1.

General Classification Of Nerve Fibers

Physiologic Classification Of Nerve Fibers
The fibers are divided in to types A and C fibers, and the type A fibers are further subdivided in to alpha ,beta , gamma and sigma fibers. Type A fibers are the typical large and medium sized myelinated fibers of spinal nerves, that transmit impulses at velocities as great as 120 m/sec. Type C fibers are the small unmyelinated nerve fibers, that transmit impulses as slowly as 0.5 m/sec.

2. Alternative Classification
• • • • • Group Ia : Fibers from the annulospiral endings of muscle spindles (average about 17 microns in diameter). Group Ib : Fibers from the Golgi tendon organ (average about 16 microns in diameter). Group II : Fibers from most discrete cutaneous tactile receptors (average about 8 microns in diameter). Group III : Fibers carrying temperature, crude, touch, and pricking pain sensations (average about 3 microns in diameter). Group IV : Unmyelinated fibers carrying pain, itch, temperature, and crude touch sensations (0.5 to 2 microns in diameter).

Effect of Local Anaesthesia on Afferent Nerve Fiber Impulses
The local anaesthetic agent prevents the increase in sodium permeability of the nerve membrane. In a normal afferent nerve-fiber an effective stimulus will cause depolarization and give rise to an impulse. When the axonal limiting membrane has been stabilized by a local anaesthetic agent depolarization is prevented and no impulse is

Pain
• Pain is a protective mechanism.

Types of Pain and Their Qualities
1- Fast pain:
• Is felt with in about 1 second after a pain stimulus is applied. 2- Slow pain : • Begins only after 1 second or more and there increases slowly over many seconds and sometimes even minutes.

Pain Receptors and Their Stimulation
• Pain receptors are free nerve endings. • The pain receptors in the skin and other tissues are
all free nerve endings. They are wide spread in the superficial layers of the skin as well as in certain internal tissues such as periosteum, the arterial walls, the joint surfaces and the flax and tentorium in the cranial vault.

Pain Stimuli :
Pain can be elicited by multiple types of stimuli. They classified as mechanical, thermal, and chemical pain stimuli.

• In general , fast pain is elicited by the mechanical and thermal types of stimuli, whereas slow pain can be elicited by all three types .

• Some of the chemicals that excite the chemical type of pain are bradykinin, serotonin, histamin, potassium ions, acids, and proteolytic enzymes.

• The chemical substances are especially important in stimulating the slow, suffering type of pain that ocurrs after tissue injury.

Pain Theory Gate Control Theory
• The passage of afferent pain impulses is either inhibited or facilitated in the gelatinosa of the spinal cord or the caudal nucleus of the trigeminal nerve. • Cells transmitting via the anterior and/or lateral spinothalamic tracts must be activated. • The Gate Control Theory postulates that an intermediary cell acts as a ‘gate’ to each transmitting cell and normally inhibits its activity.

Gate control theory
• The gate control theory of pain, is the idea that the perception of physical pain is not a direct result of activation of nociceptors, but instead is modulated by interaction between different neurons, both pain-transmitting and non-paintransmitting. The theory asserts that activation of nerves that do not transmit pain signals can interfere with signals from pain fibers and inhibit an individual's perception of pain.

Contd
• Gate control theory asserts that activation of nerves which do not transmit pain signals, called nonnociceptive fibers, can interfere with signals from pain fibers, thereby inhibiting pain. Afferent pain-receptive nerves, those that bring signals to the brain, comprise at least two kinds of fibers - a fast, relatively thick, myelinated "Aδ" fiber that carries messages quickly with intense pain, and a small, unmyelinated, slow "C" fiber that carries the longer-term throbbing and chronic pain. Large-diameter Aβ fibers are nonnociceptive (do not transmit pain stimuli) and inhibit the effects of firing by Aδ and C fibers. The peripheral nervous system has centers at which pain stimuli can be regulated. Some areas in the dorsal horn of the spinal cord that are involved in receiving pain stimuli from Aδ and C fibers, called laminae, also receive input from Aβ fibers.[3] The nonnociceptive fibers indirectly inhibit the effects of the pain fibers, 'closing a gate' to the transmission of their stimuli.[3] In other parts of the laminae, pain fibers also inhibit the effects of nonnociceptive fibers, 'opening the gate'.[3] An inhibitory connection may exist with Aβ and C fibers, which may form a synapse on the same projection neuron

•The A and B fibers tranismit impulses conveying common sensation and are inhibitory, whilst the C fibers transmit impulses concerned with pain and diminish the inhibitory effect of the inter mediary cell. •It is suggested that the activity of the intermediary cell is governed by the balance between the afferent impulses carried in the axons of the rapidly conducting thick myelinated A and B fibers and the more slowly conducting thin nonmyelinated C fibers.

Pathways for Transmission of Pain Impulses in Orofacial Region
• Impulses originating in the nerve-endings of the dental pulp & the supporting structures of the teeth are conveyed to the CNS by the second(maxillary) & the third (mandibular) divisions of the TRIGEMINAL nerve. • From cell bodies in the Gasserian ganglion , these neural pathways pass to the sensory nucleus of the V nerve which is situated in the medulla oblangata & extends to the level of the second cervical segment of the spinal cord. • Then they pass via the trigeminal lemniscus to the postero -ventral nucleus of the thalamus &then via connecting neurons to the brain. • Interruption of these neural pathways at any level may abolish the sensation of pain.

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