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Patho-Physiology of Pain in explain the experience of pain, pain categories, neuroanatomy of pain, gate control theory, psychogenic pain and measurements of pain intensity.
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general or special senses
- Dysfunctions of the general senses chronic pain, abnormal
temperature regulation, tactile dysfunction
- Pain is a complex unpleasant phenomenon composed of sensory experiences that include time, space, intensity, emotion, cognition, and motivation - Pain is an unpleasant or emotional experience originating in real or potential damaged tissue - Pain is an unpleasant phenomenon that is uniquely experienced by each individual; it cannot be adequately defined, identified, or measured by an observer
Somatogenic pain is pain with cause (usually known) localised in body tissue: a/ nociceptive pain – somatic, visceral b/ neuropatic pain
Psychogenic pain is pain for which there is no known physical cause
but processing of sensitive information in CNS is disturbed In this type of pain the psychological evaluation yields evidence that the pain itself is predominantly sustained by psychological factors
Acute and chronic pain Acute pain is a protective mechanism that alerts the individual to a condition or experience that is immediately harmful to the body Onset - usually sudden
Relief - after the chemical mediators that stimulate the nociceptors,
are removed
- This type of pain mobilises the individual to prompt action to relief it - Stimulation of autonomic nervous system can be observed during this
type of pain (mydriasis, tachycardia, tachypnoe, sweating, vasoconstriction)
Responses to acute pain
Psychological response to chronic pain
Intermittent pain produces a physiologic response similar to acute pain
Persistent pain allows for adaptation (functions of the body are
normal but the pain is not reliefed)
Chronic pain produces significant behavioural and psychological changes
The main changes are:
The pain threshold is the point at which a stimulus is perceived as pain It does not vary significantly among healthy people or in the same person over time
Perceptual dominance- intense pain at one location of the body
may cause an increase in the pain threshold in another location
- The pain tolerance is expressed as duration of time or the
intensity of pain that an individual will endure before initiation overt pain responses.
It is influenced by - persons cultural prescriptions
Children and the elderly may experience or express pain
differently than adults
Infants in the first 1 to 2 days of life are less sensitive to pain
(or they simply lack the ability to verbalise the pain experience).
A full behavioural response to pain is apparent at 3 to 12 month
of life
Older children, between the ages of 15 and 18 years,
tend to have a lower pain threshold than do adults
Pain threshold tends to increase with ageing
This change is probably caused by peripheral neuropathies and
changes in the thickness of the skin
Neuroanatomy of pain
The portions of the nervous system responsible for the
sensation and perception of pain may be divided into three
areas:
The afferent portion is composed of: a) nociceptors (nerve endings of nociceptive nerve cells) b) afferent nerve fibres c) spinal cord network
The brain first perceives the sensation of pain
- The thalamus, sensitive cortex :
perceiving describing of pain localizing
- Parts of thalamus, brainstem and reticular formation: - identify dull longer-lasting, and diffuse pain - The reticular formation and limbic system:
Nociceptors: Endings of small unmyelinated and lightly myelinated
afferent neurons
Stimulators: Chemical, mechanical and thermal noxae
Mild stimulation positive, pleasurable sensation (e.g. tickling) Strong stimulation pain
Location: In muscles, tendons, epidermis, subcutanous tissue,
joints, visceral organs
Nociceptive pain:
Transduction is the process by which afferent nerve endings participate in translating noxious stimuli (e.g., a pinprick) into nociceptive impulses
Its role: - inhibition of afferent pain signals
Mechanisms:
Descendent antinociceptive systém
Enk – enkefalinergic PAG – paraaqueductal gray EAA – excitatory amino acids RVM – rostral ventro-medial medulla