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GENERAL OR SOMATIC SENSE These sensations will depend on type of environment the
- Involves activation of receptors present in all parts of the person is used to.
body TEMPERATURE THERMAL SENSATION
0 10 C Pain
TYPES OF SOMATIC SENSE: 10 15 C Pain / Cold
15 25 C Cold
1. MECHANORECEPTIVE SOMATIC SENSE 25 36 C Cold/ Warm
- Utilize receptors with low threshold (sensitive) receptors 36 37 C Indifferent sensation
- Sensitive to mechanical stimulation: (body temp)
Touch > 37C Hot
Pressure > 40C Pain
Vibration (Pallesthesia)
Tickle & itch 3. NOCICEPTIVE SOMATIC SENSE
Position/ Proprioceptive sense - Utilizes both high & low threshold receptors
o Static position sense: ability to know position of a - 3 types:
non-moving body part in relation to environment Mechanosensitive nociceptors
o Dynamic position sense (Kinesthesia): ability to ~ Uses type A delta neurons = fast/acute pain
know which nody part is moving along with the ~ pain is due to excessive mechanical movement of
direction & range of movement body part (e.g. too much bending or stretching)
- E.g: Pacinian corpuscles, Merkels disc, Meissners Thermosensitive nociceptors
corpuscles, etc ~ Uses type A delta & type C neurons = dual sense
~ Pain due to extreme temperatures
2. THERMORECEPTOVE SOMATIC SENSE
- utilize high threshold receptors Chemosensitive nociceptors
- sensitive to thermal changes ~ uses type C neurons = slow/chronic pain
- classified into 3 groups: ~ pain due to receptor release of chemical agents in
Cold sensitive thermoreceptors response to tissue damage
~ Greater number in body ~ these chemical agents are known as P-factors or
~ Has DUAL SENSE: uses type A delta & type c neurons Pain-causing factors
(you have an acute sense followed by a delayed P-Factors (Pain-causing factors)
sense) - released every time there is tissue damage
~ Activated at 25C body temp
- release of these agents, esp. in excess, can cause pain
Warm sensitive thermoreceptors by stimulating chemosensitive nociceptors
~ Fewer in number - release can also increase sensitivity of other types of
~ Uses type C neurons (delayed or chronic sensation)
nociceptors by decreasing their stimulation threshold
~ Activated at 44C body temp
this is why when there is tissue injury, slight movement of
Pain sensitive thermoreceptors the body part already causes pain because
~ Once stimulated can cause pain mechanocceptors are altered
~ Also has dual sense: uses type A delta & type C example: tissue injury in hand, slight movement of fingers
will cause additional pain
neurons
- some directly affect/stimulate chemosensitive
~ Stimulated at temp < 15C and >40C
nociceptors & some do not directly affect the
*Adaptation:
chemosensitive nociceptors but enhance pain by
cold sensitive & warm sensitive thermoreceptors are
capable of adapting, at a range between 20C-40C increasing sensitivity of nociceptors/pain endings to
pain sensitive thermoreceptors ARE NOT capable of different P-factors
adapting Agents that directly affect chemosensitive nociceptors:
Bradykinin most effective
The Principle of Body Heat Loss & Gain: Serotonin
To have thermal sense, you have to have a TRANSFER OF Histamine
HEAT ENERGY CCK
Cold sensation: heat lost to the cooler object Acids: Lactic acid responsible for anoxic pain
Warm sensation: heat gained from hot object Acetylcholine
Indifferent sensation: there is no heat transfer (equal Proteases
stimulation of cold sensitive & warm sensitive Hydrogen & Potassium ions
thermoreceptors)
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PHYSIO B GENERAL SENSES 2
FEU-NRMF Institute of Medicine
Lecturer: Felipe Barbon, MD 2.5.14 1B-Medicine 2017
Agents that increase nociceptor sensitivity to P-factors: Cont. Distribution of Pain receptors:
(In some books called Tachykinins) pin prick & getting blood from arteries is more painful than
venipunctures
Prostaglandin: blocked by ASA (acetyl salicylic
a person will not notice TB infection because it initially destroys
acid/aspirin) the parenchyma so there is no pain; pain only starts when the
Substance P: blocked by opioids bacteria already reached the pleura causing pleuritis
- it is located in such manner (coverings of vital
Calcitonin gene related peptide (CGRP) organs/tissues) for immediate protection of these
- enhances activity & release of Substance P structures, now preventing further damage
- inhibits the enzyme that degrades Substance P,
prolonging its stay in the area enhanced activity of Purpose of pain is for protection: mimic painful body part to
P-factors enhanced sensitivity of nociceptors facilitate healing & rest of the body part for recovery
Mechanism of action of Opiods for pain management: CLASSIFICATION OF A PERSON AS TO PAIN SENSITIVITY:
Inhibits Substance P
1. Hyperpathia (Pain insensitive)
decrease Ca influx, decreasing AP generation duration of
2. Hyperalgesia (Pain sensitive, exaggerated reaction)
nociceptors
decrease sensitivity of dorsal horn by hyperpolarizing its
Primary: problem is on region where you have the
membrane (this is why other sensations are also inhibited in receptors (skin)
opioid use) Secondary: problem is on the pain pathways (spinal
cord, brainstem)
3 Major Sites where Opiods has an effect: - Allodynia (supersensitive)
1. Site of injury/ tissue damage = effect is local anesthesia ~ type of a primary hyperalgesia
2. Dorsal horn ~ even minor stimuli that cannot cause pain on normal
3. Brainstem = effect is general anesthesia
persons can cause these individuals pain
*can also affect thalamus where most pain pathway passes
~ sensitization of silent nociceptors: even non-active
receptors are eventually activated due to change in
condition of site of receptor
~ example: sunburn (altered skin) - even slight touch on
skin can cause pain
NEUROPATHIC PAIN
- pain even in the absence of nociceptor stimulation due to
damage to neurons involved in transmitting pain impulses
- pain is caused by stimulation of afferent sensory neurons
- examples: causalgia & phantom-limb pain or projected
pain (pain on amputated limb)
Upon injury, you release the P-factors: Bradykinin, 5HT (Serotonin), CENTRAL PAIN
Histamine & Prostaglandins - injury involving the thalamus (center for chronic pain) or
Release of Substance P is enhanced by CGRP at any level of the spinothalamic tract
REVIEW ON BLOOD: - usually severe & spontaneous
Agents released by platelets on blood vessel injury: 5HT, TXA2 & ADP - example: men with thick wallets in the back pocket causes
- 5HT can stimulate pain receptors & cause vasoconstriction compression of the sciatic nerve
- TXA2 derived from prostaglandins enhance activity of platelets to
move towards site of injury
- ADP enhances stickiness of platelets enabling them to form a
plug
2
PHYSIO B GENERAL SENSES 2
FEU-NRMF Institute of Medicine
Lecturer: Felipe Barbon, MD 2.5.14 1B-Medicine 2017
3
PHYSIO B GENERAL SENSES 2
FEU-NRMF Institute of Medicine
Lecturer: Felipe Barbon, MD 2.5.14 1B-Medicine 2017
PURPOSE OF PAIN
- For protection: informs center that a certain area is
injured
- Warning/threat
- Allows/Forces body to rest by limiting movement
- Basis for learning: an individual adapts to avoid same
PAIN SUPPRESSION/INHIBITION painful stimulus if it occurs again
- pain insensitive persons do not feel pain because they can
effectively suppress pain via activity of Gating Neurons & SENSORY ASCENDING PATHWAYS
the Analgesia System
DORSAL COLUMN/MEDIAL LEMINISCUS PATHWAY
ANALGESIA SYSTEM - Transmission of discriminative sensations: fine touch, fine
- Location: pressure, vibrations & proprioception
Brainstem: - Limited to mechanical sensations
~ periaqueductal gray area in midbrain & upper pons - Testing for Integrity of Dorsal Column:
~ raphe magnus nucleus in the lower pons & upper Gracilis pathway: test mechanical abilities of lower ex
medulla Cuneatus pathway: upper ex
Spinal cord: pain inhibitory complex in the dorsal horn - Tests for integrity by using discriminative tests such as:
- needs development to resist pain, but when activated it Fine touch (stereognosis, graphestesia, 2-point
will have longer effect discrimination)
- constant subjection to pain will eventually Proprioception
develop/activate analgesia system
*athletes & soldiers have greater pain tolerance because this ANTEROLATERAL/SPINOTHALAMICPATHWAY
- NTA used to suppress activity of pain sensory fibers: - Transmission of pain & thermal sensations
Enkephalins (related to Morphine) - also for non-discriminative sensations: crude touch &
- Enkephalin secreting neurons crude pressure, tickling & pleasurable sensations
Release enkephalins - broad spectrum: not limited to mechanical senses
Activity is enhanced by the presence of Serotonin & - Test for integrity:
Norepinephrine Inflict pain
Present up to the brainstem Thermal sensations
Pleasurable sensations
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PHYSIO B GENERAL SENSES 2
FEU-NRMF Institute of Medicine
Lecturer: Felipe Barbon, MD 2.5.14 1B-Medicine 2017