The document discusses pain management, emphasizing the distinction between acute and chronic pain, the pathophysiology of pain, and the role of interventional pain management techniques. It highlights the importance of understanding the psychological aspects of pain and the physiological mechanisms such as sensitization. Additionally, it notes that interventional pain management is a recognized medical specialty aimed at providing effective treatment options for various pain conditions.

2. 2IPSC India Training Institute

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Introduction
Anatomy
Fluoroscopic Anatomy
Radiological Evaluation
Pathophysiology
Lumbar Spine
Interventions
Thoracic, Sacral and
Pelvic Interventions
Neuropathic Pain
Sympathetic Interventions
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Head and Neck
Interventions
Case discussion
Troubleshooting
Schedule
Dr Swati Bhat
doctorswati29@gmail.com

4. Team IPSC India

5. Pain is "an unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage "
( IASP : 1979).
• Unpleasant
• Sensory
• Emotional experience: The problem may be brought on by something that affected the person emotionally
like the loss of a family member or inability to cope at work. The body then physically “expresses” these feelings in the form of pain
• Actual or Potential Tissue damage
• Described in terms of such damage ---Chronic pain

7. Types of Pain
· Acute Pain /Physiological
Pain
· Nociceptive
· Symptom of a disease
· Treatment of diseases cures
pain & it is self-limiting.
· Simple relationship between
pain and tissue damage
· Proportionate to the clinical
finding
· Chronic Pain /Pathological
Pain
· Neuropathic
· A disease itself, a disease of
nervous system.
· Difficult to treat & sustaining.
· Dissociated relationship
between pain and tissue damage
· Disproportionate to the
clinical finding

8. Pathophysiology of Pain

11. Enkephalins: Ca Channels presynaptic
K Channel Postsyneptic (Hyperpolarisation)

12. Gate-Control Theory
DCML
Dorsal Column Medial Meniscal system

13. Inhibitory Pathway:
Anti-nociceptive neurons
originate in the brain stem
and travel down the spinal
cord where they synapse
with short interneurons in the
dorsal horn by releasing
serotonin and norepinephrine
Connect to the limbic system and cerebral cortex
These neurons then cross over in the spinal
cord and go up to the thalamus, where they
synapse with third-order neurons.
Electrochemical signal opens voltage-
gated calcium channels in the pre-
synaptic terminal, allowing calcium to
come in—->Glutamate(excitatory
neurotransmitter) is released-> Glutamate
binds to NMDA receptors on the second-
order neurons, causing depolarization
A wave of depolarization is sent to the first-
order neurons, with sodium rushing in via
sodium channels and potassium rushing out
Activation of a nociceptor (pain receptor)
in response to a painful stimulus

14. Sensitization is a constant feature
Sensitization is a phenomenon of inappropriate or
disproportionate response to normal stimulus

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Central & Peripheral sensitisation
Ectopic discharges along nerve
axon, terminals & at DRG-
Pts may awaken at night
with pain.
SNS fibers invade DRG-
Oedema, colour changes.
Sensitization of primary
afferent terminals-
Hyperalgesia .
Active nociceptors become
sensitized and sleeping
nociceptors awaken-
Allodynia.
Damaged axons sprout, forms
collaterals- Increased area
of pain .

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Results of Sensitization
Increased
area of
pain.
Decreased
tolerability
to pain
Increased
intensity of
pain.
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id lectus. Lorem ipsum dolor sit amet, consectetur
adipiscing elit.
Development
of
psychological
problems.
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Pain become
non-responsive
to conventional
analgesics.

17. Interventional
Pain
Management
Interventions are Minimally Invasive, Non
Surgical and Target Specific and Guided
procedures to Diagnose and to treat Various
painful conditions
It fills the gap between pharmacologic management
and more invasive operative procedure

18. Important facts about pain management as the Speciality
Recognised as a 34 th Speciality in USA: American
society of Interventional pain physician
Pain as fifth vital
sign
Pain relief a human right – WHO
(world health organization)

19. Intenational Association for study of Pain-1973
World Institute of Pain-1993
Fellowship -2001

20. · Patients
· Procedure
· Timing
· Number of procedures
· Contraindications
· Complications
· Do not hesitate to
abandon
· Follow Up
Selection IS THE key