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Pain Pathway

The document summarizes pain management topics including the definition of pain, pain pathways, gate control theory, and key terminology related to sensory disturbances associated with pain. It describes how pain signals are transmitted from nociceptors along three neuronal pathways through the dorsal horn, thalamus, and cortex. It also explains the gate control theory of how non-painful stimuli can inhibit pain signals from reaching the brain.

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Salsabila Al-Basheer
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330 views

Pain Pathway

The document summarizes pain management topics including the definition of pain, pain pathways, gate control theory, and key terminology related to sensory disturbances associated with pain. It describes how pain signals are transmitted from nociceptors along three neuronal pathways through the dorsal horn, thalamus, and cortex. It also explains the gate control theory of how non-painful stimuli can inhibit pain signals from reaching the brain.

Uploaded by

Salsabila Al-Basheer
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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PAIN

MANAGEMENT

SITI NUR BAITI BINTI


SHAIK KHAMARUDIN
012013100196
OUTLINE
1. Definition of pain
2. Pain pathway
3. Gate control theory
4. Terminologies - sensory
disturbances associated with pain
DEFINITION OF PAIN
As defined by International Association
for the Study of Pain
An unpleasant sensory and
emotional experience
associated with actual or
potential tissue damage, or
described in terms of such
damage.
PAIN NEURONAL
PATHWAY

Third order
neuron

Second order
neuron

First order
neuron
PAIN PATHWAY
Conducted in 3 neuronal
pathways that transmit
noxious stimuli from
periphery to cortex.
Cell bodies of primary
afferent neurons (in
dorsal root ganglia, at
vertebral foramina at
each level) Peripheral
Reach
Each
thalamus to has single axon
tissuesthat
bifurcates
synapse
Dorsal horn
with third
order
neurons
Synapses with
2nd order
PAIN RECEPTORS
Nociceptors or pain receptors are sensory
receptors that are activated by noxious insult to
peripheral tissues.
The receptive endings are free nerve endings and
have large receptive fields(widely distributed):
Superficial skin
Joint capsule
Periostea of bones
Wall of blood vessels
Sensitive to:
Extremes of temperature
Mechanical damage
Dissolved chemicals
First pain
Noxious
sensations
Second pain

FIRST PAIN SECOND


short latency PAIN
A fibres C fibres
(tested by pin- Slower onset,
prick). duller and
Fast, sharp often poorly
and well localized
localized. sensation.
A FIBRES C FIBRES

A fibres A fibres Small and


unmyelinated
Very slow
Large Small conducting
Myelinated Lightly Respond to all
Fast myelinated types of noxious
conducting Slow stimuli
Low stimulation conducting Transmit
threshold Respond to prolonged dull
Respond to heat, pain
light touch pressure, Require high
cooling and intensity stimuli
chemicals to trigger a
Sharp response
sensation of
pain
FIRST ORDER NEURON
(PERIPHERAL)

Sensory neuron
Cell body located
in dorsal root
ganglion or cranial
nerve ganglion
SECOND ORDER NEURON
(SPINAL)
Sensory neuron
synapses on an
interneuron in the
CNS

May be located in
the spinal cord or
brain stem

Axon crosses
THIRD ORDER NEURON
(SUPRASPINAL)
Second-order neuron
synapses on a third-order
neuron in the thalamus

Right thalamus and


primary cortex receive
sensory information from
left side of body and vice
versa.

Reaches our awareness


GATE CONTROL THEORY
The Gate Control Theory of
Chronic Pain is a famous theory
about how pain works, devised
by Patrick Wall and Ronald
Melzack in 1965.
The gate control theory of pain
asserts that non-painful input
closes the gates to painful
input, which prevents pain
sensation from traveling to the
central nervous system.
Therefore, stimulation by non-
noxious input is able to
suppresses pain.
When no input comes in, the
inhibitory neuron prevents the
projection neuron from sending
signals to the brain (gate is closed).

Normal somatosensory input


happens when there is more
large-fiber stimulation (or only
large-fiber stimulation).
Both the inhibitory neuron and the
projection neuron are stimulated,
but the inhibitory neuron
prevents the projection neuron
from sending signals to the brain
(gate is closed).

Nociception (pain reception)


happens when there is more
small-fiber stimulation or only
small-fiber stimulation.
This inactivates the inhibitory
neuron, and the projection
neuron sends signals to the brain
It explains stimulation-
induced analgesia
Large-fibre input activating
inhibitory neurons reduces the
input from smaller fibres.

When we suffer a minor


injury, our instinct is to rub it
better
Stimulates larger fibres with
touch and vibrations
Reduce transmission from
smaller fibres
TERMS USED IN PAIN
MANAGEMENT
Allodynia Perception of an ordinarily non-noxious
stimulus as pain
Analgesia Absence of pain perception
Anesthesia Absence of all sensation
Anesthesia dolorosa Pain in an area that lacks sensation
Dysesthesia Unpleasant or abnormal sensation with or
without a stimulus
Hypalgesia Diminished response to noxious stimulation
(hypoalgesia) (eg: pinprick)
Hyperalgesia Increased response to noxious stimulation
Hyperesthesia Increased response to mild stimulation
Hyperpathia Presence of hyperesthesia, allodynia and
hyperalgesia usually associated with
overreaction, and persistence of the
sensation after stimulus
Hypesthesia Reduced cutaneous sensation (eg: light
(Hypoesthesia) touch, pressure or temperature)
Neuralgia Pain in the distribution of a nerve or a
group of nerves
Paresthesia Abnormal sensation perceived without an
apparent stimulus
Radiculopathy Functional abnormality of one or more
nerve roots
REFERENCE
Clinical Anesthesiology: G. Edward
Morgan, Jr. Maged S. Mikhail,
Appleton & Lange.
Lecture Notes : Clinical Anaesthesia,
Carl L. Gwinnutt, Blackwell
Publishing.
http://
science.howstuffworks.com/life/insi
de-the-mind/human-brain/pain4.htm

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