Tema 2 Lecturas Neurociencia

NOCICEPTORS
A nociceptor is a sensory receptor that responds to potentially

damaging stimuli by sending nerve signals to the spinal cord and
brain. This process, called nociception, usually causes the perception
of pain.
In mammals, nociceptors are sensory neurons that are found in any

area of the body that can sense pain either externally or internally.
External examples are in tissues such as skin (cutaneous
nociceptors), cornea and mucosa. Internal nociceptors are in a
variety of organs, such as the muscle, joint, bladder, gut and
continuing along the digestive tract. The cell bodies of these neurons
are located in either the dorsal root ganglia or the trigeminal
ganglia.[2] The trigeminal ganglia are specialized nerves for the face,
whereas the dorsal root ganglia associate with the rest of the body.
The axons extend into the peripheral nervous system and terminate
in branches to form receptive fields.
The peripheral terminal of the mature nociceptor is where the noxious

stimuli are detected and transduced into electrical energy[4]. When
the electrical energy reaches a threshold value, an action potential is
induced and driven towards the central nervous system (CNS). This
leads to the train of events that allows for the conscious awareness of
pain. The sensory specificity of nociceptors is established by the high
threshold only to particular features of stimuli. Only when the high
threshold has been reached by either chemical, thermal, or
mechanical environments are the nociceptors triggered. The majority
of nociceptors are classified by which of the environmental modalities
they respond to. Some nociceptors respond to more than one of
these modalities and are consequently designated polymodal
Nociceptors have two different types of axons. The first are the Aδ
fiber axons. They are myelinated and can allow an action potential to
travel at a rate of about 20 meters/second towards the CNS. The
other type is the more slowly conducting C fiber axons. These only
conduct at speeds of around 2 meters/second.[5] This is due to the
light or non-myelination of the axon. As a result, pain comes in two
phases. The first phase is mediated by the fast-conducting Aδ fibers
and the second part due to (Polymodal) C fibers. The pain associated
with the Aδ fibers can be associated to an initial extremely sharp
pain. The second phase is a more prolonged and slightly less intense
feeling of pain as a result from the damage. If there is massive or
prolonged input to a C fiber there is progressive build up in the spinal
cord dorsal horn.
Afferent nociceptive fibers (those that send information to, rather

than from the brain) travel back to the spinal cord where they form
synapses in its dorsal horn. This nociceptive fiber (located in the
periphery) is a first order neuron. The cells in the dorsal horn are
divided into physiologically distinct layers called laminae. Different
fiber types form synapses in different layers, and use either
glutamate or substance P as the neurotransmitter. After reaching the
specific lamina within the spinal cord, the first order nociceptive
project to second order neurons and cross the midline. The second
order neurons then send their information via two pathways to the
thalamus
PHANTOM LIMB PAIN
As many as 80% of amputees experience some kind of “phantom”

sensation in their amputated limbs. However, up to half of those who
have them do not receive any treatment for or relief from their pain.
This makes phantom pain a chronic pain condition.
What is Phantom Limb Pain?

After a limb is removed, you may continue to feel it, as though it
were still there. Phantom limb pain is not the same thing as stump
pain, which is felt in and around the incision following surgery. Stump
pain is localized to the amputation site, while phantom pain is felt in
some part of the leg that is no longer attached.
Many people describe burning sensations in their toes though they

may be missing their entire leg below the knee. This can be a
confusing and even scary sensation, leading some people to believe
that they are losing their minds. How can you feel pain in a limb that
no longer exists?
Theories About Phantom Pain
No one knows for sure why amputees have phantom pain, but a few
possible explanations are widely believed to be true.
• Memory of limb pain – some researchers theorize that after a

limb is damaged beyond repair, the brain is “used to” feeling
the pain. Even after the limb has been removed, the brain
continues to sense the same kind of pain. It is like having a
memory of the pain because the pain is wired into the brain.
• Nerve bundle stimulation – the severed nerves around the
amputation site either misfire or are stimulated in some way,
sending a pain message to the brain. These are the same
nerves that used to reach all the way into the limb. Sometimes
following surgery, these nerves form bundles called neuromas.
When they fire, the brain interprets these signals as if the nerve
were still intact, and “feels” pain in the toes.
• Rewiring of the nervous system – there has been evidence that
when a limb is amputated, changes take place in the brain and
spinal cord that cause pain to be interpreted differently than
before. It is not yet clear, however, if this is a cause of
phantom pain or if this happens as a result of it.
Symptoms of Phantom Limb Pain
Regardless of its cause, phantom pain can be a debilitating condition.

Pain is often described as burning, stabbing and throbbing -- typical
descriptor words for neuropathic pain. Phantom pain may happen in a
continuous cycle, or it may be brought on by outside factors such as
temperature change, stress or stump irritation.
Most people describe their phantom pain as if it were coming from

the distal parts of the amputated limb. In other words, feet, toes or
hands. Phantom sensations are more common in the first few months
after surgery than they are several months down the road, but they
can happen at any time after an amputation. So how do you treat
pain that isn’t there?
Treatment for Phantom Pain
Like most chronic pain conditions, no single treatment approach

works for everybody. A number of medications complementary and
alternative treatments out there work for phantom pain. Here are
some of the most common approaches.
• Medication – because it is considered a neuropathic disorder,

antidepressants and anticonvulsants are often prescribed for
phantom pain. NSAIDSs, opioids and muscle relaxants are also
on the list of medications. As with other chronic pain conditions,
finding the right medication can take time and patience.
Sometimes successful phantom pain relief takes a combination
of these medications.
• Mirror therapy – many therapists use mirrors in their treatments
to show the brain into a healthy limb in place of a stump. This
usually involves placing both limbs in a mirror box, which
makes the amputated limb appear intact. The individual is then
asked to perform exercises with “both” limbs. This tricks the
brain, and effectively reduces phantom pain for some people.
• Stump stimulation – using TENS (Transcranial electrical nerve
stimulation), applying pain-relief patches or rubbing the stump
can relieve phantom pain in some people. Using hot packs and
cold packs can work for some people. Providing an alternate
sensation from the stump can interrupt pain signals.
• Cognitive therapies – some people find relief from their phantom
pain through hypnosis, relaxation or guided imagery. These
approaches can change the way the brain interprets phantom
sensations, including phantom pain.
Usually more than one treatment approach is used to get phantom
pain under control. Some people, however, may require more
invasive forms of treatment. These include additional surgery to
untangle nerve bundles at the amputation site, stimulation of the
spinal cord or the brain to change the way pain is interpreted and
implantation of pain pumps that deliver medications directly to the
spinal cord.

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NOCICEPTORS

A nociceptor is a sensory receptor that responds to potentially

In mammals, nociceptors are sensory neurons that are found in any

The peripheral terminal of the mature nociceptor is where the noxious

Afferent nociceptive fibers (those that send information to, rather

PHANTOM LIMB PAIN

As many as 80% of amputees experience some kind of “phantom”

What is Phantom Limb Pain?

Many people describe burning sensations in their toes though they

• Memory of limb pain – some researchers theorize that after a

Symptoms of Phantom Limb Pain

Regardless of its cause, phantom pain can be a debilitating condition.

Most people describe their phantom pain as if it were coming from

Like most chronic pain conditions, no single treatment approach

• Medication – because it is considered a neuropathic disorder,

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