Somatic Sensations II PAIN & THERMAL SENSATION:

DEFINITION: A protective / warning sensation, when a noxious stimulus is applied to a part of the body. Part becomes flexed & withdrawn from source of noxious stimulus & this prevents tissue damage. Pain in a viscera warning to seek the treatment. (example: pain of appendicitis or MI is a warning).

Types of pain:
2 types of pain: FIRST / FAST PAIN SECOND / SLOW PAIN

FIRST / FAST PAIN

is pricking, sharp, short & is localized.

Example: pin prick or cut with a sharp weapon. Fast pain impulses are carried by A delta fibers from periphery to spinal cord (5-30 m/sec).

SECOND / SLOW PAIN

is burning, dull, diffuse & of prolong duration. It indicates tissue damage. Example: if fingers touch something very hot. Slow pain impulses are carried by C fibers from periphery to spinal cord (unmyelinated, velocity: 0.5 to 2 m/sec). Pain impulses are carried by lateral spinothalamic tract. Noxious stimuli are of different types: Mechanical, thermal, chemical.

Mechanical noxious stimuli:

Pin prick, cut with a sharp edge, heavy pressure. In viscera, distention or increase in pressure (example: a segment of gut is distended). Increased intracranial pressure headache.

Thermal noxious stimuli:

Extremes of temperature: burning hot or freezing cold.

Chemical noxious stimuli:

Histamine, bradykinin, serotonin, insect bites, ischemic products (like substance P).

PAIN SENSITIVITY IN BODY TISSUES:

All body tissues are not pain sensitive. Compact bone is without pain receptors (receptors are in periosteum). If a patient gets osteomyelitis no pain till periosteal involvement. In brain, no pain receptors. In meninges, pain receptors. In brain disorder, until meninges are involved, no pain. In lung tissue, no pain receptors, but in pleural membrane. In intestines, pain receptors are in peritoneum. In liver & spleen tissue, no pain receptors, but in their capsule. Pain receptors are free nerve endings called nociceptors.

ASPECTS OF PAIN:
Pain sensation has 2 aspects: Pain perception (feeling of pain). Reaction to pain (emotional aspect of pain).

INDIVIDUAL PAIN SENSITIVITY:

Reaction to pain varies in individuals. It includes: vocalization (noise making), clenching of hand, facial muscle contraction, narrowing of palpebral fissure, fall or increase in B.P, sweating & skin pallor. In some individuals violent movements of body.

SIGNIFICANCE OF PAIN RECEPTORS:

Pain receptors are almost non-adapted & that is beneficial. As long as there in noxious stimulus, pain is felt, this has got a protective value.

LOCALIZATION OF PAIN DEPENDS UPON No. OF RECEPTORS:

Regarding (visceral pain), it is not so localized, because there are less number of pain receptors in viscera. Superficial pain is more localized. Visceral pain is also referred. It radiates to a distant structure.

Ischemic pain (behind upper sternum left shoulder left arm neck may radiate to right arm. Cause: Dermatomal rule.

Dermatomal rule:

The viscera where pain is produced & where pain is referred are supplied by same sensory / dermatome of spinal cord.

Fast pain is more localized than slow. Touch receptors also play a role in pain localization.

Pain sensitivity can be tested in different ways: Pricking the skin with a measured pressure. Pinching the skin (rough method). Applying a hot stimulus (temp: above 45 degrees centigrade).

THERMAL SENSATION:

Human beings can perceive various grades of thermal sensation.

2 types of thermal receptors: Cold receptors Warmth receptors

At extremes of temperature, pain receptors are also stimulated. When there is burning hot / freezing cold pain receptors are also stimulated along with thermal.

THERMAL RECEPTORS:

Present just beneath the skin in the form of aggregations / spots (cold spots & warm spots). 4-10 times more cold spots as compared to warm spots. From warmth receptors impulses are carried by C fibers. From cold receptors impulses are carried mainly by A delta fibers & some by C fibers.

Mucus membrane of mouth is relatively insensitive to warm as compared to cold temperature.

Exposed areas are relatively less sensitive to temperature changes as compared to covered areas of body like face, scalp & hand. In exposed areas, temperature change can be detected: 0.5 to 1 degree centigrade while covered areas can detect change of 0.2 degrees even. *Neutral zone (adaptation of thermal receptors) is between 29 to 36 degrees centigrade. We dont feel warmth / cold in this zone. When temperature is below 29 or above 36, we feel warmth / cold. Here humidity factor is important. If humid, even 36 degrees is uncomfortable. In dry weather, even 45 degrees is tolerable.

If we take 2 meterials: Wood Metal With same temperature, metal is felt cooler, because it conducts more heat. Thermal receptors respond to static temperature but much more to changing temperature. If temperature is falling, we feel more cold, as compared to fixed cold temperature (during snow fall). When there are thermal changes, these effect metabolic rate in receptors, so accordingly receptors are stimulated.