Pain in surgery
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Pain in surgery

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Pain in surgery Presentation Transcript

  • 1. PAIN IN SURGERY MS Surgery – Part I May 2008
  • 2. LECTURE PLAN
    • Definitions
    • Pain pathways
    • Modifications – Current thinking
    • Pain control
  • 3. PAIN
    • Sherrington : “ the physical adjunct of an
    • imperative protective reflex ”
    • Merskey : “ Pain is an unpleasant sensory and
    • emotional experience associated with actual or
    • potential tissue damage or described in terms of
    • such damage”
  • 4. Acute Pain
    • International Association for the Study of Pain
    • “ An unpleasant sensory or emotional experience
    • associated with actual or potential tissue damage,
    • or described in terms of such damage”
    • “ Pain is always subjective; & it is unquestionably a
    • sensation in a part of the body ”
  • 5.
    • Acute pain ……
    • Survival value
    • Chronic pain ……
    • No value
  • 6. Pain Pathways
    • Previously – 3 components
    • 1. First order neurone
    • peripheral receptor  ……
    • 2. Second order neurone
    • crosses midline  spinothalamic tract  thalamus
    • 3. Third order neurone
    • projects to post-central gyrus
  • 7. Pain Pathways
    • Now
    • Peripheral receptors
    • Neural pathways
    • Spinal cord mechanisms & long tracts
    • Brain stem, thalamus, cortex & other areas
    • Descending pathways
  • 8. Pain Response
    • First pain
    • Second pain
  • 9. Nociceptors
  • 10. Neurogenic Inflammation
  • 11. Nociceptors
    • silent nociceptors
    • silent antinociceptors
  • 12. Pain Perception
    • thresholds constant
    • response and tolerance differ
  • 13. Neural Pathways
  • 14.  
  • 15. Spinal Cord Pathways
    • Initial connections
  • 16. Spinal Pathways
    • Initial Connections
    • Important second order neurones
    • 1. Wide Dynamic Range (WDR) cell
    • “ wind up ”
    • 2. Nociceptive specific neurones
    • 3. Complex neurones
  • 17. Spinal Pathways
    • Local
    • Interconnections
    • Gating
  • 18. Ascending Pathways
    • Spino-reticulo-diencephalic pathway
    • Spinothalamic tract
  • 19. Descending Pathways
    • Origin
    • Cortex
    • Thalamus
    • Brain stem – periaqueductal grey matter
  • 20. Noxious stimuli
  • 21. Response to Pain
    • Visceral Pain
    • Tonic muscular spasm
    • Somatic pain
    • Withdrawal of affected part
    • ☼ Autonomic effects
  • 22. Response to pain
    • Fast & slow pain
    • Deep & superficial pain
    • Referred pain
  • 23. C-fos
    • Proto oncogene that codes for protein fos.
    • Expressed in response to painful peripheral
    • stimuli
    • Molecular memory of pain
  • 24.
    • PAIN CONTROL
  • 25.  
  • 26. PAIN CONTROL
    • Primary analgesics
    • opioids – receptors – sites, types
    • drugs
    • routes of administration
    • side effects
  • 27. PAIN CONTROL
    • Primary analgesics
    • simple analgesics and NSAID’s drugs – inhibit COX
    • routes of administration
    • contraindications
    • COX 2 selective inhibitors – parecoxib, valdecoxib
  • 28.  
  • 29. PAIN CONTROL
    • Primary analgesics
    • Local anaesthetics
    • drugs
    • uses
    • toxic effects
    • others - Tramadol
    • - clonidine
  • 30. PAIN CONTROL
    • Secondary analgesics
    • antidepressants
    • anticonvulsants
    • anxiolytics
    • muscle relaxants
    • Ca channel blockers
    • steroids
  • 31. PAIN CONTROL
    • Interventional therapy
    • TENS/acupuncture
    • neurolytic agents
    • radiofrequency/heat treatment
    • surgery
  • 32. PAIN CONTROL
    • Psychological treatment
    • psychological support
    • behavioural therapy
  • 33. PAIN CONTROL
    • pre emptive analgesia
  • 34. Jan 1996
    • 2. Discuss the physiological basis of the different methods of pain control.
  • 35.
    • Thank you