Pain complaints remain primary reason patients seek medical advice.

Cerebral Spinal Fluid travels through the

Afferent

Efferent

The central nervous system communicates with skeletal muscle (somatic nervous system) and smooth muscle (autonomic nervous system) through ____________ pathways of ________ horn

Outputs from the CNS to the smooth muscles of the Autonomic System project from _________, ________, and ________ sections of spinal cord, as well as the mid and hind brain.

Nerves of the sympathetic system project from _________ and ________ sections of spinal cord.

Nerves of the parasympathetic system project from the ___________, __________, and ________ section of spinal cord.

"Rest and digest" goes with

4 main nerve plexus (bundles) control somatic system.

which of the following are they

No special dedicated organ. Come from all over the body (e.g. texture, temperature, pressure). Project to spinal chord.

Detect information from internal smooth muscle organs (stomach, lungs, heart). Project to spinal chord

Senses with special dedicated organs (e.g. sight, sound, smell, taste). Project directly to brain.

Nerves of visceral and somatic senses communicate with the central nervous system through ___________ pathways of ___________ horn.

With _________ reflex, sensory information is sent directly to efferent (outgoing) neurons within spinal cord, for a quick response (e.g. knee jerk).

With _______ reflex, sensory information is sent directly to motor neurons within sympathetic trunk ganglion, for an even quicker response (e.g. gut motility).

Adaptive pain signaling is a primitive evolutionary mechanism that does not protect our bodies from harm.

Noxious (e.g., harmful) stimuli sensed by nociceptor receptors found on somatic skeletal and visceral smooth tissues.

Adaptive pain signaling, Involves 5 phases: Transmission -> Conduction -> Transduction -> Perception -> Modulation.

This order is correct?

Adaptive pain signaling, Involves 5 phases: Transmission -> Conduction -> Transduction -> Perception -> Modulation.

Which two need to switch places to make the order correct?

Adaptive pain signaling, Involves 5 phases: Involves 5 phases: Transduction -> Conduction -> Transmission -> Perception -> Modulation

This order is correct?

Noxious (i.e., harmful) mechanical, thermal, or chemical stimuli release neurotransmitters (e.g., serotonin) and inflammatory signals that stimulate pain receptors (e.g., nociceptors).

In the dorsal horn, nerve fibers release neurotransmitters (e.g., substance P, glutamate) onto ascending pathway neurons that send pain and other sensory information up the spinal cord and onto the brain.

Action potential travels down nerve fibers from site of stimulation to dorsal horn of spinal cord. A-δ fibers signal sharp, localized pain; C fibers signal aching non-localized pain

Pain signals are converted into a conscious experience in the cortical structures of the brain. Not well understood, but cognitive and behavioral functions can help (e.g., relaxation).

While increased release of neurotransmitters such as glutamate or substance P in the dorsal horn can intensify pain, release of neurotransmitters such as endogenous opioids and GABA, by descending pathways, can subside pain.

Two major types of pain signaling are

Maladaptive pain signaling Results from ______ (neuropathic) or ___________ (dysfunctional) pain signaling in the nervous system.

Often result in exaggerated painful responses to normally painful stimuli (___________) and/or painful responses to normally non-painful stimuli (__________).

exaggerated painful responses to normally painful stimuli

painful responses to normally non-painful stimuli

Diabetic Peripheral Neuropathy is reported as the most common cause of maladaptive pain

Transmission: In the dorsal horn, nerve fibers from periphery release neurotransmitters onto neurons projecting to the brain. With repeated activation transmission signal strength can increase. This is known as __________________.

Transmission phase of pain and central pain sensitization

At first, Na+ influx following AMPA receptor activation leads to “normal” depolarization

However, repeated stimulation of mGluR and NMDA glutamate receptors, as well as NK1 (Substance P->Neurokinin-1) and TrkB (BDNF->Tropomyosin receptor kinase B) receptors activates kinase cascades. These kinases cascades alter receptor function by increasing AMPA receptors numbers and NMDA receptor speed, resulting in facilitated neuron depolarization and short term pain sensitization.

Kinase cascade alteration of gene expression contributes to ____________ sensitization.

(sensory neurons in the brain) These, as well as other, pre and postsynaptic receptors of transmission synapse are common targets for pain medications.

Mechanism of migraine/headache pain.

May include food cravings, mood changes, and confusion. Hours to days preceding headache.

Visual disturbances (e.g., geometric patterns, light oscillations) just before headache. Reported by 15- 30%.

Throbbing pain for longer than 4 hours after start of headache. Other symptoms include nausea, sensitivity, and allodynia.

May include cognitive impairments and fatigue that can persist for 18-24 hrs post-headache.

Short duration pain (Usually brief, but no more than 6 months).

An ongoing pain state, persisting from months to years after initial nerve damage.