New product dedisions provide a dear path to the business. New product development
astep by step process. A Complete idea is required behind new product.
1 1deal Generation: The development of a product starts with the concept and idea.
The remaining process is depending on that idea.
2 Screening of Idea: This step is cruial to ensure that unsuitable ideas, for whatever
reason, are rejected as soon as possible. Ideas need to be considered objectively,
ideally by a group or committee.
3. Concept Development and Testing: After having an idea, next is the sreening
stage. The idea should now convert into concept. It has depth information which can
be visualizing by the consumer.
4. Anaysis of business: After finalization of concept, a business case needs to be kept
algTStogether to consider whether the new service /product will be gainful.
2665.Product Development If the nev product is approved, it will be approved to the
2marketing and technical development step.
6. Test Marketing: Market testing (test marketing or) is different to consumer testing.
in that it introduces the product that follows proposed plan of marketing.
od7. Commercialization: When the concept has been tested and developed, final
0decisions are required to move the product to its introduction into the market.
8. Launch: A detailed plan of launch is required for this step. This is the important
stage for success of a product
New Drug Development
So In present business atmosphere, it is more important to take smart decisions for
business. Innovative approaches and new products can put an organization on proper
pathway and to make a big success if appropriately analyzed and executed. Make it simpler
(Fig.2.1).0
Following parameters should keep in mind for a better decision:
Analyzing existing service and product portfolio frequently.
Knowing the position of functions of business, projects of departments and
initiatives.
Understanding the distribution of funds and assessing efficiency.
Having understanding of market for new opportunities and possible competition.
2.B PRODUCT BRANDING, PACKAGING AND LABELLING DECİSIONs
2.8.1 Branding
Branding has its existence from ancient era. According to Nilson (2000), the first example
of branding is found in the oil lamps' manufacture on the Greek islands thousands of years
back. Brand elements are name, sign, term, symbol, design or distinguishing characteristics.
Brand is not only a graphical design or a logo; it is the unique identity of the product.
By American Marketing Association, Brand can be defined as name, term, sign, symbol
or design, or a combination of them intended to identijy the goods and services of one seller or
group of sellers and to diferentiate them from those of other sellersa54
Branding is a process, where a company generates loyalty among consumers in the
market. Brands are designed with a motive to communicate customers the reason for the
existence of their product. Brand should have a strong connection with customers;
2. Learning Objectives
• Gain insight into of the anatomy and physiology of pain
• Recognize terminology
• Identify the body’s physiological response to pain
• Recognize the effects of pain on the different body
systems
• Apply knowledge to assess and treat pain
3. Pain
THE TEACHING:
• Medically - pain is a symptom of
an underlying condition
THE MISSION:
• Find the source of pain
• Holistically treat the pain
THE GOAL:
• Return to a realistic, productive
life
“An unpleasant sensory and emotional experience associated with actual or
potential tissue damage.”
4. The Purpose of Pain
1. Prevents serious injury
• A light touch to something hot forces a quick reaction before serious injury occurs
2. Teaches avoidance
• A painful activity teaches what not to repeat or when to seek help
3. Prevents permanent damage
• Joint pain limits activity
• Surgery requires down time for healing
5. The Pain Roadmap
Spinal Cord
Brain
Ascending
Pathways
Descending
Pathways
Peripheral
Nerves
• Pain sensation involves a series
of complex interactions between
peripheral nerves and the central
nervous system
• Pain is a dynamic, bidirectional
process
• Multiple areas of the nervous
system help process pain signals
• Normal and pathologic processes
underlie pain mechanisms
6. The Origin of Pain
Pain Origin
Somatic or Cutaneous Pain • Arises from nociceptive receptors in the skin and mucous
membranes
• Superficial pain
• Feels like sharp, burning, pricking and is constant
• Fast or slow onset
Deep Somatic Pain • Stems from tendons, muscles, joints, periosteum and
blood vessels
Visceral Pain • Originates from internal organs: pelvis, abdomen, chest
and intestines
• Activates nociceptors of the viscera (internal organs in
main cavities of the body)
• Poorly localized and is an achy and dull sensation
• Visceral structures are highly sensitive to stretching,
ischemia and inflammation but insensitive to other
stimuli that normally provoke pain
Psychogenic Pain • Individuals “feel” pain but cause is emotional rather than
physical
7. The Process of Pain Physiology
• Pain sensation is modulated by two types of neurotransmitters or
neurochemicals:
oNeurochemicals that excite pain or try to initiate pain
oNeurochemicals that inhibit or try to stop the pain
• Pain sensation is composed of four basic processes:
oTransduction
oTransmission
oModulation
oPerception
8. The Process of Pain Physiology
Process Action
Transduction • Processes by which tissue-damaging stimuli activate nerve endings
• Three types of stimuli can activate pain receptors in peripheral
tissues: mechanical, heat, chemical
• Pain stimuli is converted to energy
• Electrical energy is known as “transduction”
• Stimulus sends an impulse across the peripheral nerve fibers known
as the nociceptor never fibers
Transmission • Nociceptive message is transmitted to the central nervous system
(CNS)
• A delta fibers send sharp, localized and distinct sensations
• C fibers relay impulses that are poorly localized, burning and
persistent
• This is the route by which the CNS is informed of impending or
actual tissue damage
Modulation • Natural inhibition or modulation of pain by the body
• Inhibitory neurotransmitters like endogenous opioids (enkephalins,
dynorphin and endorphins) that work to hinder pain transmission
Perception • Person is aware of the pain
• Somatosensory cortex identifies the location and intensity of the
pain
• Person unfolds a complex reaction – physiological and behavioral
9. The Transmission of Pain: Afferent Axons
Nerve Fibers Involved in
Transmission of Pain
A – Alpha Fibers
muscle sense
Diameter: 13-20 um
Speed: 80-120 m/s
C - Fibers
pain/temperature/itch
Small
Unmyelinated
Very slow conducting
Respond to all types of
noxious stimuli
Transmit prolonged,
dull pain
Require high intensity
stimuli to trigger
response
Diameter: . – . um
Speed: . – . m/s
A - Beta Fibers
touch
A - Delta Fibers
pain/ temperature
Small
Lightly myelinated
Slow conducting
Respond to heat,
pressure, cooling and
chemicals
Sharp sensation of pain
Diameter: 1-5 um
Speed: 5-35 m/s
Large
Myelinated
Fast conducting
Low stimulation
threshold
Respond to light touch
Diameter: 6-12 um
Speed: 35-75 m/s
PRIMARY AFFERENT AXONS
10. The Transmission of Pain: Timing
• The thickness of a nerve fiber correlates directly to the speed with which information travels
• The thicker the nerve fiber, the faster information travels
• A-alpha, A-beta and A-delta nerve fibers are insulated with a protective covering called the myelin
sheath, which helps with nerve conductivity
• C nerve fibers are unmyelinated
• A-delta and C fibers are the main fibers responsible for the transmission of pain, however new studies
suggest A-beta fibers may have an important role to play in the diagnosis and treatment of pain
Fast Pain Slow Pain
• Transmitted by the A-delta nerve fibers at a
velocity of 6-30 m/second
• Felt about 0.1 seconds after a pain stimulus is
applied
• Pin prick, cutting or burning of skin
• Caused by mechanical or thermal stimuli
• Fast, sharp pain is not felt in most deeper tissues
• Neurotransmitter released – glutamate
• Transmission route: Neo-spinothalamic tract
• Transmitted by the C-nerve fibers at a velocity
of 0.5-2 m/second
• Begins after 1 second or more and may range
from seconds to minutes
• Slow, burning, aching, throbbing, nauseous
pain and chronic pain
• Associated with tissue destruction
• Caused mainly by chemical stimuli
Neurotransmitter released – Substance P
• Transmission route: Paleo-spinothalamic tract
11. Transmission of Pain: Pull it Together
Peripheral Sensory Nerve
Spinal Cord
Thalamus
Cortex
Pain!
PAG Periaqueductal Gray Matter
C
A-delta
Afferent neurons
Modulation
Transduction
Perception
• Serotonin
• Endorphins
• Enkephalins
• Dynorphin
Neurochemical
Pain Inhibitors
Descending Inhibition
• Epinephrine
• Cortisol
• ACTH
Neurochemical
Pain Initiators
• Glutamate – Central
• Substance P – Central
• Bradykinin - Peripheral
• Prostaglandins -
Peripheral
Transmission
13. Acute Pain
• Occurs in response to injury or illness
• Responds well to interventions
• Resolves well as healing proceeds
• Short-lived
• Less than three months
• Often accompanied by sympathetic
nervous system arousal
• Adaptive pain response
• Helpful pain response, which produces a
behavior that promotes healing
Chronic Pain
• Multiple underlying mechanisms
• Requires multi-modal and interdisciplinary
treatment approaches
• Pain that persists beyond the “normal”
time expected to heal
• Longer than three months
• Changes in both peripheral and central
nervous system processing
• If acute pain is not managed well will
move into the chronic phase
Acute Pain vs. Chronic Pain
15. Acute Pain: Nociceptive
What is nociceptive pain?
• Normal response to an injury of tissues
• Most common type of pain
What are nociceptors?
• Nerves that detect or find noxious stimuli
What is nociception?
• Process whereby signals are sent to the brain by nociceptor receptors
What is the cause of nociceptive pain?
• Injury to body tissue to the skin, muscle and bones
Examples:
• Postoperative pain, bruises, burns, fractures, overused joints
• Patients will present with dull, heavy, aching pain that spreads over a wide area
16. Chronic Pain: Neuropathic
What is neuropathic pain?
• Chronic pain lasts more than six-months
What is the cause of neuropathic pain?
• Pain caused by a primary lesion or disease in the somatosensory nervous system causing varying
degrees of pain sensations
What is some the cause of neuropathic pain?
• Nerve damage due to some type of a viral infection or a disease involving the central or peripheral
nervous system (neuralgias)
Examples:
• Arthritis, migraines, shingles, multiple sclerosis, shingles
• Patients will present with a variety of symptoms from numbness to burning to stinging, pins and
needles and pricking sensations
17. Chronic Pain: Nociplastic
What is nociplastic pain?
• Nonnociceptive and nonneuropathic pain
• Inflammatory response
How does nociplastic pain work?
• Activation and sensitization of nociceptive pain pathway by a variety of mediators released at a site
of tissue
What causes nociplastic pain?
• Abnormal processing in the central nervous system, however the reason for this abnormality is
generally unknown
Examples:
• Fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome
• Patients will present with a variety of symptoms seen in both acute and chronic pain patients
18. Mixed Pain
What is mixed pain?
• Mixed pain share common clinical characteristics of all three types of pain
• nociceptive, neuropathic and nociplastic
Potential Examples:
• Sciatica, cancer pain, lumbar spinal stenosis
19. Other Types of Pain
Type of Pain Elements of the Pain
Breakthrough Pain • Pain is intermittent, transitory and an increase in pain occurs at a greater intensity
• Usually lasts from minutes to hours and can interfere with functioning and quality of
life (e.g., neuropathic pain and lower back pain)
Complex Regional Pain
Syndrome (CRPS)
• Pain condition that most often affects one limb (arm, leg, hand or foot) usually after
an injury
• CRPS is believed to be caused by damage to, or malfunction of, the peripheral and
central nervous system
Phantom Limb Pain • Pain in the absence of a limb
Referred Pain • Pain sensation produced in some part of the body is felt in other structures away
from the point of origin
• Deep pain and some visceral pain are referred to other areas
• Superficial pain is not referred
• Most common areas of referred pain include: heart, esophagus, kidneys, stomach,
colon, appendix, gallbladder, stomach, ureters (e.g., pain from a myocardial
infarction has referred pain to the left arm, neck and chest)
Chronic Pain Syndrome
(CPS)
• Different than chronic pain
• Combination of the original pain and the secondary
complications that are making the pain worse
20. Chronic Pain Syndrome: CPS
PAIN
inactivity
work
issues
altered
social
life
family
life
issues
weak
muscles
stress
anxiety
anger
fear
sadness
depression
fatigue
“A chronic pain syndrome is the
combination of chronic pain
and the secondary
complications that are making
the original pain worse”
Institute for Chronic Pain
21. Interaction of Complex Pain
Nociceptive Pain
ACUTE
Neuropathic Pain
CHRONIC
Nociplastic Pain
TYPICALLY
CHRONIC
22. Functional Effects of Pain
Body System Anticipated Change
Brain • Anxiety and fear
• Depression
• Poor concentration
• Inhibition or promotion of pain
Cardiovascular • Increased heart rate and blood pressure
• Increased need for oxygen
• Water retention
• Potential fluid overload
Endocrine • Increased blood glucose
• Increased cortisol production
Gastrointestinal • Reduced gastric emptying and intestinal motility
• Nausea and vomiting
• Constipation
23. Functional Effects of Pain
Body System Anticipated Change
Immune • Increased susceptibility to infection
• Increased or decreased sensitivity to pain
• Activation of hypothalamic-pituitary-adrenal axis (HPA)
• HPA is the central stress response system in the brain
Musculoskeletal • Tense muscles local to injury
• Shaking or shivering
• Pilo-erection or goose bumps
Nervous • Changes in pain processing
Respiratory • Increased respiratory rate
• Shallow breathing
• Increased risk for infection
Urinary • Urge to urinate/incontinence
24. Psychological Effects of Pain
Anticipated Change
Physical • Sleep disturbances
• Chronic fatigue
• Inability to keep up with daily activities
• Adverse Rx effects
Psychological • Rapid escalation or changes in mood
• Crying, anger, anxiety, irritability
• Low emotional distress tolerance
• Irrational thinking or behavior
• Fear
• Helplessness
Social • Work-related challenges
• Relationship challenges
• Intimacy challenges
• Social isolation
• Loss of role/identity
Spiritual • Hopelessness
• Questioning faith
• Guilt
• Self-pity
26. • Infants and children
• Elderly
• Racial and ethnic groups
• Women
• People with current or past history of substance abuse/addiction
• Cognitively impaired, non-verbal people
Groups at High Risk for Pain Management
27. Take Home Points
• The body’s reaction to pains to is complex and multifaceted
• Pain is transmitted from the site of injury to the brain by electrical signals
• Physiological changes triggered by pain are helpful in the beginning but become
harmful if they continue
• Understanding the anatomy and physiology of pain helps health professionals to
find better ways to treat pain
• Key interventions to prevent and treat pain begin with holistic pain assessments
• Check the Society of Hospital Medicine Pain Pathways for treatment guidelines.
29. References
National Pharmaceutical Council, INC, Joint Commission on Accreditation of Healthcare Organizations. (2001, December). . Barriers
to the Appropriate Assessment and Management of Pain. Pain: Current Understanding of Assessment, Management, and
Treatments. (15-16). Retrieved from: https://www.npcnow.org/system/files/research/download/Pain-Current-Understanding-of-
Assessment-Management-and-Treatments.pdf
Niculescu, A. B., Le-Niculescu, H., Levey, D. F., Roseberry, K., Soe K. C., Rogers, J., Khan, F., … White, F. A., ( 9, February ).
Towards precision medicine for pain: diagnositic biomarkers and repurposed drugs. Molecular Psychiatry 24:(501–522). Retrieved
from: https://www.nature.com/articles/s41380-018-0345-5
Otis, J.A., Macone, A., ( 9, April). When to Use Opioids: What I Didn’t Learn in Medical School. Practical Pain Management.
Retrieved from: https://www.practicalpainmanagement.com/resource-centers/opioid-prescribing-monitoring/when-use-opioids-
what-didnt-learn-medical-school
Riberio-Pinho, F. A., Verri Jr., W. A., Chiu, I. M., (2017, January). Nociceptor Sensory Neuron-Immune Interactions in Pain and
Inflammation. Trends Immunol. 38(1) 5-19. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5205568/pdf/nihms821842.pdf
University of Wisconsin School of Medicine and Public Health: Pain Management (2010). Retrieved from:
http://projects.hsl.wisc.edu/GME/PainManagement/index.html
Waller C. (2018). Colorado Hospital Association Opioid Safety Summit: The Addiction Treatment Ecosystem.
Wilensky, B.
Adapted from Woolf CJ. Ann Intern Med. 2004;140:441-451.
https://annals.org/aim/article-abstract/717288/pain-moving-from-symptom-control-toward-mechanism-specific-
pharmacologic-management?volume=140&issue=6&page=441
Chong MS, Bajwa ZH. J Pain Symptom Manage. 2003;25:S4-S11.
Younger J, Aron A, Parke S, Chatterjee N, Mackey S ( ) PLOS ǀ ONE “Viewing Pictures of a Romantic Partner Reduces
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30. References
BBC Horizon (2011). I Cut off My Arm to Save My Life. The Secret World of Pain – BBC Two. Retrieved from:
https://www.youtube.com/watch?v=r9YFk7-Dsgw
Cox S (2010) Nursing Standard. Basic Principles of Pain Management: assessment and intervention. (Vol 25, Issue 1).
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Dmitry, A.M., Fleming, A., (2019, April). Pain Assessment: Review of Current Tools. Practical Pain Management.
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clinically-tested-validated-pain-scales
Fink. R. (2000, July). Pain assessment: the cornerstone to optimal pain management. Baylor University Medical Center
Proceedings, 38 (3), 236-239. Retrieved from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317046/
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(2014, December). The Journal of Pain 12: 1203-1215. http://americanpainsociety.org/uploads/about/position-
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International Association for the Study of Pain: https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698
Macintyre PE, Schug SA (2007) Acute Pain Management." A Practical/Guide. Third edition. Saunders Elsevier, Edinburgh.
McCaffery M (1972) Nursing Management of the Patient with Pain. Lippincott, Williams & Wilkins, Philadelphia, PA.
Miller, F. H., Choi, M. J., Angeli, L. L., Harland, A. A., Stamos, J. A., Thomas, S. T., . . . Rubin, L. H. (2009). Web site usability
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Editor's Notes
Objectives
1. https://advances.sciencemag.org/content/5/7/eaaw1297
Slowly conducting, myelinated nociceptors in the human radial nerve (39) show a greater specificity for mechanical stimulation relative to unmyelinated nociceptors, which are often polymodal, an observation that is consistent with other species (13, 36). In the mouse, for instance, there are myelinated nociceptors that respond specifically to high-threshold mechanical stimulation (41) including hair pulling (40); in our sample, the receptive fields of A-HTMRs lacked visible hairs, and we were thus not able to test whether they responded to hair pulling. By implication, the ultrafast A-HTMRs in humans may be highly specific for mechanical stimulation (pure mechano-nociceptors), and we have no observation to the contrary. However, the human A-HTMR population may consist of subpopulations distinguished not only by differences in conduction velocities but also by their response properties. This needs to be systematically tested in a larger population.
An ultrafast system for signaling mechanical pain in the human skin
https://advances.sciencemag.org/content/5/7/eaaw1297
1.
References:
Used with permission:
Bonnie Wilensky APN,RN, C, CNS, MSN, CCN
Presentation: Addressing the Barriers to Effective Pain Management and Issues of Opioid Misuse and Abuse -
Adapted from Woolf CJ. Ann Intern Med. 2004;140:441-451.
https://annals.org/aim/article-abstract/717288/pain-moving-from-symptom-control-toward-mechanism-specific-pharmacologic-management?volume=140&issue=6&page=441
Chong MS, Bajwa ZH. J Pain Symptom Manage. 2003;25:S4-S11.
References:
Basic principles of pain management: assessment and intervention: assessment and intervention. F Cox
https://pdfs.semanticscholar.org/e7e6/423e73ce5696e2a2f1e2596258736fb2f486.pdf
http://projects.hsl.wisc.edu/GME/PainManagement/session2.4.html
References:
American Academy of Neurology and American Clinical Neurophysiology Society
Understanding the effect of pain and how the human body responds
https://www.nursingtimes.net/clinical-archive/pain-management/understanding-the-effect-of-pain-and-how-the-human-body-responds-26-02-2018/