Professional Documents
Culture Documents
DEFINITION OF PAIN
An unpleasant sensory
and emotional
experience associated
with actual or potential
tissue damage or
described in terms of
such damage
.
International
International Association for the Study of
Pain
TERMINOLOGIES
Agology the science and study of
pain
Allodynia pain caused by a stimulus
that is not normally painful
Analgesia the absence, or decrease,
of pain in the presence of a stimulus
that would normally be painful
Hyperalgesia an increased sensitivity
to a stimulus that is normally painful
Nociception the reception,
conduction, and central nervous
processing of nerve signals resulting
in the perception of pain
Somatic pain pain originating from
skin, joints, muscles, and other deep
tissues
Visceral pain pain originating from
the internal organs
TERMINOLOGIES
Noxious stimulus a stimulus which is actually
or potentially damaging to body tissues
Pain threshold the point at which an individual
just begins to feel pain; is relatively consistent
among normal individuals
Pain tolerance the greatest amount of pain that
a subject will tolerate; varies greatly among
individuals
Radiculalgia pain along the distribution of one
or more sensory nerve roots
Radiculitis an inflammation of one or more
nerve roots
Wind-up a cascade of events resulting from
ongoing stimulation of nociceptors and activation
of NMDA receptors; causes hyperalgesia and
opioid tolerance
Musculoskeletal
System
Skin
Temperature
Pain
Touch
Pressure
Proprioception
Position Sense
Vibration
Kinesthesia
Pain
TYPE OF PAIN
Physiological Pain
Pathological Pain
Is a protective
mechanism
Causes avoidance
Little to no tissue injury
Pain stops once the
stimulus is removed
TYPE OF PAIN
Chronic Pain
Acute Pain
Occurs immediately after a
stimulus is received
Severity can vary
Responds well to treatment
Subsides once stimulus is
removed
TYPE OF PAIN
TYPE OF PAIN
Referred Pain - pain that is perceived to
be in an area that seems to have little
relation to the existing pathology
Radiating Pain - pain caused by irritating
nerve roots and extending distally
Sclerotomic Pain - pain associated with a
segment of bone innervated by a spinal
segment that is a deep somatic pain
DIFFERENT
CHARACTERISTI
C AMONG PAIN
TYPES
10
Adopted
Adopted from
from Costigan
Costigan et
et al,
al, 2009
2009
Adopted
Adopted from
from Costigan
Costigan et
et al,
al, 2009
2009
12
Transmission/Perception of Pain
These receptors
generate pain signals in
response to harmful
stimuli.
Different types of
nociceptors have been
identified that respond to
mechanical,
heat and
chemical stimuli, or
any combination of these
stimuli.
Nociceptors
Nociceptors
Mechanisms of Pain
Control
Gate control theory
Descending mechanisms(Central
Biasing)
Release of endogenous opioids (endorphin)
Pain relief may result from
combination of these 3 mechanisms
-Endorphin and
Dynorphin
Stimulation of A
and C afferents
can stimulate
release of
endogenous
opioid endorphin from
hypothalamus
Dynorphin
released from
periaqueductal
Dynorphin
released
Pain Sensitization
Peripheral sensitization to pain:
Mechanisms of early-onset
central sensitization:
Winduphomosynaptic activity-dependent
plasticity characterized by a progressive
increase in firing from dorsal horn neurons
during a train of repeated low-frequency Cfiber or nociceptor stimulation.
During stimulation, glutamate + substance P
+ CGRP elicit slow synaptic potentials
Windup results from the summation of these
slow synaptic potentials.
This produces a cumulative depolarization
that leads to removal of the voltagedependent Mg2+ channel blockade in
NMDA receptors and entry of Ca2+.
Increasing glutamate action progressively
increases the firing-response to each
individual stimulus
Pain Assessment
Pain is a complex phenomenon which is
difficult to evaluate and quantify because it
is subjective
Thus obtaining an accurate and
standardized assessment of pain is
problematic
Pain Assessment
Pain Assessment
P-Q-R-S-T format
Most common
Patient is asked to rate pain on a scale
from 1 to 10
Pre- to Post-treatment
When treatments provide pain relief
patients are asked about the extent and
duration of the relief
Principles of Pain
Management
Treatment of Intractable
Pain
Treat the underlying disease
nonnarcotic analgesics and
antidepressants or anticonvulsants
narcotics
local nerve blocks
Neurosurgery
Cordotomy
Immobilisation
Rest / Slings /Splints/ Corset
Walking Aids / Wheelchair
Distraction
Hypnosis
Physical
Exercise and mobility
Physiotherapy
Hydrotherapy
Music/ Art therapy
Lifestyle Modification
CBT
Cognitive Behaviour Therapy
Physical
Pain
Neuropathic Pain
Management
Neuropathic Pain
Pharmacological
Invasive/injection therapy
Physical therapies
Psychological therapy
Complementary therapy
Anti-depressants
Best evidence base is amitriptylline
Usually well tolerated
Rapid response
1 wk to reach steady state
Anti-convulsants
Gabapentin
Short acting
Safe/ Good side-effect profile
Can use in severe renal compromise
Memory loss and reduced concentration
More expensive
Improved sleep pattern
Mood enhancement
MATUR
NUWUN
MHM 24-11-2015
45