Please answer this questions with explanation. Patient has chronic pain in her l

Question

Please answer this questions with explanation.

Patient has chronic pain in her legs since being injured 8 years ago. As a physician, you would like to treat her pain, but it would help to first know what the cause of it is. Each of the physiological issues could alter neuronal function. The patient is a vegan who eats a very low-protein diet. As such, she is deficient in several of the essential amino acids, including isoleucine.

Below is a drawing of the pathway by which pain is communicated up to the brain.

Q1. Could defective Cl- channels lead to the perception of pain? - Yes or No

Q2. Could too much Na+ in the CSF lead to the perception of pain? - Yes or No

Q3. Could a deficiency in isoleucine lead to the perception of pain? - Yes or No

Q4. Could a depletion of calcium ions in the CSF and thus the entire nervous system, cause chronic pain? -Yes or No

Q5. As a potential treatment, you suggest administration of tetrodotoxin (pufferfish toxin). This drug acts as an antagonist to voltage-gated sodium channels. Would this drug help modulate her pain? - Yes or No.

Explanation / Answer

1. Answer is YES

alterations in chloride can leads to perception of pain by three mechanisms.

-Exaggerated Primary Afferent Depolarization

- Disinhibition of polysynaptic pathways to nociceptive neurons:

-Direct relay of low threshold input to nociceptive neurons via GABA/glycinergic interneuron

2. Answer is YES

Sodium is crucial and important for neuronal excitability.for example the concentration of sodium in CSF is increased during migraine while blood plasma sodium concentration did not changed.In pain due to increased sodium in CSF because of incresed level of increased activity of capillary endothelial cell sodium potassium ATPase. it regulate sodium potasium levels.

3. Answer is NO

the deficiency of isoleucine can leads to following conditions

-Hypoglycemia,

-Dizziness

-Depression

- Confusion

-Irritation

4. answer is YES

the different types of calcium channels are involved in nociception i.e N-, P/Q- and T-type calcium channels. in pathological conditions these causes increased hypersensitivity. this increased central sensitization leads to hyperexcitability, leading to enhanced processing of nociception.central sensitization caysed by

-alteration in glutamatergic neurotransmission/NMDA receptor-mediated hypersensitivity,

-loss of tonic inhibitory controls (disinhibition),

- glial-neuronal interactions

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