NRS 313 Study Guide - Final Guide: Referred Pain, Migraine, Group C Nerve Fiber
27 May 2018
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Pain/ Neuroplasticity
• Pain is whatever the patient says it is
• Nociceptive Pathways
o Don’t give pain medication until health care team identifies the etiology- pain is
diagnostic
o The new give medications and therapies that block these specific nerve pathways
o C-Fibers: Thinly myelinated. Conducts nerve impulses slowly
▪ Noxious heat and chemical stimuli
o A-Delta: moderate myelin or medium amounts. A little faster
▪ Noxious mechanical stimulus (sharp cuts or crush injuries)
o A-Beta: Thick myelin=> fast conduction
▪ Non pain stimuli. Light touch, massage warmth and ice packs can help
o Order of neurons
▪ 1st order neurons-> enter dorsal horn (interneuron) -> 2nd order neuron ->
spinal cord heading upwards to 3rd order neurons
o Post surgery
▪ A delta pain. IV or oral pain meds can be not well managed. Stimulate the
A beta fibers if these people need quick pain relief.
▪ Gate Controlled Therapy: reduce the amount of narcotic pain medication
• Pain gate is at the interneuron
• Nociceptive Pain Neuroanatomy Cont.
o C fibers – They are small, unmyelinated/thinly myelinated fibers that transmit
dull, slow, poorly localized pain
o A-delta fibers – Moderately myelinated fibers. Activation causes sodium and
calcium ion channels to open (speeds up action potential) and transmits sharp,
fast, well localized pain.
o A-beta fibers: Thickly myelinated fibers that transmit touch/ vibration /non-
painful heat and cold. They do not transmit pain, but play a role in pain
modulation
• Brain Centers and Pain Perception
o Transduction: mechanical stimuli are converted into neurochemical response.
This happens at the neuroceptive cells. They release substance P
▪ Substance P: excites nerve cells to signal to brain there is pain
▪ Mast Cells: release histamine. Transmitter of nerve pain impulse
• Prostaglandin is synthesized
▪ Treatment: anti histamine, a beta activity, NSAIDS
o 1st Interneuron: stimulate a beta to relieve painful stimuli. Also use a TENS unit
to simulate electrical stimulation. Any other stimulation like touch, ice, or heat.
o 2nd order neuron: People can see an anesthesiologist.
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Conducts nerve impulses slowly: noxious heat and chemical stimuli, a-delta: moderate myelin or medium amounts. A little faster: noxious mechanical stimulus (sharp cuts or crush injuries, a-beta: thick myelin=> fast conduction, non pain stimuli. Light touch, massage warmth and ice packs can help: order of neurons, 1st order neurons-> enter dorsal horn (interneuron) -> 2nd order neuron -> spinal cord heading upwards to 3rd order neurons, post surgery, a delta pain. Iv or oral pain meds can be not well managed. Activation causes sodium and calcium ion channels to open (speeds up action potential) and transmits sharp, fast, well localized pain: a-beta fibers: thickly myelinated fibers that transmit touch/ vibration /non- painful heat and cold. They do not transmit pain, but play a role in pain modulation: brain centers and pain perception, transduction: mechanical stimuli are converted into neurochemical response. They release substance p: substance p: excites nerve cells to signal to brain there is pain, mast cells: release histamine.
