Understanding pain short

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Understanding pain short

  1. 1. Understanding Pain Dr Yeo Sow Nam Director, The Pain Specialist, Mount Elizabeth Hospital & Founder and Past Director, Pain Management and Acupuncture Services, Singapore General Hospital MBBS (Singapore) MMED (Anesthesiology, S’pore) FANZCA (Anesthesiology, Aust/NZ) FFPMANZCA (Pain Medicine, Aust/NZ) FAMS, Registered Acupuncturist 1
  2. 2. Sections1. What Is Pain?2. Classification Of Pain3. What Is Neuropathic Pain?4. Summary 2
  3. 3. What Is Pain? “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” International Association for the Study of Pain (IASP), 1994Merskey H, et al. (Eds) In: Classification of Chronic Pain: 3Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. 1994:209-212.
  4. 4. Classifications Of Pain 4
  5. 5. The Continuum Of Pain Insult Time to resolution Acute Chronic Pain Pain <1 month 3-6 months • Usually obvious tissue damage • Pain for 3–6 months or more2 • Increased nervous system activity • Pain beyond expected period • Pain resolves upon healing of healing2 • Serves a protective function • Usually has no protective function3 • Degrades health and function31. Cole BE. Hosp Physician 2002;38:23-30;2. Turk and Okifuji. Bonica’s Management of Pain. 2001; 53. Chapman and Stillman. Pain and Touch. 1996.
  6. 6. IASP Definitions: Peripheral Neuropathic and Central Neuropathic Pain Neuropathic pain Pain initiated or caused by a primary lesion or dysfunction in the nervous system Peripheral neuropathic pain Central neuropathic pain Pain initiated or caused by a primary Pain initiated or caused by a primary lesion or dysfunction in the lesion or dysfunction in the peripheral nervous system central nervous systemMerskey H, et al. (Eds) In: Classification of Chronic Pain: 6Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. 1994:209-212.
  7. 7. Neuropathic Pain: A Redefinition Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.Treede R-D, et al. Neurology 2008;70:1630-1635. 7
  8. 8. Presentation Across Pain States Varies Neuropathic Pain Mixed Pain Nociceptive Pain Pain initiated or caused by a Pain with Pain caused by injury to primary lesion or dysfunction neuropathic and body tissues in the nervous system nociceptive (musculoskeletal, (either peripheral or components cutaneous or visceral)2 central nervous system)1 Examples Examples Examples • Postherpetic neuralgia • Low back pain with • Pain due to inflammation • Trigeminal neuralgia radiculopathy • Limb pain after a fracture • Painful diabetic neuropathy • Cervical • Joint pain in osteoarthritis • Postsurgical neuropathic pain radiculopathy • Postoperative visceral pain • Posttraumatic neuropathy • Cancer pain • Central poststroke pain • Carpal tunnel Common descriptors2 syndrome • Aching Common descriptors2 • Sharp • Burning • Throbbing • Tingling • Hypersensitivity to touch or cold1. International Association for the Study of Pain. IASP Pain Terminology; 82. Raja et al. in Wall PD, Melzack R (Eds). Textbook of Pain. 4th Ed. 1999;11-57.
  9. 9. Development Of Neuropathic Pain Syndrome Neuropathic pain Symptoms Spontaneous pain Stimulus-evoked pain Pathophysiology Mechanisms Metabolic Traumatic Ischemic Toxic Etiology Hereditary Infectious Compression Immune-related Nerve damageWoolf CJ, Mannion RJ. Lancet 1999;353:1959-64. 9
  10. 10. Signs And Symptoms Of Neuropathic Pain Spontaneous symptoms Persistent burning, intermittent shock-like or • Spontaneous pain1 lancinating pain Abnormal unpleasant sensations, eg, shooting, • Dysesthesias2 lancinating, burning • Paresthesias2 Abnormal, not unpleasant sensations, eg, tingling Stimulus-evoked symptoms Painful response to a non-painful stimulus, eg, • Allodynia2 warmth, pressure, stroking Heightened response to painful stimulus, eg, • Hyperalgesia2 pinprick, cold, heat • Hyperpathia2 Delayed, explosive response to any painful stimulus1.Baron R. Clin J Pain 2000;16:S12-S20;2. Merskey H et al. (Eds) In: Classification of Chronic Pain:Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. 1994:209-212. 10
  11. 11. Summary• An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage• The two most frequently used approaches for classifying pain are based on pain duration (i.e. acute vs chronic pain) and underlying pathophysiology (i.e. nociceptive vs. neuropathic pain)• Acute and chronic pain are often classified along a pain continuum• Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. 11

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