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Define Pain

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A sensation of discomfort resulting from the stimulation of specialized nerve endings called nociceptors

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Another Name for Free Nerve Endings

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Nociceptors

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Define Pain Perception

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The process whereby the sensation of pain is transmitted form the PERIPHERY to the CNS

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Define Pain Reaction

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The RESULT of pain perception (AKA what the person will do about the perceived pain)

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Define Pain Reaction Threshold

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The amount of pain one must experience before exhibiting a reaction (varies between individuals and day to day)

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Gwen's definition of ions

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Particle which possess either a positive or negative charge

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3 Types of Nerve Cells Which ones is Dental Pain transmitted by

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Unipolar, Bipolar, Multipolar Dental Pain is Transmitted in Bipolar Nerve Cells

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Gwen's definition of Diffusion

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Movement of molecules/ions from an area of high concentration to a an area of low concentration

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Four Sensory Nerve Characteristics

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Cell Body Nucleus Axons Free Nerve Endings/Nociceptors

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Two types of Nerve Fibers

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A & C

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Define Pain Receptors

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Free nerve endings which initiate the conduction of an impulse along the axon

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Group A Fibers

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3-20 microns diameter myelinated RAPID conduction of 100 meters per second

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Group C Fibers

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0.5-1 microns NOT myelinated SLOW conduction of 0.5-2 meters per second

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Larger Diameter Nerve Fibers length

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A fibers 3-20 microns

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Smaller Diameter Nerve Fibers

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C Fibers 0.5-2 microns

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Inside and Outside the Cell Membrane at rest

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The extracellular fluid is positive (cations) and the intracellular fluid is negative (anions)

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How is the positive/negative concentrations across the membrane are regulated by

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Diffusion

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Define Equilibrium

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Equal distribution of positive and negative ions across the cell membrane NERVE CELL EQUILIBRIUM DOES NOT EXIST More NEGATIVE intracellular

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Define Nerve Trunk

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An extremely large bundle of nerve fibers

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What does an anesthetic "block" target?

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Nerve Trunk

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Define Ganglia

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A collection of nerve cell bodies (located outside the CNS)

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The membrane potential at Rest (x2)

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-70 to 90 mV Polarized (more neg inside than outside)

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Define Membrane Potential

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The difference in the electrical charges across the nerve membrane

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Membrane Potential is maintained by... (x2)

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1. Sodium - Potassium Pump 2. Permeability of the Cell Membrane

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Nerve Fiber Diameter Determines (x2)

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1. Speed at which the impulse can be conducted 2. Type of Pain Perceived

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Fiber diameter and speed of impulse

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Larger diameter fibers conducted impulses faster

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Fiber diameter and Type of Pain Perceived

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LARGER Fibers are with FAST pain Small Fibers are with Slow pain

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What does an anesthetic "infiltration" target?

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Free Nerve Endings (Nociceptors)

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The Two Ions Essential for Nerve Conduction

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Potassium and Sodium

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Describe the Sodium-Potassium Pump (x3)

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- Located within the cell membrane - Active during all stages of nerve rest and excitation - Resting/Unstimulated State is Polarized (Sodium on the outside and Potassium on the inside)

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Rate of ions passing through the membrane

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Sodium is pumped out of the membrane 2-5x faster than Potassium is pumped into the membrane

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The Cell Membrane Surrounds...

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Free Nerve Endings, Axons, and Cell Bodies

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Define Stimulus

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An environmental change which can be chemical, thermal, mechanical, or electrical in nature

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Define Minimal Threshold Stimulus

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The magnitude of the stimulus required to initial a nerve impulse, it is different between A & C fibers

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Minimal Threshold Stimulus

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The impulse will travel the entire length of the fiber without further stimulation. A more intense stimulus WILL NOT INCREASE the length, speed, intensity of the impulse A Stimulus of Lesser intensity will result in NO reaction at all

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Cause of Action of the Membrane

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Resting State (Unstimulated, Polarized) Minimum Threshold Stimulus Depolarization (Reverse Polarity Achieved) Repolarization (Polarity is re-established)

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"Excitation" When a minimal threshold stimulus excites the nerve...

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Permeability of the Cell Membrane Changes Reversed Polarity is Achieved INFLUX of Na enters the cell EFFLUX of K diffuses out of the cell

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Define Depolarization

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The time interval which exists while the ionic concentrations are reversing. This time is a fraction of a millisecond.

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Define Reversed Polarity

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A result of depolarization, the result of a reversal in ionic changes

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Sodium and Potassium ions after Minimum Threshold Stimuli/Excitation

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Influx of Na enters the cell Efflux of K diffuses to the outside

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Define Repolarization

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Occurs after reversed polarity, the membrane becomes HYPERPERMEABLE to K and IMPERMEABLE to Na - POLARITY IS REESTABLISHED.

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Sodium and Potassium ions during Repolarization

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Influx of K Efflux of Na

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Define Action Potential

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Rapid Sequence of Changes in the membrane potential (Neg. to Pos. or Pos. to Neg.)

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Depolarization IRT AP inside the cell

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Negative to Positive

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Repolarization IRT AP instide the cell

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Postive to Negative

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Which Stage Results in Reversed Polarity

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Depolarization

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Principle of Nerve Fibers that Apply to both A & C Fibers (x6)

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Depolarization Reversed Polarity Repolarization Absolute Refractory Period Relative Refractory Period All or None Law

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Define All or None Law

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Either the nerve fires as strongly as possible or it does not fire at all

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Define Myelin

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External Lipid Protein Coating Only Covers Large Diameter A Fibers

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Two Functions of Myelin

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1. Protects fibers from adjacent excitation 2. Expedites the conduction of an impulse

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Define Nodes of Ranvier

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Unmyelinated interruptions on myelinated fibers that occur every 1-3 mm on the nerve Exposed Membrane. Action Potentials go to these Nodes.

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Stages of Action Potential

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1. Depolarization Resulting in Revered Polarity (- to +) 2. Repolarization(+ to -)

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Define Absolute Refractory Period

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The period of time during depolarization and reversed polarity when the cell membrane cannot be re-excited

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Define Relative Refractory Period

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During Repolarization, the nerve cell membrane can be re-excited BUT it requires a greater stimulus than excitation from a resting state.

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Pain Intensity is determined by.... (x2)

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1. Number of Fibers Stimulated 2. Frequency of Excitation

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Pain Intensity - Number of Fibers Stimulated (x2)

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- Anatomy of the Area - Dimensions of the Area being Stimulated

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Pain Intensity - Frequency of Excitation

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Duration of the Stimulus

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Transmission of a nerve impulse via Nodes of Ranvier

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Saltatory Conduction

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Two Advantages of Saltatory Conduction

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1. Increases speed of impulse travel 2. Conserves Energy b/c only nodes depolarize

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Pain Control (x6)

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1. Blocking the Pathway of Pain Impulses 2. Using Psychosomatic Methods 3. Removing the Cause 4. Raising the Pain Reaction Threshold 5. Preventing Pain Reaction by Cortical Depression 6. Production of Natural Occurring Analgesics

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Local Anesthetics Prevents......

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The Conduction of Nerve Impulse by Preventing DEPOLARIZATION. Interrupts Pain Perception

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Define Psychogenic Pain

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Discomfort for which no organic cause can be determined

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Define Referred Pain

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Pain Experienced at the site other than injury

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Five Factors Affecting the pain reaction threshold

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Emotional State Fatigue Age Nationality Sex

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The most consistent reported variable affecting reactions to pain in a person

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Emotional State

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Nervous/Anxious/Poor Attitude Pain Reaction Threshold is

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LOW

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More Fatigued Pain Reaction Threshold is

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LOW

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Older Patients Pain Reaction Threshold is

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HIGH

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Younger Patients Pain Reaction Threshold is

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LOW

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Nationalities that have Lower Pain Reaction Thresholds

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Latin Americans and Southern Europeans are culturally more emotional

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Nationalities that have Higher Pain Reaction Thresholds

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North Americans and Northern Europeans

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Relationship of Pain Reaction to Behavior

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High Pain Reaction Threshold -- Hyporeaction Behavior Lower Pain Reaction Threshold -- Hyperactive Behavior

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Hyporeactive Behavior

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High Pain Reaction Threshold Can Tolerate Pain Much Better

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Hypereactive Behavior

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Low Pain Reaction Threshold

Local Anesthesia – Pain Physiology – Flashcards

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