25 JUNE 2019

Question 1

list the four mechanisms of neurpathetic pain:

Answer 1

ecpotic foci
ephatic transmission
central sensitivity
structural reorganization

Question 2

ecpotic foci means

Answer 2

pain that occurs from somewhere else

Question 3

steps of ecpotic foci:

Answer 3

1. damaged neuron will try to get a signal out
   (through demyelination or death)
2. it creates (modality or ligand) gated channels
3. creates a misfiring of pain

Question 4

what dx could be explained by ecpotic foci?

Answer 4

tinels sign in carpal tunnel syndrome

Question 5

what is tinels sign in carpal tunnel syndrome?

Answer 5

when you tap on your thumb and there is no pain, but then when you tap on your wrist there is pain

works because the your tapping on axon cell body: misfiring into pain receptors of your thumb

Question 6

ephatic transmission means

Answer 6

a short circuit

Question 7

steps of ephatic transmission:

Answer 7

a beta touch receptors will JUMP to a c-fiber free nerve ending and create a (ecptopic foci) to activate pain

Question 8

an dx example of ephatic transmission is

Answer 8

guillain -barre

Question 9

what neuropathetic problem could be explained by ephatic transmission?

Answer 9

allodynia

Question 10

allodynia could be explained by what two things?

Answer 10

ephatic transmission and

structural reorganization

Question 11

secondary hyperalygesia could be explained by

Answer 11

central sensitization

Question 12

what does central sensitization do?

Answer 12

reorganizes: increases excitatory transmitters and receptors

Question 13

how does central sensitization start?

Answer 13

a strong or long lasting stimulus

Question 14

list the steps of central sensitization:

Answer 14

1. a strong or long lasting stimulus
2. NS says “oh you must want more of that”
3. NS reorganizes so that you get increase stimulus:
   - increases excitatory trans and receptors
   * ***through LTP
4. then a mild stimulus can generate an AP at that synapse because the NS decreased the threshold.

Question 15

name sites that could generate pain?

Answer 15

1. peripheral neurons
   - ectopic foci
   - ephatic transmission
2. central neurons

Question 16

what three ways explain phantom limb pain

Answer 16

1. collatoral sprouting
2. denervation hypersensitivity
3. both

Question 17

phantom pain vs phantom sensation?

Answer 17

if nerve dies in pain pathway = pain

if nerve dies in sensory pathway = sensation

Question 18

steps of structural reorganization:

Answer 18

1. c fiber withdrawals from neuron
2. that neuron isn’t getting enough attention so calls for more stimulus
3. a -beta fiber will collateral sprout in order to synapse w/ neuron
4. touch (from a -beta) will now stimulate pain (from c-fiber)

Question 19

structural reorganization take home message

Answer 19

touch will activate pain

Question 20

dead pain cells will synapse

Answer 20

somewhere in the cauda medulla

Question 21

list five ways to help central sensitivity syndrome:

Answer 21

1. acknowledge pain
2. provide a supportive caring environment
3. education pt on pain
4. physical activity
5. rewiring activities
   ((also meds))

Question 22

motor planning occurs where?

Answer 22

frontal lobe

Question 23

decision making occurs where?

Answer 23

cerebral hemisphere

Question 24

the control circuits occurs where?

Answer 24

basal ganglia + cerebellum

Question 25

motor tracts start and end where?

Answer 25

start in cortex end in the spinal cord

Question 26

motor neurons start and end where?

Answer 26

start in spinal cord | end in the muscle

Question 27

what is the target of motor plannign:

Answer 27

the skeletal muscle

Question 28

list from top to bottom the steps of motor planning:

Answer 28

1. motor planning - frontal lobe 2. decision - cerebral hemisphere 3. control circuits - basal ganaglia + cerebellum 4. motor tracts - cortex to spinal cord 5. motor neurons - spinal cord to muscle 6. target = skeletal muscle

Question 29

motor tracts are also called

Answer 29

UMN

Question 30

motor neurons are also called:

Answer 30

LMN

Question 31

what happens in central sensitivity syndrome and what is the goal to stop it

Answer 31

1. decreased antinoception increased propronoception | 2. increased antinoception decreased proponecption

Question 32

where are motor neurons located in the spinal cord?

Answer 32

ventral horn

Question 33

presynaptically what happens in central sensitivity syndrome?

Answer 33

inhibition and facilitation

Question 34

what approach is central sensitivity syndrome?

Answer 34

top down

Question 35

presynaptic activity leads to what in central sensitivity syndrome?

Answer 35

LTP | - which is when the syndrome actually occurs

Question 36

why is uncertainty (fear of the unknown) a problem in central sensitivity syndrome

Answer 36

because our primal brain treats it as a THREAT so it reorganizes in order to never feel that pain again = increases pain stimulus