PAIN

CONTENTS

1)Definition of Pain2)Types of Pain3)The Pain receptors and their Stimulation4)Different types of Pain stimuli5)Classification of nerve fibres6)Receptor nerve ending7)Pain pathway8)Pain theories(Neurophysiologic explanation of pain control)9)Pain modulation

10)

Pain Assessment

11)

Pain Management

Definition of Pain:

Pain is defined as unpleasant sensory and emotional experience that is associatedwith actual or potential tissue damagePain is a protective Mechanism, It occurs whenever any tissue damaged and causes theindividual to respond to remove the Pain stimulus.Eg: Prolonged sitting on the Escher can cause tissue damage due to lack of blood flow to theskin.The perception of pain in turn prevents potential damage by making us respond with analteration of posture.

Types of Skin

Pain has been classified into 2 major typesi)Fast painii)Slow pain

Fast pain

It occurs within 0.1 second after the pain stimulus is applied. It is also described by manyalternate names such asSharp painPrickling painAcute painElectric painThis type of pain felt when a needle is stuck into the skin or when the skin is cut with a knife.It is felt only superficial tissues of body.

Slow Pain

It begins only after a second or more and then increase slowly over many seconds andsometimes even minutes.It is also called by names such as:Burning painAching painThrobbing painNervous painChronic Pain

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It is associated with tissue distruction. It can occur both in the skin and almost any deep tissueor organ.Fast type of pain – A d fibersSlow type of pain – C fibers

PAIN RECEPTORS AND THEIR STIMULATION:

All pain receptors are free nerve endings that line the skin tissues.Pain receptor’s Classification includes:i)Touch Sensitive- Meissner’s corpuscles

ii)

Cold sensitive- Krausels end bulb

iii)

Heat Sensitive- Ruffinie’s end organ

iv)

Pain sensitive- free nerve endingsv)Pressure sensitive- Pacininian Corpuscles

Different types of Pain stimuli:

1)Based on physical energy source:a)Electro magneticb)Chemicalc)Gravity

Mechanical displacemente)Sensibility

Mechanicalg)Thermal

Others-Social- Psychology-Behavioral

Classification of nerve fibers

Fiber A Fiber B Fiber C

Myelinated Myelinated unmyelinatedAfferentpre ganglionic somaticEfferentsympathetic efferent

Pattern Theory:-

The sensation of pain results from an appropriate intensity (or) frequency of stimulation of receptors that also respond to other stimuli such as touch, pressure, or temperature.This theory denotes pattern or coding of sensory information is the key element the coding istemporal and spatial sequency of action – potentials are generated in periphery.This theory considers the intense stimulation of non specific receptors as the adequatestimulus for eliciting pain sensation.A touch stimulus applied to a receptor produces a particular pattern of action potentials theresultant sensation is touch.A potentially damaging touch stimulus applied to the receptors produces a different pattern of action potentials resulted sensation is pain.

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Fig: shows (a & b) pattern of action potentials resulting in sensation of painAccording to this theory neural impulses from the periphery are combined and modified tosummate in CNS structures, where the pain is then localized and interpreted. According to pattern theory, Temporal and spatial summation of impulses along the pathwayfrom the skin to the cerebral levels determines the individuals sensation of pain (fig B)

Gate Control Theory:

Postulated by Melzack & Wall, 1965Dorsal horn of spinal cord act like a gate that can increase or decrease the flow of nerveimpulses, from peripheral fibers to spinal cord cells that project to the brain.(Pre synaptic inhibition of pain)Stimulation of A B receptors mechano receptors (Deep pressure like massage manual theory)

Pre synaptic inhibition

Suppression of pain from A δ and C fibers (Nociceptors)Stimulation of A δ fiber (Low Tens)Interneuron (Encephalin)Presynaptic inhibition of C fiber pains

Assessment of pain:-

OPQRST Format : Normal musculoskeletal ExaminationOrigin\ onset : Gradual\suddenHow did pain started.Position\pattern :Constant\ periodicLocalized\ RadiatingAggravating & Relieving factoryImproving\ non screening\ remainingQuality of pain : Mechanical – pressing – bursting - stabbingChemical – burningNeural – Numbness\ pins & needlesVascular – ThrobbingQuantity of pain : Intensity of pain.Radiation - Characteristics of pain radiations

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