D439 PAIN MANAGEMENT EXAM
QUESTIONS AND CORRECT ANSWERS!!
Serotonin
the 5 Neurotransmitters (excitatory)
This neurotransmitter is Released from the brainstem and dorsal horn to inhibit
pain transmission.
Neuromodulators
The _______________ (inhibitory)
• Are the natural supply of morphine-like substances in the body
• Activated by stress and pain
• Located within the brain, spinal cord, and gastrointestinal tract
• Cause analgesia when they attach to opiate receptors in the brain
• Present in higher levels in people who have less pain than others with a similar injury
myelinated (A-delta fibers) or unmyelinated (C fibers)
Each nociceptor has an axon composed of peripheral afferent nerve fibers that are either
_____________.
peripheral afferent fibers
The nociceptive impulses are transmitted from the periphery to the spinal cord via the
_____________ to the dorsal root ganglia and the superficial lamina I/II of the dorsal horn of the
spinal cord.
myelinated A-delta fibers
The fast-transmitting ______________ transmit sharp, localized nociceptive information.
,unmyelinated C fibers
the smaller-diameter ________________ relay impulses that are dull, achy, and poorly localized.
spinothalamic tracts
The A-delta fibers transmit nociceptive impulses from the dorsal horn to the interior deeper
laminae (III-IV) of the spinal cord and higher centers of the brain by way of the
_________________.
Dorsal horn neurons
_______________ carrying nociceptive input include projection neurons, local interneurons, and
propriospinal neurons.
projection neurons
Many of the _______________ have axons that cross the midline and ascend to multiple areas of
the brain, including the thalamus, gray matter of the cerebral cortex, the pons, and parts of
the medullary reticular formation. It is this cellular system of communication (action
potentials carrying nociceptive input) that allows pain, arising from any area of the body
including the nerve or areas of the brain itself, to be perceived by an individual.
Perception
four physiological processes of nociception
Once a pain stimulus reaches the cerebral cortex, the brain interprets the quality of the pain
and processes information from past experiences, knowledge, and cultural associations in
the____________ of the pain. ____________ is the point at which a person is aware of
nociceptive impulses and perceives pain.
somatosensory cortex
The ____________ identifies the location and intensity of pain
association cortex
the _________________, primarily the limbic system, determines how a person feels about it.
, Modulation
four physiological processes of nociception
The fourth and final phase of the normal pain process is known as ______________. When a
person perceives a harmful impulse, projection neurons activate endogenous descending
inhibitory mediators such as endorphins (endogenous opioids), serotonin, norepinephrine, and
gamma-aminobutyric acid (GABA), to help produce an analgesic effect. These mediators hinder
the transmission of nociceptive impulses in the dorsal horn neurons. _____________ can also
occur through peripheral and/or central sensitization, resulting in increased perception of pain.
hyperalgesia
Afferent nerve fibers sensitized by vasoactive and pronociceptive mediators lower the
threshold of activation and result in continuous nociceptive input to dorsal horn neurons and
central sensitization. Clinical manifestations of central sensitization include expansion of the
pain beyond the initial location, exaggerated response to noxious stimuli known as
_______________, and pain in response to normally non-noxious stimuli, also called allodynia.
protective reflex
A ____________ response also occurs with pain. A-delta fibers send sensory impulses to the
spinal cord, where they synapse with spinal motor neurons. The motor impulses travel via a
reflex arc along efferent (motor) nerve fibers back to a peripheral muscle near the site of
stimulation, thus bypassing the brain. Contraction of the muscle leads to a protective withdrawal
from the source of pain.
consciousness and an intact central nervous system
Pain perception requires ______________.
trauma, drugs, tumor growth, and metabolic disorders
Common factors that disrupt the pain process include ______________.
Melzack and Wall's gate-control theory
QUESTIONS AND CORRECT ANSWERS!!
Serotonin
the 5 Neurotransmitters (excitatory)
This neurotransmitter is Released from the brainstem and dorsal horn to inhibit
pain transmission.
Neuromodulators
The _______________ (inhibitory)
• Are the natural supply of morphine-like substances in the body
• Activated by stress and pain
• Located within the brain, spinal cord, and gastrointestinal tract
• Cause analgesia when they attach to opiate receptors in the brain
• Present in higher levels in people who have less pain than others with a similar injury
myelinated (A-delta fibers) or unmyelinated (C fibers)
Each nociceptor has an axon composed of peripheral afferent nerve fibers that are either
_____________.
peripheral afferent fibers
The nociceptive impulses are transmitted from the periphery to the spinal cord via the
_____________ to the dorsal root ganglia and the superficial lamina I/II of the dorsal horn of the
spinal cord.
myelinated A-delta fibers
The fast-transmitting ______________ transmit sharp, localized nociceptive information.
,unmyelinated C fibers
the smaller-diameter ________________ relay impulses that are dull, achy, and poorly localized.
spinothalamic tracts
The A-delta fibers transmit nociceptive impulses from the dorsal horn to the interior deeper
laminae (III-IV) of the spinal cord and higher centers of the brain by way of the
_________________.
Dorsal horn neurons
_______________ carrying nociceptive input include projection neurons, local interneurons, and
propriospinal neurons.
projection neurons
Many of the _______________ have axons that cross the midline and ascend to multiple areas of
the brain, including the thalamus, gray matter of the cerebral cortex, the pons, and parts of
the medullary reticular formation. It is this cellular system of communication (action
potentials carrying nociceptive input) that allows pain, arising from any area of the body
including the nerve or areas of the brain itself, to be perceived by an individual.
Perception
four physiological processes of nociception
Once a pain stimulus reaches the cerebral cortex, the brain interprets the quality of the pain
and processes information from past experiences, knowledge, and cultural associations in
the____________ of the pain. ____________ is the point at which a person is aware of
nociceptive impulses and perceives pain.
somatosensory cortex
The ____________ identifies the location and intensity of pain
association cortex
the _________________, primarily the limbic system, determines how a person feels about it.
, Modulation
four physiological processes of nociception
The fourth and final phase of the normal pain process is known as ______________. When a
person perceives a harmful impulse, projection neurons activate endogenous descending
inhibitory mediators such as endorphins (endogenous opioids), serotonin, norepinephrine, and
gamma-aminobutyric acid (GABA), to help produce an analgesic effect. These mediators hinder
the transmission of nociceptive impulses in the dorsal horn neurons. _____________ can also
occur through peripheral and/or central sensitization, resulting in increased perception of pain.
hyperalgesia
Afferent nerve fibers sensitized by vasoactive and pronociceptive mediators lower the
threshold of activation and result in continuous nociceptive input to dorsal horn neurons and
central sensitization. Clinical manifestations of central sensitization include expansion of the
pain beyond the initial location, exaggerated response to noxious stimuli known as
_______________, and pain in response to normally non-noxious stimuli, also called allodynia.
protective reflex
A ____________ response also occurs with pain. A-delta fibers send sensory impulses to the
spinal cord, where they synapse with spinal motor neurons. The motor impulses travel via a
reflex arc along efferent (motor) nerve fibers back to a peripheral muscle near the site of
stimulation, thus bypassing the brain. Contraction of the muscle leads to a protective withdrawal
from the source of pain.
consciousness and an intact central nervous system
Pain perception requires ______________.
trauma, drugs, tumor growth, and metabolic disorders
Common factors that disrupt the pain process include ______________.
Melzack and Wall's gate-control theory
