txt

N.Impulse
Innervation
click here
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus Basics of Pain Control
PainPath

PainDef
PainTypes
referPain
Lydia Melek
PainMech Hany A.K. Dawood
Theories
Oral and Maxillofacial Surgery Department
Pattern
Faculty of Dentistry - Alexandria University
StimulusSpecific
TypesN.Fibres Alexandria - Egypt
GateControl
Neuromatrix

PainGlossary

MethodControl 2020
absorpexcr
psycho-soma
PainControlAgents

Questions
1 / 70
 Objectives txt

N.Impulse
Innervation
By the end of these lectures, the students will be able to:
AnaesthAnalg
Neuron
NTrunk
Polarization differentiate between the types of sensations and how
Stimulus
they are transmitted
PainPath

PainDef
PainTypes identify the pain mechanism
referPain

PainMech
Theories
Pattern
apply pain control methods
StimulusSpecific
TypesN.Fibres
GateControl manage pain situations in dental practice
Neuromatrix

PainGlossary

MethodControl
select proper resources for further readings
absorpexcr
psycho-soma
PainControlAgents

Questions
2 / 70
 Basics of Pain Control txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Nerve Impulses
Stimulus

PainPath

PainDef Pain Pathway

PainTypes
referPain

PainMech
Theories Pain Mechanism
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix Methods of Pain Control
PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
3 / 70
N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain
Nerve Impulses
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
4 / 70
 Innervation

N.Impulse
Innervation
AnaesthAnalg
Innervation
Neuron
NTrunk
Polarization
Stimulus Somatic Autonomic
PainPath

PainDef
PainTypes Sensory Sympathetic
referPain

PainMech
Theories
Pattern
StimulusSpecific
Motor Parasympathetic
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary
Voluntary
MethodControl
absorpexcr
psycho-soma
PainControlAgents
Involuntary
Questions
5 / 70
 Sensory Innervation txt

N.Impulse
Innervation
AnaesthAnalg
Sensory Innervation
Neuron
NTrunk
Polarization
Stimulus General sensations Special Senses
PainPath

PainDef
PainTypes
referPain
of condition
PainMech
Theories
Pattern
StimulusSpecific
Touch, Pressure, Pain, Temperature
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary of position and movements “Proprioception”

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
6 / 70
 Anaesthesia vs. Analgesia txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
an aesthe s ia
Stimulus

PainPath

PainDef
PainTypes
referPain
sensation
PainMech
Theories
no a case (state) of
Pattern
StimulusSpecific
TypesN.Fibres pain
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
alge
PainControlAgents

Questions
7 / 70
 The Sensory Nerve Cell txt

N.Impulse
Innervation
Cell Body
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus syn apse terminal
PainPath
n. endings
PainDef
PainTypes
referPain

PainMech
Theories
Pattern central n. fibre peripheral n. fibre
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents
The Sensory Nerve Cell
Questions
8 / 70
 The Nerve Trunk txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents
The nerve trunk is a collection of
Questions
peripheral nerve fibres
9 / 70
 Nerve Polarization txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
Each individual nerve fibre is in
psycho-soma
PainControlAgents
either a polarized or a depolarized state
Questions
10 / 70
(All or None Rule)
 Nerve Polarization

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
Polarized
psycho-soma
PainControlAgents
(Resting) (non-conducting)
Questions State
10 / 70
 Nerve Polarization

N.Impulse
Innervation
Na Cl Na Na Cl Na Na Cl Na
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath HCO3 HCO3 HCO3 HCO3

PainDef
PainTypes
referPain
K K
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
Polarized
psycho-soma
PainControlAgents
(Resting) (non-conducting)
Questions State
10 / 70
 Nerve Depolarization txt
Stimulus
N.Impulse
Innervation
Na Cl Na Na Cl Na Na Cl Na
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath HCO3 HCO3 HCO3 HCO3

PainDef
PainTypes
referPain
K K
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
A stimulus
psycho-soma
PainControlAgents
causes depolarization of the nerve fibre
Questions
11 / 70
 Nerve Depolarization
Stimulus
N.Impulse
Innervation
Cl Cl Cl
AnaesthAnalg
Neuron
NTrunk
Na Na Na Na Na Na
Polarization
Stimulus

HCO3 HCO3 HCO3 HCO3

PainPath

PainDef
K K
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
A stimulus
psycho-soma
PainControlAgents
causes depolarization of the nerve fibre
Questions
11 / 70
 Nerve Depolarization
Stimulus
N.Impulse
Innervation
Cl Cl Cl
AnaesthAnalg
Neuron
NTrunk
K K
Polarization
Stimulus

PainPath

PainDef
NaHCO3NaHCO3Na NaHCONa
3 HCO3
Na
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
A stimulus
psycho-soma
PainControlAgents
causes depolarization of the nerve fibre
Questions
11 / 70
 Nerve Depolarization
Stimulus
N.Impulse
Innervation
Cl K Cl K Cl
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath HCO3 HCO3 HCO3 HCO3

PainDef
PainTypes
Na Na Na Na Na Na
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
A stimulus
psycho-soma
PainControlAgents
causes depolarization of the nerve fibre
Questions
11 / 70
 Nerve Depolarization
Stimulus
N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
Depolarized
psycho-soma
PainControlAgents
(Reversed Polarized) (conducting)
Questions (Action Potential) State
11 / 70
 Propagation of Nerve Impulses txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
The local analgesic agent
psycho-soma
PainControlAgents
prevents the propagation of nerve impulses
Questions (prevents pain perception)
12 / 70
 The Stimulus txt

N.Impulse
Innervation
The Stimulus is any physical energy (mechanical, thermal,
AnaesthAnalg
Neuron
chemical) that excites a receptor.
NTrunk
Polarization
Stimulus Increasing stimulus intensity will result in:
PainPath

PainDef More frequent nerve impulses to the brain

PainTypes
referPain
Increase in the number of nerve fibres stimulated
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
13 / 70
N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain
Pain Pathway
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
14 / 70
 Pain Pathway1 txt

N.Impulse
Innervation
3rd neuron 2nd neuron 1st neuron
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus
Cortex
PainPath

PainDef
PainTypes
Pain Centre Sensory Nuclei Sensory Cells
referPain

PainMech
Theories
Thalamus Pons, Medulla Trigeminal Ganglia
Pattern
StimulusSpecific
TypesN.Fibres Dorsal Horn Cells Dorsal Root
GateControl
Neuromatrix
of Spinal Cord Ganglia
PainGlossary

MethodControl
absorpexcr
psycho-soma Pain Reaction Pain Perception
PainControlAgents

Questions
15 / 70
 Pain Pathway2 txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
Trigeminal Ganglion
NTrunk
Polarization
Stimulus touch & pressure
PainPath Ophth. n.
Ascending Tract
PainDef
PainTypes
referPain Max. n.
PainMech
Theories
Pattern
StimulusSpecific
Mand. n.
TypesN.Fibres
GateControl
Descending Tract
Neuromatrix

PainGlossary
pain & temperature
MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
Sensory Root peripheral fibres
16 / 70
 Pain Pathway3 txt

N.Impulse
Cortex
Innervation
AnaesthAnalg
Neuron
Thalamus
NTrunk . Sensory cells of Proprioception
Polarization Midbrain
Stimulus . (Mesencephalic Nucleus)
PainPath
Pons . Sensory Nucleus
PainDef .
PainTypes
referPain .
PainMech .
Theories
midline
Pattern .
StimulusSpecific
TypesN.Fibres .
GateControl
Neuromatrix
.
PainGlossary .
MethodControl .
absorpexcr
psycho-soma
Medulla . Sensory Nucleus
PainControlAgents
.
Questions Spino-Thalamic Tract
17 / 70
 Pain Pathway (Trigeminal Ganglion) txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
18 / 70
 Pain Pathway (Dorsal Root Ganglion) txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus
Dorsal Horn
PainPath Cells
PainDef Dorsal horn Dorsal Root
PainTypes Dorsal Root
referPain
Ganglion
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix ant. horn
PainGlossary Ventral Root
MethodControl
absorpexcr
psycho-soma
PainControlAgents
Spinal Cord Spinal Nerve
Questions
19 / 70
 Pain Pathway txt

N.Impulse
Innervation
AnaesthAnalg
Thalamus
Neuron
NTrunk
Polarization
Midbrain
Stimulus
Pons
PainPath

PainDef
Medulla
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
20 / 70
 Pain Pathway txt

N.Impulse
Innervation Pain stimuli, as from a carious lower tooth, will initiate pain
AnaesthAnalg
Neuron impulses, which pass through the Inferior Alveolar Nerve
NTrunk
Polarization
to the Mandibular Nerve to reach Sensory Cell Bodies
Stimulus
in the Trigeminal Ganglion.
PainPath

PainDef
Then they are transmitted through the Descending Tract
PainTypes
referPain
of the Sensory Root of the Trigeminal Nerve to the
PainMech Sensory Nucleus of the Trigeminal Nerve in the Medulla.
Theories
Pattern These impulses cross the midline, and pass through the
StimulusSpecific
TypesN.Fibres Spino-Thalamic Tract, to reach the Pain Centre in the
GateControl
Neuromatrix
Thalamus, where Pain Perception mechanism terminates.
PainGlossary From the Thalamus, these impulses pass to the Cortex,
MethodControl
absorpexcr
from which Pain Reaction starts.
psycho-soma
PainControlAgents

Questions
21 / 70
N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain
Pain Definition
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
22 / 70
 Pain Definition txt

N.Impulse
Innervation The International Association for the Study of Pain
AnaesthAnalg
Neuron
defined pain as:
NTrunk
Polarization “An unpleasant sensory and emotional experience associated
Stimulus
with actual or potential tissue damage, or described in terms of
PainPath

PainDef
such damage.”
PainTypes
referPain
Pain is considered now as a part of the body’s defence system
PainMech
Theories
which triggers mental and physical behaviours to end the
Pattern
StimulusSpecific
painful experience.
TypesN.Fibres
GateControl
Neuromatrix Pain has physical and/or psychological components.
PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
23 / 70
 Descriptive Types of Pain txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
24 / 70
 Physiologic Types of Pain txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Organic vs. Psychogenic
Polarization
Stimulus

PainPath
Nociceptive vs. Neuropathic
PainDef
PainTypes
Acute vs. Chronic
referPain

PainMech
Theories
Sharp vs. Dull
Pattern
StimulusSpecific
TypesN.Fibres
Localized vs. Radiating
GateControl
Neuromatrix
actual site vs. referred
PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
25 / 70
 Referred Pain txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
26 / 70
 Types of Pain txt

N.Impulse
Innervation
Nociceptive Pain
AnaesthAnalg
Neuron Tissue damage induces inflammatory response (produces
NTrunk
Polarization
acidic medium , and releases chemical pain mediators)
Stimulus
which excite nociceptors.
PainPath

PainDef
PainTypes Neuropathic Pain
referPain
(primary lesion or dysfunction of the nervous system)
PainMech
Theories injury, trauma, damage of peripheral nerves or CNS
Pattern
StimulusSpecific infection (as herpes zoster) (post-herpetic neuralgia)
TypesN.Fibres
GateControl trigeminal neuralgia
Neuromatrix
endocrine (as diabetes “diabetic neuropathy”)
PainGlossary

MethodControl
demyelination (as multiple sclerosis)
absorpexcr phantom limb pain
psycho-soma
PainControlAgents

Questions
27 / 70
 Phantom Limb Pain txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
28 / 70
 Phantom Limb Pain

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
28 / 70
N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain
Pain Mechanism
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
29 / 70
 Pain Experience txt

N.Impulse
Pain is an Experience which depends on:
Innervation
AnaesthAnalg
The Stimulus
Neuron
NTrunk
nature
Polarization intensity
Stimulus
frequency (duration)
PainPath

PainDef
Location
PainTypes
referPain
• different number of nerve fibres per unit surface area
PainMech
• different number of nociceptors in the terminal nerve endings
Theories
Pattern
Emotional Status (stress, anxiety, fear)
StimulusSpecific
TypesN.Fibres Physical Status (fatigue, environment)
GateControl
Neuromatrix Age
PainGlossary

MethodControl
Gender
absorpexcr
psycho-soma
Race
PainControlAgents
Motivation
Questions
30 / 70
 Pain Mechanism txt

N.Impulse
Innervation Reception of stimuli and initiation of impulses by
AnaesthAnalg
Neuron nociceptors
NTrunk
Polarization
Stimulus Conduction of impulses
PainPath
electric impulses within the nerve fibres
PainDef
PainTypes neurotransmitters in synapses
referPain

PainMech
Pain mediators: Substance P, Serotonin, Histamine,
Theories
Pattern
Prostaglandins
StimulusSpecific
TypesN.Fibres Pain inhibitors: Endorphins, Enkephalins, Morphine,
GateControl
Neuromatrix Dopamine, GABA
PainGlossary

MethodControl Perception (Recognition) and Modulation of pain

absorpexcr
psycho-soma
PainControlAgents
Reaction to pain
Questions
31 / 70
N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef Pain Mechanism

PainTypes
referPain

PainMech Theories of Pain Mechanism

Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
32 / 70
 Theories of Pain Mechanism

N.Impulse
Innervation
AnaesthAnalg
Neuron
Pattern “Intensity” “Quantitative” Theory (1800s)
NTrunk
Polarization
Stimulus

PainPath
Stimulus-specific Theory (von Frey 1894)
PainDef
PainTypes
referPain Gate Control Theory (Melzack and Wall 1965)
PainMech
Theories
Pattern
StimulusSpecific
Neuromatrix Theory (Melzack 2001)
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
33 / 70
 Pattern “Intensity” “Quantitative” Theory txt

N.Impulse
Innervation
AnaesthAnalg All sensations are transmitted through the same nerves,
Neuron
NTrunk which have non-specific receptors.
Polarization
Stimulus

PainPath Pain results when terminal nerve endings are

PainDef excessively stimulated
PainTypes
referPain
(too much pressure, heat, or damage to the tissues).
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
34 / 70
 Stimulus-specific Theory txt

N.Impulse
Innervation
AnaesthAnalg The nerve endings, of each specific peripheral nerve fibre,
Neuron
NTrunk contain specialized stimulus-specific receptors,
Polarization
Stimulus mechano-receptors, thermo-receptors, or nociceptors,
PainPath which are excited by a certain form of energy,
PainDef mechanical, thermal or chemical;
PainTypes
referPain and transmit a specific sensation.
PainMech
Theories
Pattern Nociceptors are also sensitive to extreme noxious mechanical
StimulusSpecific
TypesN.Fibres
or thermal energy.
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
35 / 70
 Types of Nerve Fibres txt

diameter
N.Impulse N. fibres receptors
Innervation conduction velocity
AnaesthAnalg
nociceptors
Neuron
thin (0.4-1.2µ)
NTrunk C fibres mechano-receptors
Polarization slow (0.5-2 m/s)
Stimulus thermo-receptors
PainPath nociceptors
thin (2-6µ)
PainDef A-Delta fibres mechano-receptors
slow (5-30 m/s)
PainTypes
referPain
thermo-receptors
non-nociceptive
PainMech thick (5-12µ)
Theories A-Beta fibres mechano-receptors
Pattern fast (30-70 m/s)
StimulusSpecific
proprioceptors
TypesN.Fibres
non-nociceptive
GateControl thick (12-20µ)
Neuromatrix A-Alpha fibres mechano-receptors
fast (70-120 m/s)
PainGlossary proprioceptors
MethodControl thick (5-12µ) non-nociceptive
A-Gamma fibres
absorpexcr
psycho-soma
fast (30-70 m/s) motor and touch
PainControlAgents thin (1-3µ) non-nociceptive
B fibres
Questions slow (15 m/s) autonomic activity
36 / 70
 The Gate Control Theory txt

N.Impulse
Innervation
AnaesthAnalg Pain is not simply a direct response to a stimulus.
Neuron
NTrunk
Polarization
Pain signals must pass through nerve gates that open to allow
Stimulus them to get through, or close to prevent them from reaching
PainPath
the higher levels of the brain.
PainDef
PainTypes
referPain The brain filters, selects and modulates sensory signals from
PainMech peripheral nerve fibres.
Theories
Pattern
StimulusSpecific The gate control system is controlled through 2 mechanisms.
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
37 / 70
 The Gate Control Theory txt

N.Impulse
Innervation
AnaesthAnalg CNS activities (as attention, expectations, emotions, anxiety,
Neuron
NTrunk suggestions, memories of prior experience) exert control over
Polarization
Stimulus Pain Perception.
PainPath

PainDef Stimulation of the brain activates descending efferent fibres

PainTypes
referPain
from Midbrain and Hypothalamus to release
PainMech Endorphins and Enkephalins, which suppress
Theories
Pattern the incoming afferent nociceptive information (pain signals),
StimulusSpecific
TypesN.Fibres
by shutting off the gates at the earliest synaptic level.
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
38 / 70
 The Gate Control Theory

N.Impulse
Innervation
.
AnaesthAnalg .
Neuron
NTrunk .
Polarization Midbrain, Hypothalamus
Stimulus
.
.
PainPath . endorphins, enkephalins
PainDef .
PainTypes
referPain .
PainMech .
Theories
Pattern .
StimulusSpecific
TypesN.Fibres .
GateControl
Neuromatrix .
PainGlossary .
MethodControl .
absorpexcr
psycho-soma
Medulla . earliest synaptic level
PainControlAgents
.
Questions
39 / 70 .
 The Gate Control Theory txt

N.Impulse
Innervation Stimulation of
AnaesthAnalg
Neuron the faster larger diameter non-nociceptive nerve fibres
NTrunk
Polarization
(A-Alpha and A-Beta), transmitting “touch, pressure and
Stimulus
heat”, crowd out
PainPath
the slower small diameter nerve fibres (A-Delta and C)
PainDef
PainTypes transmitting pain signals.
referPain

PainMech
Theories
So, pain relief can be achieved when an injured area is stim-
Pattern
StimulusSpecific
ulated by rubbing, applying pressure, massage, cold packs,
TypesN.Fibres TENS, acupuncture.
GateControl
Neuromatrix

PainGlossary They also stimulate the release of Endorphins to close the gate
MethodControl for the pain signals.
absorpexcr
psycho-soma
PainControlAgents

Questions
40 / 70
 CNS Tracks txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
C,A-Delta
Theories
Pattern
pain
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
A-Alpha,A-Beta
absorpexcr
psycho-soma
non-nociceptive
PainControlAgents

Questions
41 / 70
 The Neuromatrix Theory txt

N.Impulse
Innervation Pain is a multi-dimensional experience produced by
AnaesthAnalg
Neuron characteristic “neurosignature patterns” of nerve impulses,
NTrunk
Polarization
generated by a neural network (neuromatrix) in the brain.
Stimulus

PainPath
The neurosignature for pain experience is
PainDef
PainTypes
genetically determined by the synaptic architecture of the
referPain
neuromatrix, which is continually adjusted and modified
PainMech
Theories
by psychological and sensory experiences.
Pattern
StimulusSpecific
TypesN.Fibres Physical and Psychological stress may produce lesions of
GateControl
Neuromatrix muscle, bone, and nerve tissues, changing the neurosignature
PainGlossary patterns; which give rise to chronic pain.
MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
42 / 70
 Neuromatrix txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
43 / 70
N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain
Pain Glossary
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
44 / 70
 Pain Glossary txt

N.Impulse Noxious Stimulus

Innervation
AnaesthAnalg
A stimulus which is actually or potentially damaging to normal tissues.
Neuron
NTrunk
Nociceptor
Polarization
Stimulus
A sensory receptor that is capable of transducing and encoding noxious
PainPath
stimuli.
PainDef Pain Threshold
PainTypes
referPain
The minimum intensity of a stimulus that is perceived as painful.
PainMech
The point at which a person becomes aware of “can recognize”
Theories pain.
Pattern
StimulusSpecific Pain Tolerance Level
TypesN.Fibres
GateControl The maximum intensity of a stimulus that evokes pain, and that a subject
Neuromatrix
is willing to tolerate in a given situation.
PainGlossary
The greatest level of pain which a subject can tolerate.
MethodControl
absorpexcr Pain Reaction
psycho-soma
PainControlAgents The patients‘ manifestation of their perception of unpleasant experiences.
Questions
45 / 70
 Pain Glossary txt

N.Impulse Analgesia
Innervation
AnaesthAnalg
Absence of pain in response to stimulation that would normally be painful.
Neuron
NTrunk
Hyperalgesia
Polarization An increased response to a stimulus which is normally painful.
Stimulus
(increased pain sensitivity)
PainPath

PainDef
Allodynia
PainTypes
referPain
Pain in response to a stimulus which does not normally provoke pain
PainMech
(non-nociceptive).
Theories Neuralgia
Pattern
StimulusSpecific Pain in the distribution of nerves.
TypesN.Fibres
GateControl Anaesthesia
Neuromatrix

PainGlossary
Absence of all sensory modalities.
MethodControl Pain Perception
absorpexcr
psycho-soma
It is a physio-anatomical process by which pain is received and transmit-
PainControlAgents ted by neural structures from the end organs (pain receptors) through
Questions conductive and perceptive mechanisms.
46 / 70
N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain
Methods of Pain Control
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
47 / 70
 Methods of Pain Control txt

N.Impulse
Innervation Removal of the cause
AnaesthAnalg
Neuron
NTrunk
Polarization Blocking the pathway of pain impulses (local analgesics)
Stimulus

PainPath

PainDef
Raising the pain threshold (general analgesics)
PainTypes
referPain pre-emptive, post-traumatic, implantation of spinal cord pumps
PainMech
Theories
Pattern Cortical depression (decrease pain reaction)
StimulusSpecific
TypesN.Fibres
GateControl
(general anaesthetics, sedatives)
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
48 / 70
 Methods of Pain Control txt
Recommended Regimen for Pain Control

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization Pre-emptive vs. Post-operative analgesia
Stimulus

PainPath

PainDef
Combination vs. Single agents
PainTypes
referPain
Regular Intervals vs. “When Needed” intake
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
49 / 70
 Analgesic agents absorption/excretion txt

N.Impulse Toxic
Innervation
AnaesthAnalg Blood Level
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain Blood Level
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres Therapeutic
GateControl
Blood Level
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma ≈ 8 hours
PainControlAgents
Time
Questions
50 / 70
 Analgesics regular intervals administration txt

N.Impulse Toxic
Innervation
AnaesthAnalg Blood Level
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain Blood Level
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres Therapeutic
GateControl
Blood Level
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma 4-6h 4-6h
PainControlAgents
Time
Questions
51 / 70
 Analgesics “when needed” intake txt

N.Impulse Toxic
Innervation
AnaesthAnalg Blood Level
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain Blood Level
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres Therapeutic
GateControl
Blood Level
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents
Time
Questions
52 / 70
 Methods of Pain Control txt

N.Impulse
Innervation
Using psycho-somatic methods and physical rehabilitation
AnaesthAnalg
Neuron
NTrunk
gaining the patient‘s confidence, explanation of procedures
Polarization
Stimulus physical modalities “physiotherapy” as the application of:
PainPath pressure
PainDef massage
PainTypes
referPain
heat
PainMech cold
Theories nervous system stimulation techniques (acupuncture, electro-analgesic
Pattern
StimulusSpecific therapy)
TypesN.Fibres
GateControl
Neuromatrix
control of environment
PainGlossary rest and support of the injured part
MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
53 / 70
 Methods of Pain Control
Therapeutic heat application

N.Impulse Therapeutic heat application: as using hot mouth wash,

Innervation
AnaesthAnalg
hot packs, ultrasound, shortwaves, electromagnetic radia-
Neuron
NTrunk
tion (microwaves, infra-red heating lamps)
Polarization
Stimulus
The physiological effects of heat application are:
PainPath

PainDef Relief of pain (stimulate thermo-receptors “afferent gate control”).

PainTypes
referPain Mental and body relaxation (efferent gate control).
PainMech
Theories Reduction of muscle spasm, and increase flexibility of collagenous
Pattern
StimulusSpecific
tissues.
TypesN.Fibres
GateControl Increase blood flow “vasodilatation”, which accelerates healing and
Neuromatrix
wash out accumulated metabolites. In acute injuries, the increase
PainGlossary
in capillary permeability will increase oedema formation.
MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
54 / 70
 Methods of Pain Control
Therapeutic cold application

N.Impulse Therapeutic cold application (immediate post-operative

Innervation
AnaesthAnalg
and post-traumatic); as using cold packs, ice massage, vapo-
Neuron
NTrunk
coolant Sprays.
Polarization
Stimulus
The physiological effects of cold application are:
PainPath

PainDef Relief of pain (stimulate thermo-receptors “afferent gate control”)

PainTypes
referPain Activation of Brain Stem mechanisms to exert descending inhibitory
PainMech influences that block pain signals (efferent gate control).
Theories
Pattern
StimulusSpecific
Decrease of the inflammatory response and associated swelling
TypesN.Fibres (oedema), so decreasing the production of pain mediators.
GateControl
Neuromatrix
Reduction of local metabolic activity, slowing nerve conduction,
PainGlossary
and reduction of muscle spasm.
MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
55 / 70
 Methods of Pain Control
Electro-analgesic Therapy

N.Impulse Electro-analgesic Therapy

Innervation
AnaesthAnalg
Neuron
Transcutaneous Electrical Nerve Stimulation (TENS)
NTrunk
Polarization Transcutaneous Acupoint Electrical Stimulation (TAES)
Stimulus

PainPath Percutaneous Neuromodulation Therapy (PNT)

PainDef H-Wave Therapy (HWT)
PainTypes
referPain
Piezo Electric Current Therapy (PECT)
PainMech
Theories
Pattern
Electrogalvanic Stimulation (EGS)
StimulusSpecific
TypesN.Fibres Electrical Muscle Stimulation (EMS)
GateControl
Neuromatrix Spinal Cord Stimulation (SCS)
PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
56 / 70
 Agents used for Pain Control

N.Impulse
Innervation
AnaesthAnalg
Non-opioid Analgesics
Neuron
NTrunk Paracetamol “Acetaminophen”
Polarization
Stimulus
Non-steroidal Anti-inflammatory Agents (NSAIDs)
PainPath

PainDef
PainTypes Opioid Analgesics (Narcotics)
referPain

PainMech
Theories Analgesic Adjuvants
Pattern
StimulusSpecific
TypesN.Fibres
Tranquillizers, Sedatives, Hypnotics,...
GateControl
Neuromatrix They have no analgesic effect.
PainGlossary
They reduce anxiety and apprehension.
MethodControl
absorpexcr
psycho-soma
PainControlAgents General Anaesthetics
Questions
57 / 70
 Agents used for Pain Control
(Non-opioid Analgesics)

N.Impulse
Innervation
AnaesthAnalg
Paracetamol “Acetaminophen”
Neuron
NTrunk
Polarization
It is the first choice of analgesics for mild to moderate pain,
Stimulus taking in consideration the age and general condition of the
PainPath
patient.
PainDef
PainTypes It affects the Thalamus (raise pain threshold and inhibit pain
referPain

PainMech
perception), without depressing the Cortex.
Theories
Pattern
It does not develop tolerance.
StimulusSpecific
TypesN.Fibres It has no addiction potentiality.
GateControl
Neuromatrix It does not have an anti-inflammatory effect.
PainGlossary
It does not produce gastrointestinal side effects.
MethodControl
absorpexcr
psycho-soma
It has very low allergic tendency.
PainControlAgents

Questions
58 / 70
 Agents used for Pain Control
(Non-opioid Analgesics)

N.Impulse
Innervation
AnaesthAnalg
Non-steroidal Anti-inflammatory Agents
Neuron
NTrunk (Salicylates, Ibuprofen, Indomethacin, Voltaren)
Polarization
Stimulus

PainPath
They have anti-inflammatory, analgesic, anti-rheumatic and
PainDef
anti-pyretic effects.
PainTypes
referPain They affect the Thalamus (raise pain threshold and inhibit
PainMech pain perception), without depressing the Cortex.
Theories
Pattern
StimulusSpecific
They have no addiction potentiality.
TypesN.Fibres
GateControl
They have many side effects as: gastro-intestinal distur-
Neuromatrix
bances, and inhibition of platelet aggregation (impaired co-
PainGlossary
agulation).
MethodControl
absorpexcr
psycho-soma
In general, it is recommended that patients should avoid
PainControlAgents taking over-the-counter NSAIDs for more than 10 days.
Questions
59 / 70
 Agents used for Pain Control
(Opioid Analgesics)

N.Impulse
Innervation
Morphine, Codeine
AnaesthAnalg
Neuron
NTrunk
They affect the Thalamus.
Polarization
Stimulus
They also depress the Cortex (pain reaction).
PainPath

PainDef
PainTypes
So they produce analgesia and sedation; and in high dose
referPain they produce unconsciousness.
PainMech
Theories
Pattern
They have addiction potentiality.
StimulusSpecific
TypesN.Fibres
GateControl
They have a significant number of side effects and compli-
Neuromatrix
cations, including hypotension and respiratory depression.
PainGlossary

MethodControl
absorpexcr
They are mainly used for chronic severe painful conditions.
psycho-soma
PainControlAgents

Questions
60 / 70
 Agents used for Pain Control
(Analgesic Adjuvants)

N.Impulse
Innervation
Sedatives and Hypnotics (N2 O&O2 , Barbiturates)
AnaesthAnalg
Neuron
NTrunk
They depress the Cortex.
Polarization
Stimulus Barbiturates are used as sedatives, hypnotics and general
PainPath anaesthetics (according to the dose).
PainDef
PainTypes
They have no analgesic effect, but they potentiate analgesics.
referPain

PainMech
At low blood level, the patient is sedated (calm and co-
Theories operative) (Hypothalamus depression).
Pattern
StimulusSpecific
TypesN.Fibres
As blood level increases, they cause drowsiness. Then the
GateControl
Neuromatrix
patient becomes uncooperative and over-reactive to stim-
PainGlossary ulation (especially painful); due to loss of self-control and
MethodControl over-emotion (can’t follow commands as open your mouth).
absorpexcr
psycho-soma
Then they cause hypnosis, unconsciousness;
PainControlAgents
then medullary, respiratory and cardiovascular depression.
Questions
61 / 70
 Agents used for Pain Control
(Analgesic Adjuvants)

N.Impulse
Innervation
Tranquillizers (as Valium “Benzodiazepine”)
AnaesthAnalg
Neuron
NTrunk
They are used for premedication.
Polarization
Stimulus

PainPath
Anti-convulsants (Neuroleptics) (Carbamazepine)
PainDef
PainTypes
The first-line medications for neuropathic pain
referPain (as Trigeminal neuralgia).
PainMech
Theories
Pattern
StimulusSpecific
Tricyclic Anti-depressants (TCAs) (Amitriptyline)
TypesN.Fibres
GateControl They alter emotional response
Neuromatrix

PainGlossary
(used for neuropathic pain and depressive illnesses).
MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
62 / 70
 Agents used for Pain Control
General Anaesthetics

N.Impulse
Innervation
They are mainly used for:
AnaesthAnalg
Neuron
major surgery
NTrunk
Polarization
Stimulus
mentally compromised patients
PainPath
uncontrollable apprehensive patients/children
PainDef
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
63 / 70
 txt

N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus

PainPath

PainDef
PainTypes
referPain Questions
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
64 / 70
 Q1

N.Impulse
Innervation
Which of the following statements is not correct
AnaesthAnalg
Neuron
(multiple items might be chosen)
NTrunk
Polarization
Stimulus
1 referred pain from mandibular right canine can be felt
PainPath in maxillary right canine
PainDef
PainTypes 2 referred pain from mandibular right canine can be felt
referPain

PainMech
in maxillary left canine
Theories
Pattern
StimulusSpecific
3 referred pain from mandibular right canine can be felt
TypesN.Fibres
GateControl
in mandibular left canine
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
65 / 70
 Q2

N.Impulse
Innervation
Which of the following statements is more accurate
AnaesthAnalg
Neuron
NTrunk Local analgesic agents stop
Polarization
Stimulus

PainPath
1 touch and pain sensations
PainDef
PainTypes
2 pain sensation
referPain

PainMech 3 pain and hot sensations

Theories
Pattern
StimulusSpecific 4 all sensations
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
66 / 70
 Q3

N.Impulse
Innervation
The first neuron in the pain pathway is the terminal
AnaesthAnalg
Neuron
nerve endings
NTrunk
Polarization
Stimulus
1 correct
PainPath

PainDef
2 incorrect
PainTypes
referPain

PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
67 / 70
 Q4

N.Impulse
Innervation
The cell bodies of the third neuron in the pain
AnaesthAnalg
Neuron
pathway from the oro-maxillofacial region are
NTrunk
Polarization
located in the
Stimulus

PainPath
1 mesencephalic nucleus of the trigeminal nerve
PainDef
PainTypes 2 trigeminal ganglion
referPain

PainMech
Theories
3 pons
Pattern
StimulusSpecific
TypesN.Fibres
4 medulla
GateControl
Neuromatrix
5 midbrain
PainGlossary

MethodControl
absorpexcr
6 thalamus
psycho-soma
PainControlAgents

Questions
68 / 70
 Q5

N.Impulse
Innervation
From the factors affecting the pain perception:
AnaesthAnalg
Neuron
1
NTrunk
Polarization
Stimulus
2

PainPath 3
PainDef
PainTypes 4
referPain

5
PainMech
Theories
Pattern
StimulusSpecific
TypesN.Fibres
GateControl
Neuromatrix

PainGlossary

MethodControl
absorpexcr
psycho-soma
PainControlAgents

Questions
69 / 70
N.Impulse
Innervation
AnaesthAnalg
Neuron
NTrunk
Polarization
Stimulus
Basics of Pain Control
PainPath

PainDef
PainTypes
Lydia Melek
referPain

PainMech Hany A.K. Dawood

Theories
Oral and Maxillofacial Surgery Department
Pattern Faculty of Dentistry - Alexandria University
StimulusSpecific
TypesN.Fibres
Alexandria - Egypt
GateControl
Neuromatrix

PainGlossary

MethodControl 2020
absorpexcr
psycho-soma
PainControlAgents

Questions
70 / 70