what level does acupuncture stimulate the Pain Control System (PCS)?
At the level of the brain stem.
How do endorphins act as neurotransmitters?
By stimulating the arcuate nucleus and some specific areas of the hypothalamus of the brain stem to secrete endorphins.
Where is the brain stem gate located?
At the nuclei of the reticular formation.
What is the effect of TENS on the spinal pain-gate?
It causes simultaneous suppression of pain transmission at the spinal pain-gate by acupuncture.
Where is uterine pain usually felt?
In the suprapubic region, to the peritoneum, or to the lower region of the neck.
What does the physiological method for pain relief involve?
The endogenous analgesic system.
Where is the Raphe Magnus Nucleus (RMN) located?
In the Pons and upper medulla.
Where is the pain inhibitory complex located in the spinal cord?
In the dorsal horns of the spinal cord.
Which network of neurons in the brainstem can control the PAG?
Reticular formation.
What are the three main effects of anesthesia?
Loss of consciousness and memory of the patient, loss of pain sensations, and temporary paralysis of the entire body muscles.
What type of stress can activate the Pain Control System naturally?
Severe stress, particularly when associated with strong emotional excitement.
What is the sequence of events after enkephalin binds to opiate receptors in the postsynaptic 2nd order neuron in the pain pathway?
Opening of K channels -> hyperpolarization -> inhibit their response to the pain chemical transmitter.
What are natural peptide substances produced inside the body that can bind to opioid receptors and produce pain analgesia?
Opioid peptides.
What happens when the pain gate is closed?
Pain transmission is blocked.
Which opiate receptors respond mainly to dynorphin and keto-cyclazocine?
Kappa receptors.
What effects are associated with Muta receptors?
Analgesia, euphoria, respiratory depression, miosis, and constipation.
Where does appendicitis pain localize later on?
To the right iliac fossa when the peritoneal covering is involved.
What happens to the pain sensation when the viscous is injured or diseased according to the Convergence Projection Theory?
The pain sensation is projected to or felt in the somatic structure.
What is the role of the pain inhibitory complex in the dorsal horn of the spinal cord?
It helps in pain inhibition.
Which area in the brain is associated with the pain pathway in the Pain Control System?
The midbrain.
What is the primary method of pain control discussed in the slide?
Acupuncture.
What is the role of the spinal gate in pain control?
It is involved in the gate control of pain or pain inhibition at the SGR cells.
How is pain transmission blocked at the spinal gate?
By descending inhibitory impulses through the pain control system activating enkephalin-secreting interneurons and by stimulation of large diameter fibers terminating peripherally in mechanoreceptors.
Why might rubbing the skin near a painful area relieve pain?
Rubbing the skin excites tactile and pressure receptors, which can block pain transmission.
Which fibres are not activated by TENS during pain relief?
Smaller diameter nociceptive fibres (Aδ and C).
Where is gastric pain usually referred to?
The epigastric region in the wall of the abdomen.
Where is the periaqueductal gray area (PAGA) located?
Around the aqueduct of Sylvius in the midbrain and pons.
Which pathway that transmits pain signals to the brain can control the PAG?
Ascending pain pathway.
What do enkephalins bind to during presynaptic inhibition?
Opioid receptors.
What are the clinical (experimental) methods for activating the Pain Control System?
From what are enkephalins derived?
Proenkephalins
What are the sites of synapses along the pain pathway considered as?
Gates through which pain transmission can be facilitated (if the gate is open) or blocked (if the gate is closed).
What is the role of the PAG area in pain control?
The PAG area is involved in the pain control system and its activation leads to the release of endogenous opioid peptides.
Where is the Periaqueductal Gray (PAG) located?
In the midbrain and Pons.
Which brain structure involved in homeostasis can control the PAG?
Hypothalamus.
What is the first step in presynaptic inhibition?
Enkephalin release.
What is the result of opening K channels in postsynaptic inhibition?
Hyperpolarization.
What is the overall effect of enkephalin binding to opiate receptors in the pain pathway?
It inhibits the response to pain by causing hyperpolarization and blocking the release of pain chemical transmitters.
Where are enkephalins present in high concentration?
Brain stem, spinal cord, and limbic system
Which type of anesthesia numbs a specific area of the body without affecting consciousness?
Local anesthesia.
Which type of sensory nerve is primarily stimulated by acupuncture according to the slide?
Mostly type A sensory nerve.
What is the most common type of endorphin?
Beta-endorphin, which consists of 30 amino acids.
What role do descending inhibitory impulses play in blocking pain transmission?
They activate enkephalin-secreting interneurons.
Where is the spinal gate located?
At the SGR (Substantia Gelatinosa of Rolando).
What is a Chronic Pain Management Programme (PMP)?
A psychologically based rehabilitation programme delivered in a group setting by an interdisciplinary team.
Which opiate receptors respond mainly to Endorphins?
Muta receptors.
What are the three main methods for pain relief (analgesia)?
Why does the cortex perceive pain from a diseased viscous as coming from a somatic structure?
Because the cortical sensory areas are accustomed to receiving pain impulses from the somatic structure, so when the viscous is injured or diseased, the impulses are perceived by the cortex as if coming from the somatic structure.
In what cases might a prefrontal lobectomy be used for pain relief?
In severe cases, such as terminal stages of severely painful conditions like tumors.
What is the function of the Pain Control System (PCS)?
When activated, it can reduce or even completely abolish pain sensation.
Where is the locus ceruleus located?
In the pons.
What are the main centers of the Pain Control System?
Cerebral cortex, Periventricular area, Periaqueductal gray area, Nucleus reticularis paragiganto-cellularis (NRPG), Nucleus raphe magnus (NRM), Spinal cord.
What happens after enkephalins bind to opioid receptors?
Opening of Cl- channels.
What do encephalins bind to during postsynaptic inhibition?
Opioid receptors.
What effect does hyperpolarization have on Ca2+ channels during presynaptic inhibition?
It blocks Ca2+ channels.
What effect does the binding of enkephalin to opiate receptors have on the release of chemical transmitters from the 1st order neuron?
It inhibits the release of chemical transmitters by blocking Ca influx.
From what are dynorphins derived?
Prodynorphin
What are the two main mechanisms for pain inhibition at the SGR cells?
What physiological effect explains stress analgesia in battles and accidents?
The secretion of Beta-endorphins from the hypothalamus and pituitary to general circulation, causing analgesia.
Which opiate receptors respond mainly to Dynorphins?
Omega receptors.
What does TENS stand for?
Transcutaneous Electrical Nerve Stimulation
How can electrical stimulation be used in pain control?
By stimulating certain regions of the pain control system.
What is regional anesthesia?
Anesthesia affecting a large part of the body, such as a limb or the lower half of the body.
Into how many classes are opioid peptides divided?
Three classes.
Which large sensory nerves are involved in the other mechanisms for pain inhibition?
A alpha and A beta nerves.
What effects are associated with Kappa receptors?
Analgesia, sedation, diuresis, and miosis.
Which opiate receptors are associated with hallucination when combined with glazocune drugs?
Sigma receptors.
Where is cardiac pain usually felt or referred to?
The retrosternal region, base of the left side of the neck, inner side of the arm, forearm, or even in the little finger. It may also be felt in the epigastric region.
How does acupuncture contribute to pain inhibition?
Acupuncture is one of the other mechanisms for pain inhibition at the SGR cells.
What is the primary function of a TENS device?
To deliver electrical currents across the intact surface of the skin.
What is referred pain?
Pain arisen in a viscous and felt in a related somatic structure (both the viscous and somatic structure originated from the same embryonic segment and supplied by the same spinal dorsal roots).
How does stimulation of large diameter fibers help in pain relief?
It terminates peripherally in mechanoreceptors, such as tactile receptors or proprioceptors, which can block pain transmission.
Where is the thalamic gate located?
At neurons of PVLNT (Posterior Ventral Lateral Nucleus of the Thalamus) and intralaminar thalamic nuclei.
What is the main aim of Chronic Pain Management Programmes (PMPs)?
To reduce the disability and distress caused by chronic pain by teaching sufferers physical, psychological, and practical techniques to improve quality of life.
Where is appendicitis pain initially felt?
In the skin area surrounding the umbilicus.
What are the two main mechanisms by which TENS relieves pain?
Where is renal and ureteric pain usually referred to?
The back behind the kidney, and it may also be referred to the anterior abdominal wall near the injured region.
