CLASSIFICATION OF PAIN By: Dr. Vahid Nikoui Email:
DEFINITIONS OF PAIN International Association for the Study of Pain (IASP) (WHO) An unpleasant emotional experience associate with actual or potential tissue damage or described in terms of such damage. Bell The subject‟s conscious perception of modulated nociceptive impulses that generate an unpleasant sensory and emotional experiences associated with actual or potential tissue damage or described in terms of such damage. Monheim An unpleasant emotional experience usually initiated by noxious stimulus and transmitted over a specialized neural network to CNS where it is interpreted as such.2 Mac bryde
HISTORICAL NOTE Greek - “Poin” meaning penalty. Latin -“Poena” meaning punishment from God. Homer - Thought pain was due to arrows shot by God. Aristotle - was the first to distinguish five physical senses, and considered pain to be “passion of the soul” . Plato - pain and pleasure arose from within the body, an idea that perhaps gave birth to3 the concept that pain is an emotional experience more than a localized body
Nociception Nociception (synonym: nocioception or nociperception) is defined as "the neural processes of encoding and processing noxious stimuli. "Nociceptor A nociceptor is a sensory receptor that responds to potentially damaging stimuli by sending nerve signals to the spinal cord and brain.Noxious Noxious stimulus, an actually or potentially tissue damaging event, may be mechanical, chemical or thermal.Algesia Algesia, from the Greek word algesis, is the sensitivity to pain.
TYPES OF PAIN 1. Based on speed of onset, quality & duration(1) Experimental (2) Transient (3) Acute (4) Chronic1. Experimental: noxious stimuli causes a mild uncomfortable or painful sensation.2. Transient pain: Short duration Severe5 Self limiting
3. Acute pathological pain:• Sharp, fast, pricking• Occurs very rapidly• Carried by large diameter myelinated Aδ fibers• Usually alleviated with the help of professional 4. Chronic pathological pain: • Burning, aching • Gradually increases • Carried by small diameter non-myelinated „C‟ fibers • Experience of persistent pain that lasts many months to years • Little apparent cause & not self limiting6 • Pain often increases over time & is aggravated by
2.Based on level of stimulation SOMATIC PAIN VISCERAL PAIN Associated with skin and Associate with viscera musculo-skeletal region and internal organs Superficial Deep7
Referred Pain Referred pain (sometimes referred to as reflective pain) is a term used to describe the phenomenon of pain perceived at a site adjacent to or at a distance from the site of an injurys origin. One of the best examples of this is during ischemia brought on by a myocardial infarction (heart attack) where pain is often felt in the neck, shoulders, and back rather than in the chest, the site of the injury.
SPECIFIC PAINS Headache A headache or cephalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. 1- Headache of intracranial origin Meningitis headache, Migraine, Alcoholic headache, Headache due to low pressure of CSF, Constipation headache 2- Headache of extracranial origin Headache due to muscular spasm, Headache due to nasal irritation, Headache due to eye disorders
Toothache A toothache, also known as odontalgia or, less frequently, as odontalgy, is a pain in or around a tooth. In most cases toothaches are caused by problems in the tooth or jaw, such as cavities, gum disease, the emergence of wisdom teeth, infected dental pulp, jaw disease, or exposed tooth root.
Trigeminal neuralgia Trigeminal neuralgia (TN), Tic Douloureux (also known as prosopalgia, the Suicide Disease or Fothergill‟s disease) is a neuropathic disorder characterized by episodes of intense pain in the face, originating from one of the three trigeminal nerves. It is, "one of the most painful conditions known to humans, yet remains an enigma to many health professionals." This pain may be felt in the ear, eye, lips, nose, scalp, forehead, cheeks, teeth, and/or jaw; some patients also experience pain in their left index finger.
ABNORMAL PAINS Hyperalgesia Hyperalgesia is an increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves. Allodynia Allodynia, meaning "other pain", is a pain due to a stimulus which does not normally provoke pain and can be either thermal or mechanical. Hyperpathia Hyperpathia is a clinical symptom of certain neurological disorders wherein nociceptive stimuli evoke exaggerated levels of pain. Phantom Limb Pain A phantom limb is the sensation that an amputated or missing limb is still attached to the body and is moving appropriately with other body parts.