NEURO

PAIN
- Nociceptors respond to 3 different types of stimulants mechanical, thermal, and
chemical
- Glutamate, prostaglandins and Substance P released by spinal cord or dorsal horn C
fibers > sensitive nerve endings > dorsal horn > thalamus > cortex
- Neospinothalamic tract – speeds up conduction
- Paleospinothalamic tract – uses unmyelinated C fibers for slow, continuous pain;
produces reflexes
- Analgesia system – periaqueductal gray matter; contains may opioid receptors
- Endorphins – depressed work out they are released
- Acute pain – at location at trauma; warning, vomiting
- Somatic – sharp and well localized; skin, muscles, joints
- Visceral – dull, aching, throbbing, poorly localized from internal organs
- Chronic pain – persisting pain lasting more than 3-6 months ex. Phantom limb pain can
be due to damage of CNS and loss of descending inhibitory pathways
- Referred pain visceral and somatic afferent fibers

Assessment of pain
- What questions to ask?
o What makes it worse or better?, when did it start? Wake you up in your sleep?
Respond to pain killer? What were you doing before it started? How does it
effect your day? 0-10?,

Different types of pain

- Neuropathic pain
- Neuralgia
- Trigeminal
- Postherpetic neuralgia
o Other vocab on the sheet

Pain management
- TENS Unit – non-invasive
- Acupuncture
o No regulation and no licensing exams
- Non-narcotic analgesics – COX inhibitors, block synthesis of prostaglandins
o Celebrex for arthritis
- Anti-inflammatory properties
- NSAIDS, acetaminophen
o Is not an anti-inflammatory
- Opioid analgesics or narcotics – opioid bases like morphine and codeine/ hydrocodone/
addictions
- Work on mu receptors in the dorsal horn
 o What we want the opioids to bind to
- Side effects – respiratory depression, nausea, vomiting, constipation, sedation
o Opioids depress respiration and GI tract (opioids slow everything down)
o If infused, it bypasses the brain so you don’t get the sedation effects as much
- Minimized with infusion – bypass the brain
- Adjuvant analgesics – antidepressants and anti-seizure meds/block serotonin uptake
o Amplifies effect

CBD oil is the therapeutic not THC.

FEVER
- Fever resets the hypothalamus
o Thermostat
- What temp is considered dangerous
o 108, 109 good chance you are going to die
o Denature proteins
o Worried about enzymes (proteins). Enzymes break down glucose to glycogen for
example. Nothing will work no processes
o And neurotransmitters (amino acids which are proteins)
- Exogenous pyrogens > endogenous pyrogens from phagocytes
- Under normal conditions temp is maintained or generated by adrenal gland >
epinephrine > vasoconstrict + glycolysis + increased metabolism
- FUO (fever of unknown origin) > 101 for over 3 weeks
- Dehydration
o Need water for sweat

Benefits of fever
- Kills bacteria and inhibits growth
- Sequesters serum levels of Fe, Cu, and Zn needed for bacterial growth
- Causes cellular auto-destruction so viruses can’t multiply
- Activates lymphocytes and neutrophils
- Enhances phagocytosis
- Simulates production of interferon
o Antiviral agent

HYPERTHERMIA
- Not mediated by pyrogens; never damage and denaturation
- Hypothalamus in not reset
- May be accidental, therapeutic, stroke, head trauma
- 106 F and above 109 F
- Heat cramps – cramps sweating Na levels; working in the heat
o Signs: fever, rapid, pulse ad increased BP
 o Usually associated with dehydration
- Heat exhaustion – prolonged high core temp or environmental temps; widespread
vasodilation and profuse sweating > dehydration > dehydration + low plasma volumes >
hypotension > decreased CO and tachycardia
o Signs confusion, nausea, vomiting and fainting
o You can see the vasodilation; red face
- Heat stroke – at very high core temp; greater than 104, heat loss mechanisms fail
o Complications – cerebral edema, degeneration of the CNS, swollen dendrites,
renal tubular necrosis; potentially fatal
o Usually complication to damage of Brain and CNS, does not vasodilate, does not
sweat…
- Malignant hyperthermia – rare and associated with inherited muscles disease that may
be triggered by inhaled anestthics and muscles relaxants
o Leads to altered calcium function in muscles > increased muscles activity > lactic
acid > increased in body temp and cardia arrythmias > cardiac arrest
o Metabolic acidosis
o S&S ; similar to a coma
CENTRAL FEVER
- Due to brain trauma, inflammation, increased ICP or intracranial bleeding
- This fever does not include sweating and not respond to antipyrogens

HYPOTHERMIA
- Depresses the CNS and respiration
- Promotes Clotting
- Immune response and inflammation
- Can use it to treat some conditions
o Can improve the outcome of strokes/cerebral damage
 Metabolism is slowed; demand for ATP is not there so we don’t need to
make it
 Cellular demand is diminished and cells will go in dormant state and not
do damage to themselves