Professional Documents
Culture Documents
Dewi Irawati
Department of Physiology
Medical Faculty Universitas Indonesia
Objectives
Transduction
Transmission
Perception
Modulation, integration and synaptic plasticity
Sensitization (peripheral/central)
Factors affecting
Genetic
Emotion
Cognitive
Behavior
Objectives
What is Pain?
Pain
Sensory-discriminatory
Affective and emotional
Cognitive
Behavioral
Pain
Pain
It is initiated by stimulation of
nociceptors in the
peripheral nervous system, or by
damage to or malfunction of the
peripheral or
central nervous systems.
Why is it Important to
Focus on Pain?
Unrelieved Pain
Chronic (moderate to severe) pain
Often reported by patients as
OUT OF CONTROL
They had not found adequate relief
despite new advanced pain
medications
Consequences
Somatic Pathways
Receptor
Sensory neurons
Threshold
Action potential
Primary medulla
Secondary thalamus
Tertiary cortex
Integration
Receptive field
Multiple level
Neurologic transmission
of pain stimuli
.
Adequate noxious
stimuli
depolarizes
specific receptors
action potential
occurred
conducted along
the primary
afferent fibers to
projection
neurons in the
substantia
gelatinosa at the
dorsal horn of the
spinal cord, where
the "gating"
mechanism
occurs.
AP along primary
nociceptor afferent causes
the release of transmitters
(eg, glutamate and P
substance) from the nerve
terminal which then
stimulates secondary
neurons in the dorsal horn
of the spinal cord, which in
turn send the noxious
signal to the brain. AP
action potential. (Courtesy
of Elan Corporation)
http://www.springerimages.com/Images/MedicineAndPublicHealth/1-10.1007_s11916-
Connections
There
is a very
precise laminar
fibers
organization of
the dorsal horn of
the spinal cord;
subsets of
primary afferent
fibers target
spinal neurons
within discrete
laminae.
The
unmyelinated,
peptidergic C
(red) and
myelinated A
nociceptors
(purple),
terminate most
superficially,
synapsing upon
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852643
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC285264
Somatic
Pathways
A subset of the
projection neurons
crosses over to the
opposite side of the
spinal cord ascend
to the higher centers
in the brain via the
spino-thalamic tracts,
to the thalamus and
higher centers of the
brain, including the
reticular formation,
limbic system, and
somato-sensory
cortex, providing
information about the
location and intensity
of the painful
stimulus.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC285264
PERCEPTION
Perceptual categories
Quality: sharp
Temporal: Initial pain sensation Brief
PNS axons: A fibers
CNS pathway: Somatosensory to thalamus &
cortex
Perceptual categories
MODULATION
Musculoskeletal Pain
Pain induced by
musculoskeletal disorder
(skeleton, muscles, cartilage, tendons,
ligaments, joints, and other
connective tissue)
Musculoskeletal Pain
Characteristic of host
Biological: genetics, sex, endogenous pain control
Psychological: anxiety, depression, coping, behavior
Cognitive
Environment
Disease
History
Present disease
Pai
n
Socialization
Lifestyle
Traumas
Cultural: expectations, upbringing,
role
Fibre type
Muscle/Joint
Cutaneous
Small myelinated
Group III
A-delta
Non-myelinated
Group IV
NOCICEPTORS
Somatosensory specificity:
Sensitization
Peripheral Sensitization
Inflammatory Pain
Central Sensitization
Cramp
Due to ischemia
Can be due to locally generated contractions
(contractures) in some metabolic diseases
Usually exercise induced EIC (or EAMC exercise associated
muscle cramps)
DOMS
Fibromyalgia
RSI
Fibromyalgia
Prevalence 1-2%
Widespread muscle ache/pain
Local tender points
Unknown cause (has been used as criterion for
diagnosis)
Psychological factor?
Psychosocial factors
Stress
Altered periRepetitive
pheral nerve
mechanical
environment.
stress
Multiple sites
Musculoskeletal
tissue
inflammation
Ectopic
firing
(+Nervi
nervorum?)
Central
nociceptive/
pain
systems
PAIN
Nociceptor
sensitization
Pain Management
Non Pharmacology
Physical
Exercise
Surgical
Acupuncture
Psychotherapy
Psychology
Physically
Tranquilizer
Massage
Anesthetic
Drugs
Pain
Killers
Drugs
Pharmacology
Musculoskeletal Pain
Summary
Musculoskeletal Pain
Summary
Musculoskeletal Pain
Summary
Useful web-sites
http://www.georgiapainphysicians.com/l2
_edu_pharma_mod2_slides.htm
http://www.archway.ac.uk/Activities/Depar
tments/SHHP/current/Pain/fop2j_cramp.htm
http://cme.medscape.com/viewarticle/495
071
http://www.wellcome.ac.uk/en/pain/microsi
te/science4.html
http://www.physsportsmed.com/issues/199
9/11_99/schwellnus.htm
Thank
You