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Physiological Of Pain Peripheral aspect of nociceptors is a free nerve ending embedded throughout the tissue.

This free nerve ending can be located without any of the associated accessory structure which has a high threshold to activation and sensitive to potentially tissue damaging stimuli such as mechanical, thermal, electrical and chemical stimuli which can be potentially results of tissue damage The Nociceptors exist in Small diameter which is divided into two; - Myelinated A fibres1 with conduction velocity between 5 and 30 meter per second - Non myelinated C fibres2 Properties Receptors Afferents Action potential conduction velocity Subjective sensation Onset sensation Localization Duration of sensation Subjective response Fast Pain Free nerve ending A (group III) fibres 5 30 m/s (slow) Sharp, pricking pain Short latency, quick onset Well localized, easily identified Short lasting Endure, possible emotional involvement Slow Pain Free nerve endings C (group IV) fibres 0.5 2 m/s (very slow) Dull, burning, throbbing pain Long latency, slow onset Poorly localized, diffuse Long lasting Emotional and automatic response

Subjective involvement of both transient and prolonged pain can be illustrated by referring to the pain sensations that accompany an injury such as stubbing toe: Initially, sharp pain is associated due to physical damage. This transient pain is followed by a duller, throbbing pain, which last much longer. This prolonged pain caused by on-going release of chemical mediators from the damage tissue, due to this condition the affected area prone to be more sensitive to the previously innocuous stimuli but which now produce painful sensation. This sensitization (state of being sensitive) takes place either at the free nerve endings or in the neurons of the dorsal horn of the spinal cord (central sensitization). The condition of being more sensitive is called hyperalgesia and is also associated with allodynia (tenderness) attributed to the affected tissue. The central aspects of the nociceptive afferent nerves are transmitted to the spinal cord where it influences reflex activity or is further transmitted via specific pathways to higher brain centres. Nociceptor afferent enters the spinal cord via dorsal root and make synaptic connection with other neuron. The reflexes involving nociceptive afferents are the flexor and extensor reflexes.Nociceptive inputs make excitatory connection with flexor muscle group and inhibitory polysynaptic connection with extensor motoneuron

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A fibres are referred to as group III fibres C fibres are referred as group IV fibres

Physiological Of Pain


These cross the midline of the spinal cord to transmit information to the higher centres via the lateral spinothalamic pathway on the contralateral side of the spinal cord The pathways are therefore always referred to second order neurons. different polysynaptic connections from the same nociceptive afferent excite extensor motoneurons and inhibit flexor motoneurons in the contralateral Physiological Of Pain NOT FOR SELL . This action serves to move away from the initial stimulus and therefore act in a protective fashion. where this ascending pathway ends at the third-order neurons of the thalamus which convey the information on the noxious stimulus to the cerebral cortex Pain Modulation The nociceptive afferents terminate on second-order neurons. flexion muscle action in the limb where the original noxious stimulus arose while simultaneously switching off activity in the extensor muscle of the affected limb. and the contralateral is the opposite side from the primary nociceptive Nociceptive inputs make excitatory polysynaptic connections with motoneurons supplying flexor muscle groups and in inhibitory polysynaptic connections with extensor motoneurons on the ipsilateral side. where they make synaptic connection either with interneurons serving the reflexes describe above or with second order neurons (transmission cell or T Cells). where most unmyelinated primary afferents terminate and the central nociceptive processing begins. it is blocked by the SG cells which is located on the presynaptic compartment of the end of nociceptive neuron before entering the 2nd order tract. At the same time. it is 1st stimulated by the nociceptive afferent. which then terminate on the second-order neurons which then transmit the nociceptive information to the higher center.Mechanism of Central Nociceptors Reflex The spinal cords have two sides in the reflex concept. It is formed by several distinct In order for the SG cells to inhibit the gate. the SG cells (substantia gelatinosa) is an inhibitory which influence the nociceptive information. I + P - + L Substantia gelatinosa (SG. where Ipsilateral is the side where the primary nociceptor enters via dorsal horn. lamina II) which is formed by groups of interneuronis a spinal cord region. before the nociceptive information get pass. the SG works if only the nociceptor is active. On the time this pathway is active. This action serves to stabilized the body during flexion of the ipsilateral The nociceptors afferents entering the spinal cord grey matter terminate in the dorsal horn. Mechanosensitive afferent Nociceptive Reception SG Cell Transmission Cell (T Cell) adamcyclops@gmail. in other words. This information of nociceptive information can be stop on the level of spinal cord by altering with other interneuron .

Example where a soldier who has sustained with injury to part of the body is initially unaware of it untul some time later.I L This mechanosensitive afferent can be activate by stimulating receptors in the s in.and postsynaptically at spinal cord. this follows with the release enkephalins that subsequently inhibit the transmition cells both pre. faster pain respinses produced when an injury first occur.c m Physiological Of Pain  § § § S This means the SG cell is the main component of pain modulation. e citement and even pain itself can all reduce or even abolish the feeling of pain associated with injury. this statement is saying about the pain gate theory. thermal Raphe Nucleus Grey matter stimulation and electrotherapy (TENs . Descending Input P + ©    NOT FOR S . The higher cognitive centres in the brain can have some inflence on these processes. stress. massage. Higher Brain Centers     ¨ ¨ ¨ Therapies TENS essage anipulation Thermal Traction Compression  Inhibition of pain transmission Large Diameter Afferent Cutaneous Receptor Joint Receptor Muscle Receptor Limbic system is a term used collectively to describe structures such as the hypothalamusm hippo-campus and amygdala. traction and compre ssion. The affect of endogenous opioids are associated with prolonged aspects of pain rather than initial. fear. This Opioids technique is refer to the modulation of pain from the physiotherapy such as Pe i -aqueductal joint manipulation. which brings more inhibition of the nociceptors afferent terminals and preventing the transsmisition of the nociceptive information to the higher center.S aqueductal grey matter and rephe nucleus). this can be removed by actions + of neurons projecting from othre areas of the CNS associated whith pain 3 modulation which is the limbic system L Activation of this area stimulate the productionof naturally occuring (endogenous4 opioids which act as inhibitory action of the inhibitory interneurons which allows the e citation of the descending input. the more stimulatiion of this SG cell. which originate form the midbrain (peri. in certain situation. usually after reaching saftey. This structure involve in emotion and mood and can have wide influence on other aspects of nervous system including control of pain 4 3 Occur form with in naturally without any out side influence ¦¦¥ ¡ £ ¢¡ ¤   adamcyc s mail. In normal circumstances this usually inactive due to further influence of inhibitory intrneurons from other I P part of the brain. Inhibitor of the Block Inhibitory Interneurons Allow descending Input descending input The decending input also have a major role in pain Descending Inputs modulation. where the the pain is modulated by provinding mechanism which is the inhibition of mechanosensitive and decending input. Inhibitor Interneurons muscles and jonts as well as being activated artificially by electrically.