definition of pain - classification - categories and different clinical types of pain - assessment of pain and how to manage using pharmacological and non-pharmacological intervention
Physiology of Pain, Characteristic of pain, Basic consideration of nervous system, Pain receptor, Mechanism of pain causation, Theories of pain, Pathways of pain, Pain Receptors
definition of pain - classification - categories and different clinical types of pain - assessment of pain and how to manage using pharmacological and non-pharmacological intervention
Physiology of Pain, Characteristic of pain, Basic consideration of nervous system, Pain receptor, Mechanism of pain causation, Theories of pain, Pathways of pain, Pain Receptors
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
INTRODUCTION
HISTORY
EPIDEMIOLOGY
DEFINITIONS OF PAIN
BENEFITS OF PAIN
NOCICEPTION
PAIN RECEPTORS
THEORIES OF PAIN
CHARACTERISTICS OF PAIN
PAIN PATHWAY
MECHANISM OF PAIN
PAIN ASSESSMENT
APPLIED ASPECTS
CONCLUSION
REFERENCES
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Define Pain
Theories of Pain
Pain Gate Control theory
CONTENTS
3. Pain is defined as unpleasant sensory
and emotional experience that is
associated with actual or potential
tissue damage.
(International association for the study of
pain,Merskey et al, 1979)
Pain is one of the most common reasons
a person seeks medical attention.
Can you Define Pain ?
4. Pain is a protective mechanism, person try to
remove the tissue damage.
loss of pain perception can cause and increase
tissue damage (eg:- bed sores)
5. Subjective sensation
Pain Perceptions – based on expectations,
past experience, anxiety, suggestions
Affective – one‟s emotional factors that can
affect pain experience
Behavioral – how one expresses or controls pain
Cognitive – one‟s beliefs (attitudes) about pain
Physiological response produced by
activation of specific types of nerve fibers
7. Types of pain
Fast pain (Aδ)
Or
Sharp pain
Prickling pain
Acute pain
Electric pain
Slow pain (C fibers)
or
Burning pain
Aching pain
Chronic pain
8. Cutaneous Pain – sharp, bright, burning; can have a
fast or slow onset
Deep Somatic Pain – stems from tendons, muscles,
joints, periosteum, & b. vessels
Visceral Pain – originates from internal organs;
diffused @ 1st & later may be localized (i.e.
appendicitis)
Psychogenic Pain – individual feels pain but cause is
emotional rather than physical
9. Referred pain
Occurs away from pain site
Example:Angina pectoris
Types of referred pain:
Myofascial Pain – trigger points, small hyperirritable
areas within a muscle in which nerve impulses
bombard CNS & are expressed at referred pain
Sclerotomic & Dermatomic Pain – deep pain; may
originate from sclerotomic, myotomic, or dermatomic
n. irritation/injury
10. Sclerotome: area of bone/fascia that
is supplied by a single n. root
Myotome: m. supplied by a single
n. root
Dermatome: area of skin supplied by
a single n. root
11. Properties of pain fibers
Fast pain
Receptors -Free nerve endings
Afferent -Aδ(group III) fibers
Action potential-Relatively slow
Conduction velocity-5-30m/s
Subjective sensation-Sharp,pricking pain
Onset of sensation & Localisation-
Short latency,easily identified
Duration -Short lasting
Subjective response -Reflex withdrawl,
less emotional involvement
Myelinated
Large diameter fibers
Slow pain
1) Free nerve endings
2) C (group IV) fibers
3) Very slow
4) 0.5-2m/s
5) Dull,burning & Throbbing
pain
6) Poorly localised,diffuse
7) Long lasting
8) Difficult to
endure,possible emotional
& automatic response
9) Non myelinated
10) Small diameter fibers
27. Pain Gate control Theory
Ronald Melzack
(1929)
Patrick Wall
(1925-2001)
28. Substantia Gelatinosa (SG) in dorsal horn of spinal
cord acts as a „gate‟ – only allows one type of
impulses to connect with the SON
Transmission Cell (T-cell) – distal end of the SON
If A-beta neurons are stimulated – SG is activated
which closes the gate to A-delta & C neurons.
If A-delta & C neurons are stimulated – SG is
blocked which closes the gate to A-beta neurons.
Pain Gate control Theory
29. Gate - located in the dorsal horn of the spinal
cord
Smaller, slower n. carry pain impulses
Larger, faster n. fibers carry other sensations
Impulses from faster fibers arriving @ gate 1st
inhibit pain impulses (acupuncture/pressure, cold, heat,
chem. skin irritation).
Pain Gate control Theory
33. Central Biasing Theory
Descending neurons are activated by: stimulation
of A-delta & C neurons, cognitive processes,
anxiety, depression, previous experiences,
expectations
Cause release of enkephalins (PAG) and serotonin
(NRM)
Enkephalin interneuron in area of the SG blocks
A-delta & C neurons
34. Endogenous Opiates Theory
Stimulation of A-delta & C fibers causes release of B-
endorphins from the PAG & NRM
Or
ACTH/B-lipotropin is released from the anterior
pituitary in response to pain – broken down into B-
endorphins and corticosteroids
Mechanism of action – similar to enkephalins to block
ascending nerve impulses
Examples: TENS (low freq. & long pulse duration)
35. 1. Intensive (Summation ) Theory
2. Specificity Theory
3. Strong‟s Theory
4. Pattern Theories
5. Central summation Theory
6. The Fourth Theory of pain
7. Sensory interaction Theory
8. Pain Gate control Theory
Theories of Pain
36. Erb -1874
According to this theory “every stimulus was
capable of producing pain if it reached sufficient
intensity”.
Developed by Goldscheider -1894
Both stimulus intensity and central summation as
critical determinants of pain. It was implied that
the summation occurred in the dorsal horn cells.
Intensive (Summation ) Theory
37.
38. Von Frey -1895
This theory is based on the assumption that the free
nerve endings are pain receptors, and that the other 3
types of receptors are also specific to a sensory
experience.
Pain perception was viewed as a function of the
amount of physical damage alone.
Specificity Theory
39.
40. Strong – 1895
Pain was an experience based on the noxious stimulus
& the psychic reaction or displeasure provoked by the
sensation
Strong‟s Theory
41. Nafe – 1934
All cutaneous qualities are produced by spatial &
temporal patterns of nerve impulses rather than by
separate, modality-specific transmission routes.
Pattern Theories
42. Livingston – 1943
The intence stimulation resulting from nerve &
tissue damage activated fibers that projected to
internuncial neuron pools within the spinal cord.
Abnormal reverberating circuits were created, with
self activating neurons.
Prolonged abnormal activity bombarded cells in the
spinal cord, & information was projected to the
brain for pain perception.
Central summation Theory
43. Hardy, Woff & Goodell- 1940
Expanded on strong theory
Stated that pain was composed of 2 components:the
perception of pain & the reaction one has to it.
Physiopsychological process involving cognitive functions
of the individual & influenced by past
experinces,culture, & various psychological factors that
produce great variation in the “reaction pain
threshold”
The Fourth Theory of pain
44. Noordenbos – 1959
2 systems involving transmission of pain & other
sensory information with a fast & slow system.
The slow system, composed of unmyelinated small
diameter fibers, was presumed to conduct somatic &
visceral afferents.
The fast system, composed of large fibers, was said
to inhibit transmission of the small fibers.
Sensory interaction Theory
46. Pain Evaluation
Need to determine underlying cause if possible
Pain is subjective
Difficult to describe and characterize objectively
47. In all types of pain accurate assessment is essential.
However simply asking the patient “how much does it
hurt” is not enough.
There is no direct relationship between physical
pathology and the intensity of pain.
The patient‟s subjective experience may be difficult to
communicate.
Pain Assessment
48. OPQRST Format
Origin/Onset of pain
Position /pattern of pain
Quality of pain
Quantity of pain
Radiating pain
Signs &Symptoms
Treatment
ASSESSMENT OF PAIN
49. Origin /Onset of pain: how did the pain started:
suddenly/gradually
Mechanism of injury
Position/pattern: constant or periodic
Localized/ radiating
Aggravating and relieving factors
Improving/worsening/remain same
Quality of pain: mechanical-pressing stabbing
Chemical-burning
Neural-numbness/pins and needles
Vascular- throbbing
50. Quantity of pain: intensity of pain
Radiation: characteristics of pain radiation
Signs and symptoms: Functional,
psychological
Treatment: Previous treatment
Current treatment effectiveness
51. Verbal rating scale
Wong/baker faces
Pain diagrams / Body diagrams
Visual analogue scale
McGill pain questionnaire
Tools used to measure pain
58. Visual Analogue Scale
The VAS is a simple robust pain
measurement tool
It can be used to measure severity & or
Improvement
It can be reliably used for children over
the age of five
The VAS is usually designed as a 10cm line
with descriptors at each end.
59. Visual Analogue Scale
No Pain Worst pain
Possible Pain
The example shows a patient recording a 9.0
i.e. The patient has made a mark 9cms from the no pain end
of the scale.
NB The VAS can be compromised if descriptors or numbers
are added between the end points.
{The 10 cm line allows for easy measurement and recording}
60. i. Sheila Kitchen.Electrotherapy:Evidence-Based Practice
ii. Val Robertson, Alex Ward, ohn Low and Ann
Reed.Electrotherapy Explained-Principles & Practice.
iii. Basana Kumar Nanda.Electrotherapy Simplified.
Newdelhi:Jaypee brothers;2008.
iv. Susan B O‟Sullivan, and Thomas J Schmitz. Physical
Rehabilitation. Newdelhi:Jaypee brothers;2007.
References