Romina Alexis D. Pinson, M.D.

Department of Anesthesiology
UST Hospital
a. Physical discomfort

b. Grief or misery

c. Mental suffering

a. All of the above

 Noun
Physical suffering or discomfort caused by illness or
injury

 Verb
Cause mental or physical pain to: "it pains me to say
this"
 Synonyms
• noun. ache - grief - misery - suffering - affliction –
anguish verb. hurt - ache - grieve - ail - afflict -
distress - smart
“an unpleasant sensory and emotional
experience associated with actual or
potential tissue damage, or described in
terms of such damage."
 4

1 3
2
Protopatic
Noxious pain

light touch

temperature
Epicritic discrimination
Non-noxious
proprioception

pressure
 Mechanonociceptors
Polymodal mechanoheat
nociceptors
Silent nociceptors
- free nerve endings

High treshold for activation

a. A alpha

b. A delta

c. C fibers

d. B fibers
 A alpha A delta C fibers
Size 13-20 1-5 .2-1.5
micrometers micrometers micrometers

Efferent (M) Afferent (S) Afferent (S)

Myelination heavily thinly unmyelinated
myelinated myelinated
Conduction very fast moderate slow
velocity
Type of pain NA first pain second pain
a. Corticospinal tract

b. Spinothalamic tract

c. Reticulospinal tract

d. Thalamocortical tract
1st order Dorsal root ganglion/
sensory ganglia of CN
2nd order Thalamus

3rd order Cerebral Cortex

Spinothalamic
Tract
 Perception

Modulation

Transmission

Transduction
 peripherally at the nociceptor

 in the spinal cord

 supraspinal structures

This modulation can either inhibit (suppress)

or facilitate (aggravate) pain
 results in …
• a decrease in threshold

• an increase in the frequency of response to the

same stimulus intensity

• decrease in response latency

• spontaneous firing even after cessation of the

stimulus
 Facilitation
• Wind up of 2nd order neurons
• Receptor field expansion
• Hyperexcitability of flexion reflexes

 Inhibition
• Segmental
• Supraspinal
Gate theory of pain
 Pathophysiology

 Etiology

 The affected area

 Due to injury, disease process or abnormal
function of a viscera

 Usually nociceptive

 Resolves within a month or upon treatment

 superficial

Sharp
Pricking
Throbbing
Burning
Well localized
deep

Dull
Aching
Less localized
 persists beyond the usual course of an acute
disease

1 to 6 months

 nociceptive, neuropathic, or mixed

 psychologicalmechanisms or environmental
factors frequently play a major role
 Terms Description
Allodynia Perception of nonnoxiuos stimulus
Analgesia Absence of pain perception

Dysesthesia Unpleasant/ abnormal sensation with or

wihtout a stimulus

Hyperalgesia Increased response to noxious stimulation

Hypoalgesia Decreased response to noxious stimulation

Hyperesthesia Increased response to mild stimulation

Paresthesia Abnormal sensation perceived without an

apparent stimulus

Neuralgia Pain in the distribution of a nerve

 painis a subjective experience that is influenced
by psychological, cultural, and other variables