Pain is Unwanted, unpleasant sensory and emotional experience associated with actual or potential tissue damage, it is usually a subjective experience. Pain is classified by duration and etiology. Pain is of two types Acute pain Chronic Pain

1. Pain Management
Raghavendra S.Hegde
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2. Pain
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7. Pathophysiology
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8. {pathophysiology}
• Basically, noxious signals send impulses to the spinal cord,
which relays the information to the brain.
• The brain interprets the information as pain, localizes it, and
sends back instructions for the body to react.
• Pain sensation is mediated by pain receptors, or nociceptors,
which are present in the skin, superficial tissues and virtually
all organs, except for the brain.
• These receptors are essentially the nerve endings of so-called
“first-order neurons” in the pain pathway.
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9. • The axons of these neurons can be myelinated, A type, or,
unmyelinated, C type.
• Myelinated A fibers conduct at FAST speeds and are
responsible for the initial SHARP pain perceived at the time of
injury.
• Unmyelinated C fibers conduct at SLOWER speeds and are
responsible for a longer-lasting, dull, diffusing pain.
• First-order neurons travel by way of spinal nerves to the spinal
cord, where they synapse with second-order neurons in the
dorsal horn.
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10. • These second-order neurons cross over to the OTHER side of
the cord, before ascending to the brain.
• This is how information of pain on the left side of the body is
transmitted to the right side of the brain, and vice versa.
• There are two major pathways that carry pain signals from the
spinal cord to the brain: -
1.The spinothalamic tract
2.The spinoreticular tract
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11. • The spinothalamic tract: second-order neurons travel up
within the spinothalamic tract to the thalamus where they
synapse with third-order neurons;
• Third-order neurons then project to their designated locations
in the somatosensory cortex.
• This pathway is involved in LOCALIZATION of pain.
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12. • The spinoreticular tract: second-order neurons ascend to the
reticular formation of the brainstem, before running up to the
thalamus, hypothalamus, and the cortex.
• This tract is responsible for the EMOTIONAL aspect of pain.
• Pain signals from the face follow a DIFFERENT route to the
thalamus.
• First-order neurons travel mainly via the trigeminal nerve to the
brainstem, where they synapse with second-order neurons, which
ascend to the thalamus.
• Pain from the skin, muscles and joints is called SOMATIC pain.
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13. • While pain from INTERNAL organs is known as VISCERAL pain.
• Visceral pain is often perceived at a DIFFERENT location in a
phenomenon known as REFERRED pain.
• For example, pain from a heart attack may be felt in the left
shoulder, arm or back, rather than in the chest, where the
heart is located.
• This happens because of the CONVERGENCE of pain pathways
at the spinal cord level.
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15. Diagnosis
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16. Numeric Scales
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17. WONG BAKER FACES
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