(A Project of National Medical Centre Karachi)

Disorder of Neurological System.

(PAIN)

BY:
Shahzad Bashir
Lecturer, NMC ION.

1
 Objectives
• At the completion of this unit learners will be
able to:
1. Review the concept of somatosensory pathway.
2. Describe the function of Nociceptors in
response to pain information.
3. Describe the function of endogenous analgesic
mechanism as they relate to transmission of pain
information.
4. Describe the proposed mechanism of pain relief
associated with the use of heat, cold & TENS
2
i.e. Transcutaneous electrical nerve stimulation.
 THE SOMATOSENSORY SYSTEM
• The somatosensory system relays information about
four major modalities: touch, temperature, pain, and
body position.
• Somatosensory information is sequentially
transmitted over three types of neurons:
• First-order neurons: (Which transmit information from
sensory receptors to dorsal horn neurons)
• Second-order CNS association neurons: (Which
communicate with various reflex circuits and transmit
information to the thalamus)
• Third-order neurons: (Which forward the information from
the thalamus to the sensory cortex).
Cont….
 Cont….
• The fibers of different dorsal root ganglion neurons
conduct impulses at varying rates, ranging from 0.5 to
120 m/second.
• There are three types of nerve fibers that transmit
somatosensory information: types A, B, and C.
• Type A fibers: (Which are myelinated, have the fastest rate of conduction,
convey cutaneous pressure and touch sensation, cold sensation, mechanical
pain, and heat pain.
• Type B fibers: (Which also are myelinated, transmit information from
cutaneous and subcutaneous mechanoreceptors ).
• Type C fibers: (Which are unmyelinated and the slowest rate of
conduction. They convey warm-hot sensation and mechanical and chemical as
well as heat- and cold-induced pain sensation .
 PAIN

• Pain is both a protective & an unpleasant

sensation associated with actual or potential tissue
damage.
• Pain is an unpleasant or emotional
experience
originating in real or potential damaged tissue
• Unpleasant sensations (Sensory and
emotional) associated with either potential or
actual tissue damage.
 Conti

• There are two pathways for pain transmission:

1. The pathway for fast, sharply discriminated pain
that moves directly from the receptor to the spinal
cord using myelinated Aδ(10 to 30 m/second)
fibers and from the spinal cord to the thalamus
using the neospinothalamic tract
2. The pathway for slow, continuously conducted
pain that is transmitted to the spinal cord using
unmyelinated C fibers(0.5 to 2.5 m/second) and
from the spinal cord to the thalamus using the
more circuitous and slower-conducting
paleospinothalamic tract
NEUROANATOMIC PATHWAY.
SENSORY PATHWAYS
 Conti

• Type I / Nocciceptive /Immediate Pain

It is activated due to actual tissues injury

• Type II / Inflammatory Pain

It is caused due to inflammatory process

• Type III / Naturopathic Pain

It arises due direct nerve injury
PAIN
PHYSIOLOGY OF PAIN
ENDORPHINS
COMMON SITES FOR REFERRED PAIN

Slide 10-21
 ACUTE PAIN

• Acute pain is a protective mechanism that alerts the

individual to a condition or experience that is
immediately harmful to the body.
• Sudden onset, short duration, severe
• It lasts less than 6 months
• It often results from injury, surgery
• It is presenting symptoms of some infections i.e.
pharyngitis, appendicitis, otitis media etc……….
 RESPONSES TO ACUTE PAIN

- Increased heart rate

- Increased respiratory rate -  blood sugar
- Elevated blood pressure -  gastric acid
- Pallor or flushing, -  gastric motility
dilated pupils
 CHRONIC PAIN

• Continuous, long term process

• Lasts more than 6 months.

• Examples: Back pain, cancer pain, arthritis

 Conti

Cutaneous pain
• It is superficial coming from the skin or close to the
surface of the body.
• It is sharp pain

Deep somatic pain

• Deep somatic pain originates from deep structures
• i.e. muscles, joints, blood vessels etc……..
 Conti

Visceral pain
• Visceral pain refers to pain in internal organs, the
abdomen, or chest.
• i.e. renal pain, peptic ulcer pain, pain in cholecystitis
etc……
Referred pain
• Referred pain is pain that is present in an area
removed or distant from its point of origin. The area
of referred pain is supplied by the nerves from the
same spinal segment as the actual site of pain . i.e.
MI pain etc…..
 Naturopathic Pain

• It is caused due to peripheral nerves damage .i.e.

Trigeminal neuralgia.

Neuralgia
• It is characterized by severe, brief, often repetitive
attacks of throbbing pain.

Postherpetic pain
It is caused due to herpes virus infection (Varicella)
 References
• Porth, MC. (6th ED). Pathophysiology. (2002).
Philadelphia. USA. Lippincott Willams&
Willkins, A Wolters Kluwer Company

• McPhee, J. S., & Papadakis, A. M. (2011). Current

Medical Diagnosis and Treatment.
(50th ED). Chicago. USA: Mc Graw Hill