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Sensory disturbances
Sensory disturbances can affect multiple systems including vision, hearing, smell, taste, superficial sensations like touch and pain, deep proprioception, and visceral sensations. Sensory pathways involve somatosensory receptors in the skin and muscles that transmit signals through peripheral nerves to the spinal cord and brain. Disturbances can be peripheral affecting individual nerves or segmental affecting dermatomes, and include hypoesthesia, hyperesthesia, anesthesia, dysesthesia, and paresthesia. Pain has many classifications including location, duration, and type including nociceptive, neuropathic, and psychogenic. Diagnosis involves history, exam, and tests to evaluate intensity and underlying cause. Treatment options include both non-pharmac
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Sensory disturbances
- 1. Sensory disturbances. Pain. TheI.M. Sechenov First Moscow State Medical University Chair of nervous diseases
- 2. Special • vision, hearing,smell, taste General • superficial (exteroception) • pain • temperature • tactile • deep (proprioception) • vibration • muscle-joint • spatial • pressure • complex types of sensation • location • stereognosis • visceral (inretoception) Types of sensation
- 3. Types of receptors Somatosensoryreceptors in the skin: •Free nerve ending (pain, temperature) •Tactile disk of Merkel •Peritrichial nerve endings around a hair follicle (touch) •Tactile corpuscle of Meissner. •Vater−Pacini corpuscle (pressure, vibration) •End bulb of Krause (cold?) •Ruffini corpuscle (warmth?) Receptors in muscle, tendons, and fascia: •Annulospiral ending of a muscle spindle (stretch) •Golgi tendon organ (tension) •Golgi−Mazzoni corpuscle (pressure)
- 4. Cross section ofa mixed peripheral nerve From Baehr, Duus' Topical Diagnosis in Neurology, 2005, Thieme
- 5. Classification of sensorynerve fibres Type of fibre Sensation Diameter (µ) Velocity of conduction (m/s) А β tactile, vibration 5 - 12 30 - 70 А δ pain (fast, well localized), cold 2 - 5 12 - 30 С pain (delayed, poorly localized), heat 0,4 - 1,2 0,5 - 2
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- 7. The cortical representationof different parts of the body The cortical representation of different parts of the body in the primary somatosensory cortex of the postcentral gyrus (left) and the primary motor cortex of the precentral gyrus (right) in the human being. (After Penfield, W., H. Jasper: Epilepsy and the Functional Anatomy of the Human Brain. Little, Brown, Boston 1954.)
- 8. Sensory disturbances • Hypoesthesia– decrease of sensation • Hyperesthesia – increase of sensation • Anaesthesia – loss of sensation • Dysesthesia – abnormal sensation • Paresthesia – sensation of tingling, burning, pricking, or numbness of a person's skin
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- 10. Segmental – radicular Segmental – dissociated disturbance: -All types - superficial - deep sensation Types of sensory disturbances
- 11. Spinal conductive Types ofsensory disturbances disturbance: - All types - superficial - deep sensation
- 12. Medullar (alternating) Hemispheral (hemitype) disturbance: - All types -superficial - deep sensation Types of sensory disturbances
- 13. Monofilament Cylinder with aplastic and metal tips Tuning-fork tactile temperature vibration Devices to assess the sensation
- 14. Additional methods forinvestigation of sensory fibers • Electroneuromyography (EMG) the amplitude of evoked potential and velocity of conduction for sensory nerves • Somatosensory evoked potentials Early and late components • Quantitative sensory testing Heat, cold, vibration and pain thresholds
- 15. PainPain An unpleasant sensoryand emotional experience associated with actual or potential tissue damage or described in terms of such damage International association for the study of pain, 1986
- 16. • Transient short duration •Acute within a period of injury and healing • Chronic beyond the normal healing period PainPain • Local • Referred • Irradiating
- 17. Nociceptive •is caused bystimulation of peripheral nerve fibers that respond only to stimuli approaching or exceeding harmful intensity (nociceptors); described as throbbing, aching, bursting Neuropathic •is caused by damage or disease affecting any part of the nervous system involved in bodily feelings (the somatosensory system); described as “burning,” “tingling,” “electrical,” “stabbing,” or “pins and needles Psychogenic •is pain caused, increased, or prolonged by mental, emotional, or behavioral factors PainPain
- 18. Peripheral mechanisms ofneuropathic pain • Spontaneous ectopic activity • Sensitization of pain receptors • Pathological interaction of fibers (ephapse) • Hypersensitivity to catecholamines
- 19. Central mechanisms ofpain • Central sensitization • “Wind up” phenomenon • Disinhibition
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- 21. Types of painsensation disturbances • Hypoalgesia – decrease of pain sensation • Analgesia – loss of pain sensation • Hyperalgesia – increase of pain sensation • Hyperpathia - a painful syndrome characterized by an abnormally painful reaction to a stimulus, especially a repetitive stimulus, as well as an increased threshold • Allodynia - a pain due to a stimulus which does not normally provoke pain • Anaesthesia dolorosa - is pain felt in an area (usually of the face) which is completely numb to touch
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- 24. Phantom limb painPoststroke pain Neuropathic pain
- 25. Complex regional painsyndrome Neuropathic pain • The most common symptoms overall are burning and electrical sensations, described to be like "shooting pain". • The patient may also experience muscle spasms, local swelling, abnormally increased sweating, changes in skin temperature (usually hot but sometimes cold) and color (bright red or a reddish violet), softening and thinning of bones, joint tenderness or stiffness, and/or restricted or painful movement. • Type I, formerly known as reflex sympathetic dystrophy does not have demonstrable nerve lesions. • Type II, formerly known as causalgia, has evidence of obvious nerve damage.
- 26. Diagnosis of pain •Anamnesis • Physical investigation • Evaluation of pain intensity (VAS) • Additional methods of investigation(MRI, EMG)
- 27. • Massage • TENS •Acupuncture • Neurostimulation • Neurosurgery • Physiotherapy • Biofeedback • Psychotherapy Non-pharmacological treatment of pain
- 28. • Local anesthetics •NSAIDs • Opiates • Antidepressants • Anticonvulsants Pharmacological treatment of pain