Professional Documents
Culture Documents
Physiology of Pain
Dr. Gautam Das MD, FIPP
Chairman, Indian chapter of
World Institute of Pain
Pain management:
What is new?
Newer developments in understanding the
pathophysiology of pain.
Newer concepts of analgesic therapy.
Newer drugs to manage pain.
Interventional Pain Management to diagnose &
treat pain.
Definition of PAIN
Pain is "an unpleasant sensory and
emotional experience associated with
actual or potential tissue damage, or
described in terms of such damage"
( IASP : 1979).
Types of Pain
Types of Pain
Acute Pain
Chronic Pain
/Physiological Pain
Nociceptive
Symptom of a disease
Treatment of diseases
cures pain & it is selflimiting.
/Pathological Pain
Neuropathic
A disease itself, a
disease of nervous
system.
Difficult to treat &
sustaining.
Types of Pain
Acute Pain
/Physiological Pain
Simple relationship
between pain and
tissue damage
Proportionate to the
clinical finding
Biological function &
our friend
Chronic Pain
/Pathological Pain
Dissociated
relationship between
pain and tissue
damage
Disproportionate to
the clinical finding
No Biological
function
PAIN: an alarm?
True for Acute Pain which is our friend.
Chronic Pain is a false alarm, it is a
disease itself.
Chronic Pain
With ongoing
tissue damage
Without ongoing
tissue damage
Central Sensitization is a
constant feature
Pain
Acute Pain
Chronic Pain with tissue damage
Chronic Pain without tissue damage
Pathogenesis of
Chronic PAIN
Sensitization
Sensitization is a phenomenon of
inappropriate or disproportionate response
to normal stimulus
Peripheral Sensitization
Central Sensitization
Peripheral sensitization
Peripheral sensitization
Sensitization of primary afferent terminals.
Active nociceptors become sensitized and
Central
Sensitization
Central Sensitization
Central Reorganisation.
Wind up (summation of signals)
Up-regulation of NMDA receptor
Ectopic activity
Depression inhibitory synapses
Activation of WDR cells.
Central re-organization
NMDA receptor
Treatment of Pain:
MUTIMODAL APPROACH
Interventional Pain Management
Combination analgesics
Adjuvant therapy
Physical medicine
Psychological intervention
Treatment of Pain
Recovery
Operation
Strong
opioids
Weak
opioids +/nonNon- opioids +/opioids adjuvant
Non-pharmacological
methods
Treatment of Pain
Recovery
Operation
Strong
opioids
Weak
opioids +/nonNon- opioids
opioids
World of Misery
Non-pharmacological
methods
Treatment of Pain
Recovery
Operation
Strong
opioids
Weak
opioids +/nonNon- opioids
opioids
Non-pharmacological
methods
FAQs:
What are the types of Pain?
Acute Pain/ Nociceptive Pain
Chronic Pain/ Neuropathic Pain
Mixed type/ Combination of Nociceptive &
Neuropathic Pain
FAQs:
What is principle of treatment?
Acute Pain: Treat disease/ Regional analgesia/
Paracetamol +opioid/ NSAIDs
Chronic Pain: Correct Neuropathy
Tramadol+opioid/ TCA/ Anticonvulsant/
Clonidine/ IPM
Mixed Pain: Stop Nociceptive input/
opioid+Paracetamol/ TCA/ Anticonvulsant/
Clonidine
FAQs:
Why Ultracet is a very good
analgesic for chronic pain?
Can be used for years together even in renal
failure and cardiac patients.
Unlike NSAIDs, it has multidoal action which
is very useful in chronic pain.
Add TCA in burning pain/ Anticonvulsant in
shooting pain/ Clonidine in cramping pain.
It is the first line drug in all chronic pain.
Summary
Multimodal approach is necessary for chronic pain.
Interventional Pain Management works in most situations
where all other options has failed.
Combination analgesic therapy specially Tramadol +
Paracetamol is very useful & ideal combination in treating
moderate to severe chronic pain.
Adjuvant therapy is necessary in most cases.
Physiotherapy & Rehabilitation is essential too.