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pain - Coggle Diagram

- - - - less than 6 months’ duration and
        
        an underlying pathology can be identified.
        
        Acute pain consists of a complex combination of unpleasant sensory, perceptual, and emotional experiences with
        associated autonomic, psychological, emotional, and behavioral reactions
        that occur in response
        to a noxious stimulus provoked by acute injury or disease.
        
        Mediated through rapidly conducting pathways and is associated with
        increases in muscle tone, heart rate, blood
        pressure, skin conductance, and other manifestations of
        increased sympathetic nervous system activity.
    - - persistent pain
        
        persists beyond the normal
        time for tissue healing
        
        Chronic pain is pain that does not resolve in the usual time it
        takes for the disorder to heal or that continues beyond the
        duration of noxious stimulation.
        
        Any pain lasting longer than 3 months or 6 months.
        
        Chronic persistent pain is generally associated with physical,
        psychological, and social dysfunction.
        
        Chronic persistent pain may be the result of changes in
        sympathetic nervous system and adrenal activity, reduced
        production of endogenous opioids, or sensitization of
        primary afferent and spinal cord neurons.
        
        These individuals frequendy have increased sensitivity to both
        noxious (hyperalgesia) and
        nonnoxious (allodynia) stimuli.
    - - the experience of pain in 1 area
        when the actual potential tissue damage is in another area
        
        Referred pain is felt at a location distant from its source.
        
        Pain is referred in one of 3 ways:
        
        From one area to another derived from the same embryonic segment,
        because the peripheral neural pathways from these
        different areas converge on the same or similar areas of the
        spinal cord and synapse with the same
        second-order neurons to
        ascend the spinal cord and reach the central cortex.
        
        From one area to another derived from the same dermatome,
        
        From a nerve to its area of innervation,
    - - Nociceptor are free, noncorpuscular peripheral nerve endings
        consisting of a series of spindle-shaped,
        thick segments linked by thin segments to produce a
        "string-of- beads" appearance.
        
        The beads and end bulbs contain
        
        mitochondria,
        
        glycogen particles,
        
        vesicles, and
        
        bare areas of axolemma that are not
        covered by Schwann cell processes.
        
        Nociceptors are present in almost all types of tissue.
        
        Nociceptors can be activated by
        
        intense thermal,
        
        mechanical, or
        
        chemical stimuli from exogenous or endogenous sources.
        
        When nociceptors are activated,
        they release a variery of neuropeptides
        from their peripheral terminals,
        including
        
        substance P and
        
        a number of breakdown products of
        arachidonic acid such as
        prostaglandins and leukotrienes.
        
        Nociceptors also convert the initial stimulus into electrical activity,
        In the form of action potentials by a process known as transduction.
      - Peripheral Nerve Pathways
        
        C fibers
        
        Group IV afferents
        
        small, unmyelinated nerve fibers that
        transmit action potentials quite slowly,
        at the rate of 1.0 to 4.0 meters/second.
        
        They respond to noxious levels of
        mechanical, thermal, and chemical stimulation, causing pain that is generally described
        as dull, throbbing, aching, or burning.
        tingling or tapping
        
        Activation can be reduced by opiates.
        
        A-delta fibers
        
        Group III afferents
        
        Small diameter myelinated fibers
        30 meters/second
        
        Most sensitive to high-intensity mechanical stimulation
        The sensations associated with A-delta fiber activity are generally described as
        sharp, stabbing, or pricking.
        
        Generally not blocked by opiates.
        
        C fibers
        A-delta fibers
        
        diag of ascending neural pathway of pain via A-delta & C fibers
        
        Central Pathways
        
        The peripheral first-order C and A-delta afferents project
        from the periphery to the gray matter of the spinal cord.
        
        The C and A–delta fibers synapse either directly or via interneurons,
        with second-order neurons
        in the superficial dorsal horn of the gray matter (the substantia gelatinosa).
        
        The second-order neurons in the dorsal horn are known as
        transmission orT cells.
        
        T cells make local connections
        within the spinal cord,
        either
        
        with efferent neurons as part of spinal cord reflexes or with
        
        afferent neurons that project toward the cortex.
        
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        Sympathetic nervous
        system influence
        
        Abnormal sympathetic activation caused by a
        -hyperactive response of the sympathetic nervous system to an acute injury or by a
        -failure of its response to subside,
        can increase pain severity and
        cause exaggerated signs and symptoms of sympathetic activity
        such as
        
        excessive vasomotor o r sweating reactions.
        
        Causalgia,
        
        reflex sympathetic dystrophy (RSD),
        
        shoulder-hand syndrome,
        
        posttraumatic dystrophy,
        
        Sudeck's atrophy, and
        
        sympathetically maintained pain.
        
        IASP – complex regional pain syndrome CRPS –Type I and Type II (nerve involvement)
        
        Role of Substance P
        
        SubstanceP is a chemical mediator that is thought to be involved in the transmission of
        neuropathic and inflammatory pain.
        
        It is abundant in the CNS & is found in
        approximately 20% of C fibers.
        
        Theories of Pain
        
        Intensity theory
        
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        Intensity theory
        Cartesian Dualistic Theory
        Specificity Theory
        Pattern Theory
        Gate Control Theory
        Neuromatrix Model
        Biopsychosocial Model
        
        Cartesian Dualistic Theory
        
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        Specificity Theory
        
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        Pattern Theory
        
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        Gate Control Theory
        
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        Neuromatrix Model
        
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        Biopsychosocial Model
        
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        Measuring pain
        
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