Name: Adeleke kemi

Registration
number:U21DLNS20271

Definition of pain
An unpleasant sensory and
emotional experience associated
with actual or potential tissue
damage, or described in terms of
such damage”

Causes of pain

Pain starts with noxious stimuli

that may be mechanical, thermal,
chemical, inflammatory, or tissue
damage.
Some other causes of pain include:
• headache.
• toothache.
• sore throat.
• stomach ache or cramps.
• muscle cramps or strains.
• cuts, burns, or bruises.
• bone fractures.
Pain pathway
The process of converting noxious
stimuli into action potentials
involves several steps.
Firstly, tissue damage can occur
secondary to chemical, thermal or
mechanical insults. These events
are detected by nociceptors; which
are Aδ (A-delta; myelinated with a
conduction rate of 20 m/s) and C
(unmyelinated with a conduction
rate of 2 m/s) fibers. The Aδ fibers
transmit pain stimuli at a faster rate
than C fibers. As a result, Aδ fibers
is involved in protective spinal reflex
arcs that causes individuals to
withdraw from a noxious stimulus;
while C fibers facilitate the
transduction of slow, burning type
pain.
In response to the stimuli,
nociceptors transduce this
information into nerve impulses by
releasing a myriad of
neurotransmitters such as
prostaglandins, bradykinins,
substance P and histamine, which
all promote an inflammatory
response and simultaneously
propagate pain signals to the spinal
cord.

Neurotransmitters
The action potential associated with
this event is propagated along the
nociceptors and carried to the
dorsal horn of the spinal cord.
Within the dorsal horn of the spinal
cord, the nociceptors diverge
cranially and caudally for two to
three spinal segments, forming the
dorsolateral tract of Lissauer.

Dorsolateral tract of Lissauer

At these levels, nociceptors (first
order neurons) then synapse with
the cell bodies of the fibers of the
spinothalamic tracts (second order
neurons) at varying layers of the
dorsal column known as Rexed
laminae:
• Rexed lamina I
(dorsomarginal nucleus) –
responding to thermal or noxious
stimuli to the skin.
• Rexed lamina II (substantia
gelatinosa) – believed to regulate
sensory input.
• Rexed laminae IV – VI
(nucleus proprius) – also called the
deep dorsal column nuclei, these
cells respond to cutaneous stimuli
as well as afferent information from
visceral and deep somatic
receptors.
• Rexed laminae VII & VIII –
are responsible for transmitting
deep somatic stimuli from muscles
and joints.

Laminae of the spinal cord

The fibers of the spinothalamic tract
leave the dorsal column and
decussate in the anterior white
commissure of the cord. Fibers
concerned with pain and thermal
sensation coalesce in the lateral
funiculus (with the ventral
spinocerebellar tract forming its
lateral border) to form the lateral
spinothalamic tract. Those fibers
concerned with light touch and
pressure sensation congregate in
the anterior funiculus to form the
ventral spinothalamic tract.

Spinothalamic tract
These tracts have a somatotopic
arrangement from lateral to medial:
sacral fibers, lower limb fibers,
trunk fibers and upper limb fibers.
This arrangement is maintained
throughout the ascending circuit.
The spinothalamic tract takes this
information to several central points
for integration and processing. It
gives off the spinoreticular fibers,
which in turn synapse with neurons
of the nucleus raphe magnus in the
medulla oblongata. At the level of
the midbrain, it gives branches that
synapse with cells of the
periaqueductal grey matter, nucleus
raphe dorsalis, and the reticular
formation. The rest of the fibers of
the tract terminate in the ventral
posterolateral and intralaminar
nuclei of the thalamus.

Thalamus: The gate through which

the pain stimuli arrive to the brain
From the thalamus, third order
neurons travel through the posterior
limb of the internal capsule and
terminate at corresponding
somatotopic areas of the
somatosensory cortex (Brodmann
area 3, 1, 2). The cerebral cortices
not only allow conscious perception
of pain, but it also stimulates the
hypothalamus, amygdala and
periaqueductal grey matter, which
in turn inhibits pain transmission via
the release of endogenous opioids,
norepinephrine and γ-aminobutyric
acid (GABA).

Diagram for pain pathway

Types of pain
There are several different types of
pain. Itʼs possible to experience
more than one type at the same
time.
Acute pain
Acute pain develops over a short
period of time. It tends to occur
suddenly, often as a result of a
known injury, illness, or medical
procedure.
For example, acute pain may result
from:
● injuries such as cuts, burns,
muscle strains, or bone
fractures
● illnesses such as food
poisoning, strep throat, or
appendicitis
● medical procedures such as
injections, dental work, or
surgery
Acute pain tends to be sharp, rather
than dull. It usually goes away
within a few days, weeks, or
months, after the cause has been
treated or resolved.
Chronic pain
Chronic pain lasts, or comes and
goes, over multiple months or years.
It may result from a variety of health
conditions, such as arthritis,
fibromyalgia, chronic migraine, or
cancer. Some people also
experience chronic pain following an
injury, even after the initial injury
has healed.
In some cases, the cause of chronic
pain is hard to identify. Some people
experience chronic pain when
thereʼs no other evidence of
underlying injury or illness. This is
known as functional pain.
Nociceptive pain
Nociceptive pain is caused by tissue
damage. For example, it may result
from injuries such as cuts, burns,
bruises, or fractures. It may also
result from certain health conditions
that cause tissue inflammation and
damage, such as arthritis,
osteoporosis, or inflammatory
bowel disease (IBD).
When nociceptive pain develops in
your skin, muscles, ligaments,
tendons, joints, or bones, itʼs known
as somatic pain. When it develops in
your internal organs, itʼs known as
visceral pain.
Nociceptive pain may be acute or
chronic, depending on the
underlying cause. It may feel achy,
throbbing, or sharp.
Neuropathic pain
Neuropathic pain results from nerve
damage, which may be caused by a
variety of injuries and illnesses. For
example, you may experience
neuropathic pain if one of the discs
in your spine slips out of place and
puts pressure on a nerve.
You may also develop neuropathic
pain as a result of certain illnesses,
such as shingles, diabetes, multiple
sclerosis, or cancer.
Neuropathic pain may feel like a
stabbing, shooting, burning, or
prickling sensation. You may also
find that youʼre hypersensitive to
touch, movement, or hot and cold
temperatures.
Functional pain
Functional pain is pain thatʼs caused
by no obvious injury or damage to
your body. It tends to be chronic,
although acute functional pain may
also develop. Examples of
functional pain syndromes include:
● fibromyalgia, which causes
widespread pain throughout
the body
● irritable bowel syndrome (IBS),
which causes abdominal pain
● temporomandibular
dysfunction, which causes jaw
pain
● chronic cardiac chest pain,
which causes chest pain

Managing pain without

medicines
Many non-medicine treatments are
available to help you manage your
pain. A combination of treatments
and therapies is often more
effective than just one.
Some non-medicine options
include:
● Heat or cold – use ice packs
immediately after an injury to
reduce swelling. Heat packs are
better for relieving chronic
muscle or joint injuries.
● Physical therapies – such as
 walking, stretching,
strengthening or aerobic
exercises may help reduce
pain, keep you mobile and
improve your mood. You may
need to increase your exercise
very slowly to avoid over-doing
it.
● Massage – this is another
physical therapy; it is better
suited to soft tissue injuries and
should be avoided if the pain is
in the joints. There is some
evidence that suggests
massage may help manage
pain, but it is not recommended
as a long-term therapy.
● Relaxation and stress
management techniques –
including meditation and yoga.
● Cognitive behaviour therapy
(CBT) – this form of
psychological therapy can help
you learn to change how you
think and, in turn, how you feel
and behave about pain. This is
a valuable strategy for learning
to self-manage chronic pain.
● Acupuncture – a component of
traditional Chinese medicine.
 Acupuncture involves inserting
thin needles into specific points
on the skin. It aims to restore
balance within the body and
encourage it to heal by
releasing natural pain-relieving
compounds (endorphins).
Some people find that
acupuncture reduces the
severity of their pain and
enables them to maintain
function. However, studies on
the effectiveness of
acupuncture in managing pain
is inconclusive.
● Transcutaneous electrical
nerve stimulation (TENS)
therapy – low voltage electrical
currents pass through the skin
via electrodes, prompting a
pain-relieving response from
the body. There is not enough
published evidence to support
the use of TENS for the
treatment of some chronic pain
conditions. However , some
people with chronic pain that
are unresponsive to other
treatments may experience a
benefit.
Pain medicines
Many people will use a pain
medicine (analgesic) at some time
in their lives.
The main types of pain medicines
are:
● Paracetamol – often
recommended as the first
medicine to relieve short-term
pain.
● Aspirin – for short-term relief of
fever and mild-to-moderate
pain (such as period pain or
headache).
● Non-steroidal anti-
inflammatory drugs (NSAIDs),
such as ibuprofen – these
medicines relieve pain and
reduce inflammatiofn (redness
and swelling).
● Opioid medicines, such as
codeine, morphine and
oxycodone – these medicines
are reserved for severe or
cancer pain.
● Local anaesthetics (drops,
sprays, creams or injections) –
used when nerves can be easily
reached.
● Some antidepressants and anti-
 epilepsy medicines – used for a
specific type of pain, called
nerve pain

Phantom pain
What is phantom limb pain? After an
amputation, some people
experience pain in the part of the
limb that's no longer there. This
sensation is phantom limb pain. The
pain is real. The phantom part refers
to the location of the pain: the
missing limb or part of the limb
(such as fingers or toes).
Symptoms
Characteristics of phantom pain
include:
● Onset within the first week
after amputation, though it can
be delayed by months or longer
● Pain that comes and goes or is
continuous
● Symptoms affecting the part of
the limb farthest from the body,
such as the foot of an
amputated leg
● Pain that may be described as
shooting, stabbing, cramping,
pins and needles, crushing,
throbbing, or burning
Refrence
https://www.healthline.com › health
Better health. Vic gov. Au
https://www.ncbi.nlm.nih.gov › pmc
Ken.hub.com
https://my.clevelandclinic.org ›
health