PHY 222 - General

Physiology 2

Pa
in
Types and Categories
of Pain
Name : Nagy Ibrahim Ali ElSamahy
ID : 5212305

Types and
Categories of Pain
Basic (main) Categories of Pain:
Nociceptive Pain
Has 2 important
subcategories:
1. Somatic pain
Superficial (skin
layers)
Deep (internal

Neuropathic
Pain
Central nervous
system
Peripheral
nervous
system

Nociceptive
Pain

Typical type of pain

Everybody has experienced this

It results from damage to tissues
(tooth ache, fracture, skin
lesion)
Signal of
Tissue irritation, Impending injury, or Actual injury
Perception of Pain
Related to specific stimulus
Hot, sharp, extreme cold,
Aching, throbbing quality

 Affected area:
Activation of nociceptors -------
Signal transmission via peripheral
nerves and
spinal cord to -------
The brain
Activation of complex spinal reflexes
Withdrawal
Perception, cognitive and affective
responses
(possibly) voluntary action
Subtypes Nociceptive Pain
Somatic Pain
Constant, aching,throbbing, welllocalized

1- Somatic
Pain
Divided in two subcategories:
a) Superficial somatic pain (cutaneous)
)Pain derived from skin, subcutaneous tissue and mucous
membrane
Moderate/brief noxious stimuli
No tissue injury; protection against further injury
First pain
Mediated by A nociceptors; brief and localized
Sharp, pricking or stabbing quality
Second pain
Mediated by C nociceptors
Burning, throbbing, aching sensation

 association with
Cutaneous tenderness
Pain elicited by moderate pressure on skin
Elicited by pinching or pressing on the skin
Hyperalgesia
Primary at site of injury
Lowered pain threshold, increased response to
suprathreshold stimuli and spontaneous pain
Secondary in much larger surrounding area
Increased blood flow
Vascular permeability ----- edema
Sensitization and Activation of adjacent nociceptors

b) Deep Somatic Pain

Arises from
Skeletal muscle; joint receptors (tendons and fascia);
deep structures
Accompanied by
Definite autonomic response
Sweating, nausea, changes in blood pressure,
lowerd heart rate
Reaches CNS via paleospinal and archospinal thalamic
pathways

Reactions to somatic pain

A startle response
Flexion - withdrawal reflex
Postural readjustment
Orientation of head and eyes to examine the
damaged
area
Autonomic response
NE and E release
ACTH and/or Cortisol release
Vasoconstriction and piloerection
Behavioral patterns
Vocalization
Rubbing designed to diminisch pain

2- Visceral
Pain
(usually) Time limited
Exception for arthritis!
Responsive to (general) analgesics

Class I, II and III analgesics

Nociceptors respond mainly to
Intensities of mechanical stimulation, i.e. pressure
Other nociceptors respond to chemical stimulation
Causes:
Spasm of smooth muscle in hollow viscus
Destension/stretching of ligament
Stretching of tissues
Intestinal obstruction
Chemical means
Arterial thrombosis; gastrointestinal lesions;
tumors

Two main types:

1) Arising from viscus itself
True or localized visceral pain
Occurs early in the disease
Feeling of malaise, autonomic phenomena
Usually on midline and deep in the body
Vague, dull, aching pain
Referred visceral pain
Embryonic origin viscerotomes!
Later stage of disease
With increasing intensity of pain

2) Arising from parietal peritoneum or

pleura
Localized parietal pain
Referred parietal pain
Usually sharp, occasionally stabbing
pain
Involvement of peripheral part of
diaphragm:
Lower chest and ipsilateral part of
abdominal wall
(Lower six intercostal nerves)
Involvement of central part of

Neuropathic Pain
results from damage to the nerves themselves and is often
set off by diseases like diabetes or shingles Injury and/or
malfunction
Injury and/or malfunction
Peripheral nervous system
Central nervous system
Pain often triggered by injury/malfunction
No involvement of the nervous system
Persisting well beyond healing process
Quality of pain:
Burning, lancinating, electric shock
Allodynia often present
Frequently chronic character
Less robust (or no?) response to treatment
with classical analgesics

 Allodynia

Terminolo
gy

Pain due to stimulus that does not normally provoke pain

Dysesthesia
Unpleasant abnormal sensation, whether spontaneous or
evoked
Paresthesia

Abnormal sensation, whether spontaneous or evoked

Hyperalgesia
Increased response to stimulus that is normally painful
Hyperesthesia
Increased sensitivity to stimulation

Psychogenic Pain
(psychosomatic)
Reserved for rare situations
With no somatic disorder present or
detectable
Psychological factors play a role in
perception and complaint of pain
Exaggerated presentation of pain

Mixed
Category Pain
Some pain conditions caused by mixture
Nociceptive and Neuropathic factors
Initial nervous system dysfunction
------ inflammatory mediators
Neurogenic inflammation
Clinical examples:
Migraine headaches
Myofascial pain
Chronic pain