2.
An unpleasant sensory and emotional experience
associated with actual or potential tissue damage
Other manifestations of pain related to tissue injury
include hyperalgesia , allodynia
It is almost UNIVERSAL experience
It is associated with more or less dicomfort , distress ,
resulting from the specific stimulation of specilalized
nerve endings
Definition ;
3. Pain is derived from latin word POENA meaning
“punishment from the god “.
Cola was intially used to cure pain , using caffeine as
pain reliever
Hippocrates was the first person introduced active
ingredient that is ASPIRIN now a days using as
NSAIDS
Queen victoria was the first one taken anathesia for
pain control during childbirth ; chloroform is used
History;
4.
Allodynia ; pain due to non – noxious stimulus to
normal skin.
Analgesia ; absence of pain on noxious stimulation
Anaesthesia Dolorosa ; pain in a area or region
which is anaesthetic.
Causalgia ; a syndrome of sustained burning pain
after a traumatic nerve lession combined with
vasomotor and sudomotor dysfunction
Terms ;
5.
Central pain ; pain associated with a lesion of the
central nervous system.
Dysaesthesia ; an unpleasant abnormal sensation
Hyperalgesia ; increased sensitivity to noxious
stimulation
Hyperaesthesia ; increased sensitivity to stimulation
excluding special senses
Hyperpathia ; a painful syndrome characterisied by
delay over reaction and after sensation to stimulus
Hypoalgesia ; diminshed sensitivity to noxious
stimulation
Terms ;
6.
Hypoaesthesia ; decreased sensitivity to stimulation
excluding special senses
Neuralgia ; pain in the distribution of nerves
Neuritis ; inflammation of nerve
Neuropathy ; a disturbance of function or
pathological change in a nerve
Nociceptor ; a receptor preferentially sensitive to
noxious stimulus
Pain threshold ; the least stimulus intensity at which
a subject persives pain
Terms ;
7.
According to the american pain foundation , more
than 50million people in the US suffer from chronic
pain.
An additional 25% , 20 million experience acute pain
from injury or surgery
The annual incidence of moderate – intensity back
pain is 10% - 15% in the adult population with a
point prevalance of 15% - 30%
The national institute for occupational safety and
health estimated that the cost of low back pain alone
was between 50 billions – 100 billions per year
Epidemology ;
9.
Acute pain has sudden onset,usually subsides
quickly and is characterised by sharp , localised
sensations with an identifiable cause
Last > 30 days associated with muscles strains and
tissue injury such as trauma
A poorly treated pain can cause psychological stress
and compromise the immune system due to the
release of endogenous corticosteroids
Acute pain;
10.
Acute pain is usually characterised by increased
autonomic nervous system activity resulting in
Psychological symptoms such as
anxiety
Tachypnoea
Tachycardia with hypertension
Pallor
Diaphoresis
Pupil dilation
Acute Pain
11.
Viseral pain is a type of nociceptive pain that comes
from the internal organs
Unlike somaatic pain it is harder to pinpoint
Pain is described as general aching or squeezing pain
It is caused by the activation of pain receptors in the
chest, abdomen or pelvic areas
In cancer patient pain is caused by tumour
infiltration, constipation, radiation & chemotherapy
Visceral Pain
12.
Somatic pain ;
Superficial pain ;
It is also known as CUTANEOUS
PAIN
Arises from superficial
structure's as skin &
subcutaneous tissues
It is sharp bright pain with a
burning quality and may be
slow in onset
Deep somatic pain ;
It orginates in deep body
structures such as peristeum ,
muscles , tendons , joints &
blood vessels
Strong pressure , ischemia ,
tissue damage act as stimuli for
brain damage
Radiation of pain from original
site of injury occur
13.
Chronic pain is pain long lasting longer than 3 to 6
months
It begins when pain persists after the initial injury
has healed
It adversely effects the function and wellbeing of
patient
It may be nociceptive , inflammatory , neuropathic or
functional in origin
It varies from unrelenting extremely severe pain to
pain of escalating or non- escalating nature
Chronic pain ;
15.
Main effects of chronic
pain ;
Effect on physiological
function
Psychological changes
Social consequences
Contributing factors ;
Peripheral mechanisms
Peripheral central
mechanisms
Central mechanisms
16.
Peripheral mechanisms ; + of peripheral nociceptors ,
contribute to pain associated with chronic
muscoskeletal , visceral , vascular disorders
Central mechanism ; associated with injury disease
of CNS; characterised by burning , hyperalgesia ;
associated with spinal cord injury , multiple sclerosis
Peripheral – central mechanisms ; abnormal function
of both peripheral portions associated with loss of
descending inhibitary pathways
Contributing factors
17.
Chronic pain types ;
Chronic malignant
pain;
It occurs in 60 – 70% of pt’s
with cancer
Pain may be related to cancer
therapy / tumour
Pain may be somatic and
visceral
Chronic non –
malignant pain ;
Pain lasts for many years and
progressive in nature
May be nociceptive ,
neuropathic , or mixed in
nature .
18.
Types of non malignant chronic pain ;
Neuropathic pain;
it is a result of an injury of
the nervous system
Described as aching
Burning
Shooting
Stinging
Tenderness / sensitivity to
skin
Musco skeletal pain ;
Occurs due to
musculoskeletal disorders
such as
Rheumatoid arthritis
Osteoarthritis
Fibromyalgia
Peripheral neuropathies
19.
Based on transmission;
FAST PAIN
Lasts about 0.1 sec after pain
stimulus is applied
It is described as sharp pain ,
acute & electrical pain
It is not felt in deeper tissues of
the body
SLOW PAIN
Begins after 1 sec or more and
many range from seconds to
minutes
Described as slow , burning ,
aching , nauseous and chronic
pain
Associated with tissue
destruction
20.
OTHERS TYPES OF PAIN
REFERRED PAIN
Pain that is perceived at the site
different from its point of origin
Pain from viscera
Eg ; pain associated with MI
commonly is referred to the left
arm , neck , chest
BREAKTHROUGH PAIN
Pain is intermittent , transitory
& an increase in pain occurs at
a greater intensity
Usually lasts from minutes to
hours
Eg ; neuropathic pain
lower back pain
21.
Also called NOCICEPTORS
Thers are sensory receptors that are activated by
noxious insults to peripheral tissues
These receptors are widely ditributed in the
Skin
Dental pulp
Periosteum
Meninges
Pain receptors ;
22.
Nerve fibers involved in pain
transmission
Nerve fibers
A fibres
A- BETA Fibres
A- DELTA Fibres
C fibres
23.
A Fibres ;
A Beta fibres
Large
Myelinated
Fast conducting
Low stimulating threshold
Respond to light touch
A Delta fibres
Small
Lightly myelinated
Slow conducting
Respond to heat , pressure ,
cooling , & chemicals
Sharp sensation of pain
24.
Small and unmyelinated
Very slow conducting
Respond to all types of noxious stimuli
Transmit prolonged dull pain
Require high intensity stimuli to trigger a response
C Fibres
27.
It includes four distinct processes ;
Transduction
Transmission
Modulation
Perception
Pathophysiology of pain ;
28.
Process by which noxious stimuli lead to electrical
activity in sensory nerve endings
Speciliazed receptors distributed all over the body
which respond to physical & chemical stimuli
They are 1 . Extroreceptors
2 . Proprioseptors
3 . Interoseptors
Transduction ;
29. PROPRIOSEPTORS ;
sensory receptors provides
information from musculoskeletal
structures
Eg ; pacinian corpuscles ; receptors
concerned in the preception of
pressure
EXTROCEPTORS ;+ by immediate
external environment
Provide information from skin
& mucosa
Eg; Meissner’s corpuscles ;
tactile receptors on skin
merkel’s corpuscles ; tactle
receptors in submucosa of
tongue and oral mucosa INTEROSEPTORS ;
Sensory receptors located and transmit
impulses from the viscera of the body
Sensation from these receptors are
involved in the involuntary
functioning of the body
Eg ; free nerve endings ; perceive
visceral pain and other sensation
30.
Neural events that carry the nociceptive input into the CNS
1) PERIPHERAL SENSORY NERVE ; Primary afferent neuron carries
nociceptive input from sensory organ into the spinal cord
2) SECOND ORDER NEURON ; Carries input to the higher centers
through spinal cord
3) THIRD ORDER NEURON ; Interaction of neurons between the
thalamus cortex and the limbic system as the nociceptive input reaches
these higher centers
Transmission ;
31.
PERCEPTION ; Reaching of the nociceptive input to the cortex is
perception
It is at this level suffering & pain behaviour begins
MODULATION ; Ability of the CNS to control the pain transmitting
neurons
several areas of brain & cortex have been identified that can either enhance
or reduce nociceptive input
34.
ACUTE PAIN ; Tachycardia , diaphoresis , mydriasis
, pallor
CHRONIC PAIN ; acute cases become severe then
chronic pain occurrs no obvious signs
LABORATOTY TESTS ;
Pain is always subjective there are no laboratory tests
It is diagnosed based on patients description and
history
Signs of pain ;
35.
Comprehensive history intake ;
Medical history
Physical history
Family history
Questioning on characteristics of pain – onset ,
duration, location , severity , intensity
Evalution of pschycological status
Assesment of pain ;
36.
P - Palliative
Q - Quality
R - Regon / Radiation
S - Severity
T - Time related
Pain assesment
37.
Pain assesment tools ;
RATING SCALES ;
Provide a simple way to
classify the intensity of pain
and should be selected based
on patients ability to
communicate
Simple descriptive pain
intensity scale
Visual analog scale
Faces scale
Verbal rating scale
Pain thermometer
MULTIDIMENSIONAL
SCALES ;
Helpful in obtaining
information about pain but
time consuming to assess
Brief pain inventory
Neuropathic scale
The oswestry disability index