ANAES Lec 1

Cells of the Nervous System - covered by myelin sheaths so deliver is

neuron cells similar to other cells of the body
but have a distinctive shape
motor neuron has its soma in the spinal cord
and receives excitation from other neurons and
conducts impulses along its axon to a muscle
sensory neuron a specialized at one end to be
highly sensitive to a particular type of stimulation
(touch, temperature, odor, etc.)
faster
- they close the gate = block pain signals
explains why:
- drugs (pain relievers like aspirin)
- competing stimuli (acupuncture)
- mere expectation of treatment effects (like
placebos) can sometimes block pain

Nerve Impulse example:

- electrical message that is transmitted down the bumping the head
axon of a neuron - initial trauma activates the A-delta, and
- impulse does not travel directly down the axon eventually, C-fibers
but is regenerated at points along the axon - rubbing the traumatized area stimulates the
- speed of nerve impulse ranges from A-beta fibers, which activate the SG to close
approximately 1m/s to 100m/s the spinal gate
- thus, inhibiting transmission of the painful
Pain stimulus
- derived from the Latin word poena, meaning
fine, penalty, or punishment. Factors which can OPEN the Gate
- an unpleasant sensory and emotional Physical conditions
experience associated with actual or potential - extent of injury
tissue damage, or described in terms if such - nature of injury
damage Emotional states
- anxiety
What is pain? - worry
o shooting o pounding - tension
o throbbing o cramping - depression
o numb o stabbing Cognitive states
o sore o tender - focusing on the pain
o burning o aching - boredom
o agony o annoying Lack of activity
o sharp o debilitating - fitness
- exercise
Nociceptors
- sensitive to repeated or prolonged stimulation Factors which can CLOSE the Gate
Physical conditions
mechanosensitive excited by stress and tissue - medication
damage - counterstimulation (heat, massage,
chemosensitive excited by the release of acupuncture)
chemical mediators Emotional states
o bradykinin, histamine, prostaglandins, - positive emotions (happiness, optimism)
arachidonic acid - relaxation
- rest
primary hyperalgesia due to injury Mental state
secondary hyperalgesia due to spreading of - intense concentration or distraction
chemical mediators - involvement and interest in activities
Activity
GATE CONTROL THEORY - fitness
- With this theory, pain depends on the relative - exercise
____ of traffic in two different sensory pathways
which carry information from the sense organs INTEGRATION AND APPLICATION OF PAIN
to the brain THEORIES
Using trigger points as an example, pain
slow/small fibers theories can be integrated and applied to pain
- no myelin sheaths, so messages delivered management strategies
more slowly
- very intense stimuli (like that caused by a Pain management begins with identifying the
tissue injury) send strong signals on these source of pain, decreasing the chemical and
slow fibers mechanical causes, and facilitating tissue
- they open the gate = you feel pain healing
fast/large fibers
- deliver most sensory information to the brain

Therapeutic modalities, medications, exercise,
and surgery are examples of tools used to
facilitate tissue healing and reduce pain.
o Manual therapies such as muscle
energy, massage, and myofascial
release are non-traditional ways to
manage pain.
PAIN
Need for Pain
short latency warn the organism that it is in
danger so it will alter the situation (e.g. withdraw
limb, take flight, respond with defensive
maneuver)
long latency immobilize the organism so that
recovery from injury can occur
Pain Mediators
- Tissue ___
- They ___
- Neurons releases substance P, which stimulates
mast cells and blood vessels
- Histamine released from mast cells and
bradykinin released from blood vessels add to
pain stimulus
Substance P
- neurotransmitter that is released by a
nociceptor axon and results in vasodilation
(swelling of blood capillaries)
- causes mast cells to release histamine,
which contributes to swelling and
inflammation
Bradykinin
- byproduct of the breakdown of material
(kininogen) found in the extracellular spaces
- can directly stimulate the pain receptors (i.e.
causes neurons to depolarize)
o ANAES Lec 2
Lidocaine synthetic version of cocaine
o Topical applied to membranes
o Infiltration injected near neurons
o Infused into CSF spinal
o Mechanism blocks Na channels in
neurons; no Na, no action potential
Capsaicin (Chillies)
- generates its heat in the mouth by causing
the release of substance P in the mouth
- in large quantities, it depletes substance P
from nerve terminals and can bring relief
from pain (e.g. with shingles)
NSAID
- nonsteroidal anti-inflammatory drugs
- salicylates, inhibit the creation of the
enzymes needed to create prostaglandin
(chemical mediator for pain)
Opioids
- morphine, oxycodone, codeine
mechanisms poorly understood
Endorphins
- naturally manufactures by brain, they may
block peripheral transmitters or
hyperpolarize neurons
Pain Transmission
- tissue injury causes release of:
bradykinin
histamine
potassium
prostaglandins
serotonin
- these substances stimulate nerve endings
starting the pain process

Histamine
- produced by mast cells
- can bind to nociceptor membranes, and
cause depolarization
- also causes blood capillaries to become
leaky, leading to swelling, inflammation at
the site of injury
- (we use antihistamines to reduce pain and
swelling or to counteract upper respiratory
systems leaks..runny nose)

Control of Pain
Gate Theory of Pain
Local Anesthesia
NSAID, Opioids
CNS control of pain
Acupuncture placebo

Gate Theory
- e.g. gentle pressure on a fresh injury
may help reduce pain
Local Anesthesia