Professional Documents
Culture Documents
Cuong Ngo-Minh
Objectives
To differentiate between Nociceptive from Neuropathic types of pain
on neural basis
Definitions 1
PAIN: an unpleasant sensory and emotional experience
associated with actual or potential tissue damage or described in terms of such damage by the International Association for the Study of Pain.
nociceptors. It is usually associated with TISSUE DAMAGE as well as inflammation processes. Nociceptive pain is sub-categorized into A1) somatic which can be superficial (skin) or deep pain (eg tumor infiltration, arthritis) A2) visceral (eg. Pancreatitis, Crohns disease).
Pathophysiology: SOMATIC pain signal start with the AFFERENT MYELINATED A-delta fibers (sharp pain) then goes to the C fibers (delayed dull pain). Visceral pain (eg endometriosis): the afferent travel with sympathetic and parasympathetic fibers.
Definitions 2
B) Neuropathic pain is caused by an injury to the peripheral or
central nervous system or is due to sensitazation of central pain neurons.
B1) Sympathetic via maintained sympathetic Efferent activity eg Complex regional pain syndrome type 1 Reflex sympathetic dystrophy Pain wildly out of proportion to soft tissue or bone injury but no nerve injury. Nerve block may help. - Type 2 causalgia where pain wildly out of proportion to nerve injury (by EMG-NerveConductionStudy). B2) Non-Sympathetic via damage to peripheral nerve (eg. Mechanical herniated disc, Neuroma of Morton, Infectious: post-herpetic neuralgia) C) Central via Central nervous system Deafferation pain: no need for peripheral stimulus eg. Post stroke, spinal cord injury, Phantom Limb)
List of medications prescribed (acetaminophen, Nsaids, narcotics, Review of system to look for red flags
Systemic symptoms of neurological symptoms
asthenia,
Muscolo- Neurological exam, ? Swelling ? Redness ? AllodyniaHyperesthesia search for signs to decide if nociceptive vs neuropathic Mental status r/o sign of co-morbid mental illness
PRN short acting opioid and adjuvant (eg pre-gabelin). Treat comorbid conditions: eg. Antidepressant. Use laxatives with narcotics.
non-pharmacologic and pharmacologic modalities to relieve pain and co-morbid conditions (eg depression). Set action plan with client and caregivers.
Contrast resp. depression caused by opioids to resp rate 6-8bpm of dying patient in which resp depression is not caused by opioids but a natural part of dying process. Titrate Rx to provide appropriate pain control.
Ressources
1) Managing pain. The Canadian Healthcare Professionals Reference
by the Canadian Pain Society, Dr Jovey Editor 2) Practice Based Learning program from McMaster University, Module on Chronic Non Cancer Pain, Vol 11(10), August 2003