Patomechanism of Pain

dr. Henny Anggraini Sadeli SpS(K)

Definition of PAIN
Pain is unpleasent sensory and emotional experience associated with actual or potential tissue damage, or discribe in term of such damage
( IASP, 1986 )

HAS/Neuro/2007

Types of Pain

Nociceptive Pain

Inflammatory Pain

Neuropathic Pain
Spontaneous pain and hypersensitivity to pain in association with damage to or a lesion of the nervous system

Transient pain in response to a noxious stimulus

Spontaneous pain and hypersensitivity to pain in response to tissue damage and inflammation

-survival -protecting from injury -promoting healing

-maladaptive pain -pain as disease

HAS/RSHS/FKUP07

Types of Pain

Visceral Pain
Deep,squeesing,pressure Poorly localized Sometimes referred
Eg. Heart, lung, liver, pancreas,etc

Somatic Pain
Pain from nerve endings in tissues/bones Aching, gnawing Well localised
Eg. Bone metastases, bone fracture Myofacial pain

Neurophatic Pain
Pain from nerve irritation/damage Sharp, electrick shock, burning, tingling Often follow nerve pathway

Peripheral NeP
Eg. Polineuropathy Mononeuropathy Radicular Pain Trigeminal neuralgia Post herpetic neuralgia

Central NeP
Eg.Post stroke pain Spinal cord pain

Mixed Pain
Hennys

Low Back pain

Spontaneous Pain

Stimulus Evoked Pain/ hypersensitivity to pain

allodynia

HAS/Neuro/RSHS-FKUP

hyperalgesia

Hypersensitivity to pain

HAS/neuro

PAIN BEHAVIOUR

AFFECTIVE

COGNITIVE

SENSORY

Waddel G, 1992

Biopsychosocial & chronic pain disability model

HAS/Neuro/RSHS-FKUP

Hennys

Hennys

Hennys

Pain Mechanism
Nociception : transduction-conductiontransmission-perception Phenotypic switches Peripheral sensitization Ectopic exitability Central sensitization Decreased inhibition Structural reorganization
HAS/neuro

Hennys

Excitability in dorsal horn neurons is determined by balance between exitatory inputs from primary afferents and inhibitory inputs (local and descending)

HAS/Neuro/2006

Hennys

Hennys

Hennys

Descendens exitatory
Primary afferent nociceptor

Descendens inhibitory 5HT, NE

BDNF TNF IL-1 COX2 PGE2

microglia

P2X4

CB1

opioid

gly

Central Sensitization

inhibitory excitatory

Glutamate

GABA

SP
CGRP Somatostatin(-)

NMDA AMPA/kainate mGluR NK1 VGCC EP

Ca++
COX2 PGE2

GABA
2CC Dorsal horn neuron

apoptosis HAS/RSHS/FKUP07

interneuron

Hennys

Central Sensitization
A reduction in activation threshold An increased responsiveness An expansion of receptive field in dorsal horn neurons

Henny/neuro

Hennys

Hennys

Structural reorganization

hennys

hennys