Physiology of Pain (PPT) Nervous System PhysiologyShaista Jabeen
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Physiology of Pain (PPT)
Nervous System Physiology
INTRODUCTION
BENEFITS OF PAIN SENSATION
COMPONENTS OF PAIN SENSATION
PATHWAYS OF PAIN SENSATION
FROM SKIN AND DEEPER STRUCTURES
FROM FACE
FROM VISCERA
FROM PELVIC REGION
VISCERAL PAIN
CAUSES OF VISCERAL PAIN
REFERRED PAIN
DEFINITION
EXAMPLES OF REFERRED PAIN
MECHANISM OF REFERRED PAIN
NEUROTRANSMITTERS INVOLVED IN PAIN SENSATION
ANALGESIA SYSTEM
ANALGESIC PATHWAY
GATE CONTROL THEORY
APPLIED PHYSIOLOGY
Short Notes
pdf ppt
Physiology of Pain (PPT) Nervous System PhysiologyShaista Jabeen
https://www.youtube.com/channel/UCrrAABI7QDRCJ1yMrQCip_w/videos
https://www.facebook.com/ShaistaJabeeen/
https://www.facebook.com/Human-Physiology-Lectures-100702741804409/
Physiology of Pain (PPT)
Nervous System Physiology
INTRODUCTION
BENEFITS OF PAIN SENSATION
COMPONENTS OF PAIN SENSATION
PATHWAYS OF PAIN SENSATION
FROM SKIN AND DEEPER STRUCTURES
FROM FACE
FROM VISCERA
FROM PELVIC REGION
VISCERAL PAIN
CAUSES OF VISCERAL PAIN
REFERRED PAIN
DEFINITION
EXAMPLES OF REFERRED PAIN
MECHANISM OF REFERRED PAIN
NEUROTRANSMITTERS INVOLVED IN PAIN SENSATION
ANALGESIA SYSTEM
ANALGESIC PATHWAY
GATE CONTROL THEORY
APPLIED PHYSIOLOGY
Short Notes
pdf ppt
In this presentation I have tried to explain in brief about pain management, different types of pain, its diagnostic criteria, its physiology, and its treatment approaches both pharmacological and non pharmacological
Comprehensive description of pain pathways which covers related definitions, benefits, theories, classification and mechanism of pain with factors that affect pain and diagnosis of pain. Also covers assessment and management of pain along with brief description of ascending and descending pain pathways.
In this presentation I have tried to explain in brief about pain management, different types of pain, its diagnostic criteria, its physiology, and its treatment approaches both pharmacological and non pharmacological
Comprehensive description of pain pathways which covers related definitions, benefits, theories, classification and mechanism of pain with factors that affect pain and diagnosis of pain. Also covers assessment and management of pain along with brief description of ascending and descending pain pathways.
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Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
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Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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1. Concept Of Pain
SHAHINA BANO
(Lecturer, DUHS, DION&M)
Year 1, semester II
Objectives
At the end of the session learners will be able to:
1. Define the process of pain (physiological changes)
2. Describe the different theories of pain theory.
3. differentiate between acute and chronic pain
4. Discuss the non pharmacologic interventions pain management.
5. identify pharmacologic interventions for pain management
Concept of pain
• . The International Association for the Study of Pain (IASP) defines pain as
• “an unpleasant, subjective sensory and emotional experience associated with actual or potential tissue
damage, or described in terms of such damage” (IASP, 2010).
• It is the most common reason for seeking health care. It occurs with many disorders, diagnostic tests, and
treatments.
Nociception
• The extent to which pain is perceived depends on the interaction between the body analgesia system,
the nervous system's transmission and mind’s interpretations of stimuli and its meaning.
The peripheral nervous system includes specialized primary sensory neurons that detect mechanical, thermal, or
chemical conditions associated with potential tissue damage.
When these nociceptors are activated, signals are transduced and transmitted to the spine and brain where the
signals are modified before they are ultimately understood and then “felt.”
The physiological processes related to pain perception are described as nociception
2. Physiology of pain
• The physiological process are involved in nociception:
1. Transduction
2. Transmission
3. Perception
4. Modulation
Transduction of Pain
• Specialized pain receptors or nociceptors can be excited by mechanical, thermal and chemical stimuli.
3. • Pain stimuli is converted to electrical energy. This electrical energy is known as Transduction. This
stimulus sends an impulse across a peripheral nerve fiber (nociceptor).
Transduction of Pain
• During the transduction phase, harmful stimuli trigger the release of biochemical mediators, such as
prostaglandins, bradykinin, serotonin, histamine, and substance P, which sensitize nociceptors.
• Painful stimulation also causes movement of ions across cell membranes, which excites nociceptors.
• This conversation is known as Transduction.
• Pain medications can work during this phase by blocking the production of prostaglandin (e.g., ibuprofen
or aspirin) or by decreasing the movement of ions across the cell membrane (e.g., local anesthetic)
Transmission
• The second process of nociception, transmission of pain, includes three segments.
• During the first segment of transmission, the pain impulses travel from the peripheral nerve fibers to the
spinal cord.
• There are primarily two types of peripheral nerve fibers that conduct painful stimuli.
1) The fast, myelinated A- delta fibers:
send sharp, localized, and distinct sensations.
2) The small, slow unmyelinated C fibers:
Relay slower impulses that are poorly localized, visceral, and persistent
Example: after stepping on a nail, a person initially feels a sharp localized pain, which is result of A- fiber
transmission. Within a few seconds, the whole foot aches from C-fiber stimulation.
After the pain impulse ascends the spinal cord, information is send quickly to higher centers in the brain.
4. • The second segment is transmission of the pain signal through an ascending pathway in the spinal cord to
the brain
• The third segment involves transmission of information to the brain where pain perception occurs.
• Pain control can take place during this second process of transmission.
• For example, opioids (narcotic analgesics) block the release of neurotransmitters, particularly substance P,
which stops the pain at the spinal level
Perception of Pain
• It is the third process of nociception.
• It is when a person becomes conscious of the pain. It is believed that pain perception occurs in the
cortical structures, which allows for different cognitive behavioral strategies to be applied to reduce the
sensory and affective component of pain
• For example, Cognitive–behavioral therapy and approaches such as distraction ,imagery and music can
help direct the client’s attention away from pain.
Modulation of Pain
• This is the fourth system, often describes as the “descending system,”.
• These descending fibers release substances such as endogenous opioids, serotonin and norepinephrine
which can inhibit the ascending of noxious impulses in the dorsal horn
5. Types of pain
• Pain is categorized by:
Duration (acute or chronic)
Pathological condition (e.g., cancer or neuropathic)
Acute Pain
• Also known as Transient Pain.
• Acute pain is protective, has an identifiable cause, is of short duration, and has limited tissue damage and
emotional response.
• It eventually resolves, with or without treatment, after an injured area heals.
• Acute pain has a predictable ending (healing) and an identifiable cause, health team members are usually
willing to treat it aggressively. Unrelieved acute pain can progress to chronic pain (Kehlet et al., 2006).
Chronic Pain
• Chronic pain, also known as persistent pain, is prolonged, usually recurring or lasting 3 months or longer,
and interferes with functioning.
• Chronic pain is not considered protective, may not have an identified cause, and leads to great personal
suffering.
• Chronic may be noncancerous (non-malignant) or cancerous(malignant).
• Example of chronic pain arthritis, low back pain, headaches and peripheral neuropathy.
Cancer Pain
• Cancer pain may be acute and/or chronic. It can be due to tumor progression and its related pathological
process, invasive procedures toxicities of treatment, infection and physical limitations.
6. • Cancer pain can be sensed at the actual site of the tumor or distant to the site. This kind of pain is called
referred pain.
• Not all clients with cancer will experience pain.
Neuropathic pain
• Neuropathic pain is associated with damaged or malfunctioning nerves due to illness (e.g., diabetic
peripheral neuropathy), injury (e.g., spinal cord injury pain), or undetermined reasons.
• Neuropathic pain is typically chronic; it is described as burning, “electric-shock,” and/or tingling, dull, and
aching.
Episodes of sharp, shooting pain can also be experienced. Neuropathic pain tends to be difficult to treat.
Types of Pain by Location
• Superficial or coetaneous pain
– Pain resulting from stimulation of skin
• Deep or Visceral pain
– Pain resulting from stimulation of internal organ
• Referred pain
– Perception of pain is in unaffected areas. Common phenomena in visceral pain because many
organs themselves have no pain receptors. Example. MI
• Radiating pain
– Sensation of pain extending from initial site of injury to another body part. Example: low back
pain, sciatic nerve irritation radiating down to leg.
INTENSITY of pain
• Most practitioners classify intensity of pain by using a standard scale:
• 0 (no pain) to 10 (worst possible pain) scale.
– 1 to 3 range is deemed mild pain
– 4 to 6 is moderate pain
– 7 to 10 is deemed severe pain and is associated with the worst outcomes
Factors Influencing Pain
• Degree of pain perception
• Past experience
7. • Social factors : attention ,family support
• Physiological factors: Age, Fatigue, Genes
• Social factors: Attention, Previous experience, Family and social support
• Psychological factor :Anxiety, Coping style
• Spiritual factor
• Cultural factor
• Response of health professionals
Gate-Control theory of Pain
Psychologist Ronald Melzack and the anatomist Patrick wall proposed the gate control theory for pain in 1965 to
explain the psychological aspects of pain are as important as the physiological aspects.
• According to them, the pain stimuli transmitted by afferent pain fibers are blocked by Gate mechanism
located at the posterior gray horn of the spinal cord. if the gate is opened, pain is felt. if the gate is closed,
pain is suppressed.
• The gate control theory combines cognitive, sensory, and emotional components in addition to the
physiological aspects.
• The mechanism act on a gate control system to block the individual’s perception of pain.
• Pain perception is regulated through a gating mechanism at the dorsal horn of the spinal cord.
• The gating mechanism causes vasoconstriction and decreased nerve conduction velocity, thereby
reducing the transmission of noxious stimuli.
• As a result, the level of conscious awareness of painful sensation is altered.
• The large-diameter cells have the ability, when properly stimulated, to ‘‘close the gate’’ and thus block
transmission of the pain impulse to the brain .
• Stimulants such as cutaneous massage, opioid release, and excessive stimulation all activate the large-
diameter cells to close the gate.
• Clinically, the effectiveness of several nonpharmacologic modalities, such as massage, acupuncture, and
acupressure, supports the gate control theory
9. • Pain impulses can be regulated or even blocked by gating mechanism located along the central nervous
system.
• The theory suggests that pain impulses pass through when a gate is open and that impulses are blocked
when a gate is closed.
• This gating mechanism can be found in the cells of dorsal horn of the spinal cord, thalamus and limbic
system
Pain Threshold
• Pain threshold is the point at which a person feels pain.
• Pain threshold can be different for different individuals, because stress, exercise and many other factors
increase the release of endorphins, raising an individual’s pain threshold.
• The amount of circulating substances vary with every individual, so the response to pain will be different
among different individuals.
Pain Management
Assessment
As pain intensity is considered the fifth vital sign
In assessing a patient with pain, the nurse reviews the patient’s description of the pain and other factors that may
influence pain (e.g., previous experience, anxiety, and age) as well as the person’s response to pain relief
strategies.
COLDERRA
C= Characteristic of pain, e.g Sharp pain, dull pain, diffused pain, pressure, squeezing, heaviness
O= Onset of pain. When pain started, and how pain initiated?
L= Location of pain.
D= Duration of pain. For how long pain persists?
E= Exacerbating factors. What factor/factors increase the pain? e.g activity, exercise, diet, drug
R=Relieving factors. What factor/factors relieve pain, e.g drug, rest etc
R=radiating. Does pain radiate (spread) anywhere else or not
A=Associated factors. What other symptoms do occur with pain e.g diaphoresis, nausea, vomiting etc
Pain Scale (Liker Scale)
12. The FLACC scale has been validated in children 2 months to 7 years old and rates pain behaviors as manifested by :
Facial expressions, Leg movement, Activity, Cry, and Consolability
measures that yield a score of 0 to 10.
13. Pain Management
• Pain management strategies include both pharmacologic and nonpharmacologic approaches.
• These approaches are selected on the basis of the patient’s requirements and goals.
• Appropriate analgesic medications are used as prescribed. They are not considered a last resort to be
used only when other pain relief measures fail. Any intervention is most successful if initiated before pain
sensitization occurs, and the greatest success is usually achieved if several interventions are applied
simultaneously.
Pharmacological Approaches
• Pharmacologic pain management involves the use of:
Opioids (narcotics)
Nonopioids such as nonsteroidal anti-inflammatory drugs (NSAIDS)
Coanalgesic drugs
• These agents work by different mechanisms. Using two or three types of agents simultaneously can
maximize pain relief while minimizing the potentially toxic effects of any one agent.
• When one agent is used alone, it usually must be used in a higher dose to be effective
Opioids
• Opioids can be administered by various routes, including oral, intravenous, subcutaneous, intraspinal,
intranasal, rectal, and transdermal routes.
• The goal of administering opioids is to relieve pain and improve quality of life; therefore, the route of
administration, dose, and frequency of administration are determined on an individual basis.
Side effects of Opioids
• Respiratory depression
• Nausea and vomiting
• Constipation
• Tolerance and addiction
Nonsteroid Anti-inflammatory Drugs (NSAIDs)
• NSAIDs are thought to decrease pain by inhibiting cyclo-oxygenase (COX), the rate-limiting enzyme
involved in the production of prostaglandin from traumatized or inflamed tissues.
• Example:
14. • Asprin, Ibuprofen, Diclofanic sodium (Dicloran), Acetaaminophen (paracetamol), Mafemanic acid
(Ponston)
Side effects of NSAIDS
• Gastric ulceration
• Impaired kidney and liver function
• Bleeding tendencies
Coanalgesics
• A coanalgesic (formerly known as an adjuvant) is a medication that is not classified as a pain medication.
• Coanalgesics have properties that may reduce pain alone or in combination with other analgesics, relieve
other discomforts, potentiate the effect of pain medications, or reduce the pain medication’s side effects.
• Examples of medications used to reduce the side effects of analgesics include stimulants, laxatives, and
antiemetic.
Non pharmacological Approaches
• Cutaneous Stimulation
– Massage
– Application of heat or cold
– Acupressure
– Contralateral stimulation.
• Transcutaneous Electrical Nerve Stimulation (TENS)
• Cognitive–Behavioral Interventions
– Distraction
– Guided Imagery
– Relaxation Techniques
• Selected Spiritual Interventions
Non Pharmacological Approaches
16. References
• Berman, A., Frandsen, G., Snyder, S., Kozier, B., & Erb, G. L. (2016). Kozier and Erb's fundamentals of
nursing, volumes 1-3 (10th ed.).
• Delaune, S. C. (2010). Fundamentals of nursing (4th ed.). Delmar Pub.