Lesson 1.2

Dentistry Degree
01
UNIT I: General
concepts
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Unit I
GENERAL CONCEPTS
INDEX
§ Lesson 1: General Pathophysiology
and Semiology
§ Lesson 2: Microorganism-induced
Diseases
§ Lesson 3: Environment-induced
Diseases
§ Lesson 4: Inherited Diseases
§ Lesson 5: Pathophysiology of the
Immune System
§ Lesson 6: Pathophysiology of Tumor
Diseases
§ Lesson 7: Nutrition-related Diseases
© Copyright Universidad Europea. Todos los derechos reservados 2

1.2
UNIT I: General
Pathophysiology
and Semiology

Unit I. Lesson 1.2
INDEX
§ GENERAL CONCEPTS
PATHOPHYSIOLOGY AND SEMIOLOGY
§ PATHOPHYSIOLOGY AND SEMIOLOGY
OF PAIN
§ INFLAMMATION, FEVER AND SIRS
§ LESION, ADAPTATION AND CELL DEATH

Unit I. Lesson 1.2: Pain
CONCEPT OF PAIN
Pain is defined as an unpleasant sensory

and emotional experience associated
with actual or potential tissue damage
or describe in terms of such damage.
(International Association for Study of Pain)
5© Copyright Universidad Europea. Todos los derechos reservados

CONCEPT OF PAIN
• It is usually perceived as unpleasant and untimely, but it

has a protective and warning function in situations that
may threaten health.
• It is the symptom most associated with the self perception

of disease and the most frequent reason to seek medical
assistance (relevant semiology and clinical data).
• Each individual pain perception is different and personal

and is influenced by many factors (physiological,
psychological, cognitive, sociocultural, etc.).

NEUROPHYSIOLOGY OF PAIN
2.1. Pain transmission pathways. CEREBRAL CORTEX
THALAMUS
SPINOTHALAMIC
TRACT
Ad and C
fibers
NOCICEPTORS
Chemical
substances
STIMULI
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2.1. Pain transmission pathways.
STEPS:
Transduction
Transmission
Modulation
Perception
STEPS:
Transduction
Pain is perceived through nociceptors, localized as sensorial nerve endings,

specially abundant in the skin, in muscles, in periosteum, and less in the internal
organs.
Examples of pain situations: compression, stretching, fractures, tumefaction,
ischemia, virus and bacteria, inflammation, tumors, heat

STEPS:
Transduction
Nociceptors are sensitized through the release of different mediators as a

consequence of tissue lesion:
üBradykinin üAcids
üSerotonin üAcetylcholine
üHistamine üProteolytic enzymes
üPotassium ions üProstaglandins
üCytokines üROS
STEPS: Transduction can be defined as the

transformation of the physical stimulus into a
Transmission
nerve signal produced by chemical
mediators.
Fibers through which pain signals are transmitted from nociceptors to spinal cord
are of two types:
A delta (Aδ) C
•Myelin fibers •Non-myelin fibers
•Diameter 1-5 microns •Diameter 0,3-1,5 microns
•Rapid conduction •Slow conduction velocity
velocity •Slow pain
•Acute pain
STEPS:
Transmission
On reaching the spinal cord, pain

signals use ascendant pathways to the
encephalon.

STEPS:
On reaching the spinal cord, pain

Transmission
signals use ascendant pathways to the
encephalon.
ASCENDANT PATHWAYS
NEOSPINOTHALAMIC PATHWAY PALEOSPINOTHALAMIC PATHWAY
• Pain from A-delta fibers • Pain from C type fibers
• Fast pain • Slow chronic pain
• Neurotransmitter: GLUTAMATE • Neurotransmitter: SUBSTANCE P

STEPS:
Perception
In the cerebral cortex, pain signals are perceived, described,

interpreted and a response is obtained.
NEOSPINOTHALAMIC PATHWAY PALEOSPINOTHALAMIC PATHWAY

Thalamus à Secondary somatostetic
Thalamus à Primary somatostetic
cortex, lymbic system, hypothalamus
cortex
and prefrontal region
Localization, intensity and quality of Pain memory, and autonomic
pain response
2.2. Modulation of pain.
Along with the fibers that conduct the pain impulse, the brain has several systems
capable of modulating or inhibiting pain.
This system capable of suppressing the arrival of painful signals is called the analgesia
system:
ANALGESIA ABSENCE OF PAIN

Natural opioids Gate control

or endorphins theory of pain

à Natural opioids system or endorphins:

CEREBRAL CORTEX
In the spinal cord

and central nervous
system there are THALAMUS
endogenous
ENDOGENOUS
opioid-rich
OPIOIDS
interneurons
(endorphins) that SPINOTHALAMIC
are released when TRACT
PGs ROS
stimulated and can
partially block the KININS
neurotransmission of NOCICEPTORS
the pain signal. CYTOKINES
à Natural opioids system or endorphins:
• Natural opioids (endorphins, dynorphins, and enkephalins) are present in

neurons in the brain, spinal cord, and digestive tract.
• By binding to specific receptors present on neurons, they inhibit the pain

impulse.

à Gate control theory of pain:
There is a gating mechanism at the spinal cord, so competing impulses can block nerve
transmission.
Small diameter fibers (A-delta and C) transmit fast and slow painful impulses.
Larger diameter fibers (A-beta) carry tactile impulses from the skin.

The impulses that travel through the different types of fibers, upon reaching the
medulla, meet with a door, which allows or prevents the passage of impulses to the
brain.
•If the impulses from the small- • If tactile impulses

diameter fibers exceed the predominate, the door
impulses from the large-
diameter tactile fibers, the closes and painful
door opens and the painful impulses will be
impulses travel unchecked to rejected at the door
the brain.

This explains why a light stimulus such as massaging a stubbed toe can reduce the
intensity and duration of pain.

TYPES OF PAIN
According to its According to its

According to its ORIGIN
DURATION INTENSITY
• Nociceptive pain • Acute • Mild

• Somatic pain • Chronic • Moderate
• Visceral pain • Severe
• Neuropathic pain

TYPES OF PAIN
3.1. According to its ORIGIN.
à Nociceptive pain:
Triggered by direct activation of nociceptors. It can be of two types:
Somatic pain Visceral pain

• Nociceptors of skin, muscles, • Viscera and vessel nociceptors.
bone, joints, meninges, serous, • Inaccurate location.
connective tissue, etc. • Continuous or intermittent.
• Precise location. • Accompanied by vegetative
• Continuous. manifestations but not associated
• It increases in intensity with with muscle contracture.
pressure and causes muscle • It is often irradiated or referred.
contracture.
TYPES OF PAIN
à Visceral pain:
Referred pain
It is perceived in an area of the skin's

surface away from the damaged
viscus.
Visceral fibers synaptate at the level

of the spinal cord near the fibers that
innervate other areas of the
subcutaneous tissue of the body.
TYPES OF PAIN
à Visceral pain:
Referred pain
Most frequent referred pains:
• Heart: Left arm, precordial
• Bile ducts: Scapula tip
• Liver, bile ducts, stomach, pancreas:
epigastrium
• Large intestine: meso- and hypogastrium
• Urinary tract: inguinal region
https://commons.wikimedia.org/wiki/File:1506_Referred_Pain_Chart_en_español.jpg
TYPES OF PAIN
à Neuropathic pain:
It occurs as a consequence of direct injury to the CNS
or peripheral nerves.
GABA reduction hypothesis in C fibers.
Intense.
It affects areas of the body whose sensitivity depends

on damaged structures.
1. Spinal cord compression

2. Post-herpetic neuralgia
3. Trigeminal neuralgia
4.
26© Copyright Universidad Europea. Todos los derechos reservados Brachial plexopathy
TYPES OF PAIN
3.2. According to its DURATION.
Useful pain Acute pain Chronic pain Useless pain

• Abrupt onset, of short duration and • Persistent, continuous, more diffuse.
well localized. • + 6 months, it is not usually
• Warning meaning. associated with an identifiable
• Little psychological component. cause.
• With sympathetic adrenal reaction • Important psychological
component (depression, irritability,
etc.)
• Minor sympathetic adrenal
reaction.
• Ex: Cancer pain
TYPES OF PAIN
3.3. According to its INTENSITY.
MILD MODERATE SEVERE
• It interferes with
• Allows you to rest.
• Interferes with
perform regular • It requires
regular activities
activities treatment with
major opioids.
SEMIOLOGY OF PAIN
• Intensity: Numerical and analog scales, tests
• Quality: Sharp, burning, stabbing, etc.
• Location: Extension, irradiation
• Chronology: Beginning, duration, evolution, rhythmicity
• Modifying factors: Triggers, aggravators, improvement
• Accompanying factors: Attitude of the patient, other manifestations, etc.


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Dentistry Degree

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© Copyright Universidad Europea. Todos los derechos reservados 2

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Pain is defined as an unpleasant sensory

(International Association for Study of Pain)

5© Copyright Universidad Europea. Todos los derechos reservados

• It is usually perceived as unpleasant and untimely, but it

• It is the symptom most associated with the self perception

• Each individual pain perception is different and personal

6© Copyright Universidad Europea. Todos los derechos reservados

© Copyright Universidad Europea. Todos los derechos reservados

Pain is perceived through nociceptors, localized as sensorial nerve endings,

9© Copyright Universidad Europea. Todos los derechos reservados

Nociceptors are sensitized through the release of different mediators as a

STEPS: Transduction can be defined as the

On reaching the spinal cord, pain

12© Copyright Universidad Europea. Todos los derechos reservados

On reaching the spinal cord, pain

13© Copyright Universidad Europea. Todos los derechos reservados

In the cerebral cortex, pain signals are perceived, described,

NEOSPINOTHALAMIC PATHWAY PALEOSPINOTHALAMIC PATHWAY

ANALGESIA ABSENCE OF PAIN

15© Copyright Universidad Europea. Todos los derechos reservados

Natural opioids Gate control

16© Copyright Universidad Europea. Todos los derechos reservados

à Natural opioids system or endorphins:

In the spinal cord

à Natural opioids system or endorphins:

• Natural opioids (endorphins, dynorphins, and enkephalins) are present in

• By binding to specific receptors present on neurons, they inhibit the pain

18© Copyright Universidad Europea. Todos los derechos reservados

à Gate control theory of pain:

à Gate control theory of pain:

•If the impulses from the small- • If tactile impulses

20© Copyright Universidad Europea. Todos los derechos reservados

à Gate control theory of pain:

21© Copyright Universidad Europea. Todos los derechos reservados

According to its According to its

• Nociceptive pain • Acute • Mild

22© Copyright Universidad Europea. Todos los derechos reservados

Triggered by direct activation of nociceptors. It can be of two types:

Somatic pain Visceral pain

It is perceived in an area of the skin's

Visceral fibers synaptate at the level

GABA reduction hypothesis in C fibers.

It affects areas of the body whose sensitivity depends

1. Spinal cord compression

Useful pain Acute pain Chronic pain Useless pain

MILD MODERATE SEVERE

• Intensity: Numerical and analog scales, tests

• Quality: Sharp, burning, stabbing, etc.

• Location: Extension, irradiation

• Chronology: Beginning, duration, evolution, rhythmicity

• Modifying factors: Triggers, aggravators, improvement

• Accompanying factors: Attitude of the patient, other manifestations, etc.

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