Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory FunctionMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. Pricking one’s finger with a needle would cause minimal pain, whereas experiencing abdominal surgery would produce more pain. This distinction is an example of which pain theory?a. Gate control theoryb. Intensity theoryc. Specificity theoryd. Pattern theoryANS: CAccording to the specificity theory, a direct relationship exists between the intensity of pain and the extent of tissue injury. Pattern theory proposes that any somatic sense organs respond to a dynamic range of stimulus intensities. Different sense organs have different levels of responsiveness to stimuli. Gate control theory (GCT) integrates and builds upon features of the other theories to explain the complex multidimensional aspects of pain perception and pain modulation. Pain transmission is modulated by a balance of impulses conducted to the spinal cord where cells in the substantia gelatinosa function as a “gate.” The spinal gate regulates pain transmission to higher centers in the CNS. There is no intensity theory of pain.PTS: 1 DIF: Cognitive Level: Remembering 2. Which pain theory proposes that a balance of impulses conducted from the spinal cord to the higher centers in the central nervous system (CNS) modulates the transmission of pain?a. Gate control theory (GCT)b. Pattern theoryc. Specificity theoryd. Neuromatrix theoryANS: AThe gate control theory (GCT) explains that a balance of impulses conducted to the spinal cord, where cells in the substantia gelatinosa function as a spinal gate, regulates pain transmission to higher centers in the CNS. Pattern theory proposes that any somatic sense organs respond to a dynamic range of stimulus intensities. Different sense organs have different levels of responsiveness to stimuli. According to the specificity theory, a direct relationship exists between the intensity of pain and the extent of tissue injury. Neuromatrix theory is an advancement of the gate control theory and proposes that the brain produces patterns of nerve impulses drawn from various inputs, including genetic, sensory-discriminative, affective-motivational, and evaluative-cognitive experiences.PTS: 1 DIF: Cognitive Level: Remembering 3. Which type of nerve fibers transmits pain impulses?a. A-alpha (Aα) fibersb. A-beta (Aβ) fibersc. A-delta (Aδ) fibersd. B fibersANS: COf the available options, only medium-sized Aδ fibers transmit pain impulses. A-beta (Aβ) fibers are large myelinated fibers that transmit touch and vibration sensations. They do not normally transmit pain but play a role in pain modulation. A-alpha (Aα) fibers and B fibers do not play any role in pain.PTS: 1 DIF: Cognitive Level: Remembering 4. Where are the primary-order pain-transmitting neurons located within the spinal cord?a. Lateral root gangliab. Dorsal root gangliac. Anterior root gangliad. Medial root gangliaANS: BThe cell bodies of the primary-order neurons, or pain-transmitting neurons, reside in the dorsal root ganglia just lateral to the spine along the sensory pathways that penetrate the posterior part of the cord. They are not in contact with lateral root, anterior root, or medial root ganglia.PTS: 1 DIF: Cognitive Level: Remembering 5. Where is the gate in the gate control theory (GCT) of pain located?a. Substantia gelatinosab. Marginal layerc. Nucleus propriusd. Dorsolateral tract of LissauerANS: AThe synaptic connections between the cells of the primary- and secondary-order neurons located in the substantia gelatinosa and other Rexed laminae function as a pain gate. The remaining options do not act in this function.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. Which spinal tract carries the most nociceptive information?a. Archeospinothalamicb. Paleospinothalamicc. Dorsal spinothalamicd. Lateral spinothalamicANS: DMost nociceptive information travels by means of ascending columns in the lateral spinothalamic tract (also called the anterolateral funiculus). The paleospinothalamic tract is part of the lateral spinothalamic tracts and carries slow impulses for chronic pain. The other tract is the neospinothalamic tract which carries fast impulses for acute pain. The archeospinothalamic and dorsal spinothalamic tracts are not part of this system.PTS: 1 DIF: Cognitive Level: Remembering 7. Where is the major relay station of sensory information located?a. Basal gangliab. Midbrainc. Thalamusd. HypothalamusANS: CAlthough the organization of all of the ascending tracts is complex, the principal target for nociceptive afferents is the thalamus, which, in general, is the major relay station of sensory information. The Aδ and C fibers synapse in the laminae of the dorsal horn, cross over to the contralateral spinothalamic tract, and then ascend to synapse in the midbrain through the neospinothalamic and paleospinothalamic tracts. Impulses are then conducted to the sensory cortex. Descending pain inhibition is initiated in the cerebral cortex or from the midbrain and medulla. The hypothalamus has a major role in temperature regulation. A complex interaction of neural networks and neurotransmitters promote wakefulness and sleep. The hypothalamus, brainstem, and basal forebrain are involved in promoting wakefulness.PTS: 1 DIF: Cognitive Level: Remembering 8. Where in the CNS does a person’s learned pain response occur?a. Cerebral cortexb. Frontal lobec. Thalamusd. Limbic systemANS: AThe cognitive-evaluative system overlies the individual’s learned behavior concerning the experience of pain and can modulate the perception of pain and is mediated only through the cerebral cortex.PTS: 1 DIF: Cognitive Level: Remembering 9. Massage therapy relieves pain by closing the pain gate with the stimulation which fibers?a. Aβb. Aδc. Bd. CANS: AMassaging stimulates different Aβ fibers to close the pain gate. Aδ, B, and C fibers do not have a role in pain modulation.PTS: 1 DIF: Cognitive Level: Remembering 10. What part of the brain provides the emotional response to pain?a. Limbic systemb. Parietal lobec. Thalamusd. HypothalamusANS: AThe limbic and reticular tracts are involved in alerting the body to danger, initiating arousal of the organism, and emotionally processing the perceived afferent signals, not
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