Professional Documents
Culture Documents
Akut Membandel
Ardi Pramono
Pain ??
An unpleasant sensory and emotional
experience associated with actual or
potential tissue damage, or described in
terms of such damage.(The International
Association for the Study of Pain)
Involved:
Transduction: Change of noxious stimulus to
electrical modalities
CLINICAL PAIN
Inflammatory response
surgery, cancer & chronic pain
Peripheral Sensitisation
Central sensitisation
Metabolic & endocrine changes
An affective component
Categorized
1) acute pain, which is primarily due to
nociception
Somatic pain
Visceral pain
TREATMENT OF PAIN
GOALS OF THERAPY
Pathophysiology
Pain arises when nociceptors become sufficiently
stimulated/damaged (i.e. by strength and/or duration of
exposure)
or when visceral nociceptors are sufficiently
deformed/damaged to generate humoral and/or cellular
responses.
Parallel ascending pathways detect the affective
(unpleasantness) and sensory (discriminative)
components to convey to the CNS the information about
damage in the tissue served.
Resultant activation of descending pathways leads to
modulation/inhibition of the nociceptive input.
Pathophysiology
stimulation also produces altered gene
expression in the spinal cord & brain
leaving behind a physical memory of
nociception & pain.
In the periphery, immune cells activated
by neural & humoral events respond by
releasing cytokines, as well as
endogenous opioids.
Term
Neurotransmitter
Receptor1
Substance P
Glutamate
Excitatory
Aspartate
Excitatory
Somatostatin
Inhibitory
Acetylcholine
Muscarinic
Inhibitory
Enkephalins
Inhibitory
-Endorphin
-Endorphin
Inhibitory
Norepinephrine
Inhibitory
Adenosine
A1
Inhibitory
Serotonin
5-HT1 (5-HT3)
Glycine Inhibitory
NK1
Effect on Nociception
Excitatory
Excitatory
P1, P2
A, B
Excitatory
Inhibitory
Inhibitory
Systemic Responses to
Acute Pain
Efferent limb is mediated by the sympathetic
nervous and endocrine system
cathecolamine release:
Cardiovascular effects
Respiratory effects
Gastrointestinal and urinary effects
Endocrine effects cathecolamine, cortisol,
glucagon increase
Immune effects: depress the reticuloendothelial
system
Management
Pain measurement:
Visual analog scale (VAS)
McGill pain questionnaire (MPQ)
Multimodal analgesia
Low-tech
High-tech
PAIN
INTENSITY