/  9
 
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
1Purusotham chippala MPT
 
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
d)
Mechanical displacemente)Sensibility
f)
Mechanicalg)Thermal
h)
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.
2Purusotham chippala MPT
 
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 
3Purusotham chippala MPT

Share & Embed

More from this user

Add a Comment

Characters: ...