Professional Documents
Culture Documents
Ascending fibres
to the brain Efferent fibres to the
periphery- complete
the circle
Release of pain-facilitating
“fight-or-flight” mediators: prostaglandins,
Acute histamine, bradykinen
epinephrine
(immediate)
release
Chronic
Pain Classifications
Acute:
• of traumatic injury, surgical procedure, or a medical
Duration of 0 to 7 days.
• The cause may be known or unknown.
• usually occurs as part of a single and treatable event.
• a result disorder.
• often (not always) associated with autonomic nervous
system responses (tachycardia, hypertension, diaphoresis).
• decreases with time.
• Examples of diagnoses that are associated with acute pain
include: fractured femur, appendicitis, burns, procedural
pain.
8
Acute exacerbation of a recurring painful
condition:
Headache
Myalgia
Periarticular pain
Arthralgia
Headache: A symptom: primary or
secondary
Vascular HA / Migraine
75% of sufferers
No aura
All other symptoms the same
3. Cluster headache
Predominantly affects men aged 40-60
HA occurs same time each day, last 10 min-3h
50% of patients: night-time
Woken 2-3 h after sleep with steady intense unilateral
orbital pain.
Conjunctivitis and nasal congestion (watery) is
experienced at same side of head as HA
Ch.ch: periods of acute attack, typically a number of
weeks- few months (1-3 attacks per week)
Nausea is usually absent and family history uncommon
5. Other Causes of HA
**Sinus Headache:
- infection/blockage of the paranasal sinuses >
inflammation/distension of the sensitive sinus walls.
- Localised: peri-orbital, forehead area
- with stooping, blowing nose. Upon awakening,
subside after a while
- OTC analgesics + decongestants
- Persistent > bacterial infection> Dr.
Headache:
- All secondary causes of HA except sinusitis
need to be referred.
- Fever, hangover, some NSAIDS (like what?)
- eye strain, infection (e.g. meningitis),
depression, anxiety, glaucoma > OTC not
effective
- Temporal arteritis, raised ICP
- ‘weekend’HA
Secondary HA:
Glaucoma: frontal HA with pain in the
eye.
Sometimes, but not often, the eye
appears red and is painful. Vision is
blurred and the cornea can look cloudy.
In addition, the patient may notice
halos around the vision.
Secondary HA:
Meningitis: severe generalized HA associated
with fever, an obviously ill patient, neck
stiffness, a positive kernig’s sign (pain behind
both knees when extended) and latterly a
purpuric rash all classically associated with
meningitis
Adults
Verbal Rating Scales
None Mild Moderate Severe
Numerical Rating Scales
0 = no pain 10 = worst pain ever
• Simple • Complex
-No longer than 15 mins -> 15 mins