Beruflich Dokumente
Kultur Dokumente
- Introduction to pain
o the symptom most likely to inspire people to seek medical care
o defined as a sensory & emotional experience that is unpleasant and has the
role of alerting us to potential damage to the body or body tissues
o there are different qualities and experiences of pain
thermal:
chemical:
o the role of sensory receptors is to convert stimulus energy to electrical energy, which
can be conducted down the axons (nerve fibers) of neurons –we call these conducting
impulses action potentials
o first order sensory neuron –carries action potentials from the sensory receptor to the
central nervous system (to either the spinal cord or brain)
impulse arrives in the dorsal horn of the spinal cord, which is where
communication between the first-order & second-order sensory neuron
occurs
o second order sensory neuron
cell body of second-order sensory neurons are located inside the dorsal horn
of the spinal cord
signal can be inhibited (not passed on) or passed onto the second order
neuron at this point
nerve fibers of the second-order sensory neurons cross over from one side of
the spinal cord to the other
this cross-over is called decussation
as a result of decussation, signals that originate on one side of the
body get carried to the alternate side of the brain
fibers of second order sensory neurons carry impulses up spinal cord, through
the brainstem to the thalamus:
- one pathway involves nociceptor passing signal via a type A delta nerve fiber
- The other pathway involves nociceptor passing signal via type C nerve fibers
o the signals carried by these fibers are perceived as dull, burning, throbbing pain
o impulses are conducted up the spinal cord to the brainstem via the spinoreticular
tract
passes up spinal cord to the brainstem, and then on to multiple sites in brain
adds emotional overtones to perceptions of pain
- one type of modulation occurs at the level of communication between the first-order and
second-order sensory neurons (in dorsal horn)
o other fibers, called type A beta fibers, are also conducting information to this
synapse
the type A beta fibers are carried in the same nerves that are carrying type A
delta fibers & type C fibers
type A beta fibers (like the type A delta fibers) are large diameter, myelinated
fibers (fastest conduction speed)
type A beta neurons also synapse with second-order sensory neurons –and
the impulse/information carried by the second-order neuron is conducted via
the spinothalamic tract –and is subsequently carried to the primary
somatosensory cortex by third-order sensory neurons
- the third mechanism of pain modulation is associated with the endogenous opiod system
o the endogenous opiods: enkephalins, endorphins, dynorphin
- somatic pain
o subcategories:
superficial somatic pain
typical experienced in response to mechanical or thermal stimuli
- visceral pain
o this types of pain is associated with internal organs, which have nociceptors in their
walls
o deep throbbing pain
o impulses related to this type of pain are carried by type C nerve fibers
o through unconscious neural reflexes, this kind of pain can trigger nausea, vomiting
and other symptoms
o this type of pain is difficult to localize –is often experienced as referred pain –i.e.,
brain interprets the pain as occurring at the body surface
- neuropathic pain
o unlike somatic pain & visceral pain, neuropathic pain occurs when nerves themselves
are damaged (rather than when nociceptors are activated)
- comprehensive pain assessment in a health care setting involves a number of question areas
o intensity
assessed via pain scales
verbal scales:
picture scales-
o onset
o duration
o frequency
o location
o quality
examples -burning, aching, sharp, etc.
o associated symptoms
o precipitating factors
o alleviating factors
o impact
o in the 20th century- Melzack and Wall developed the gate control theory of pain-
eduation
type of work
income-
less access to healthcare, less continuity of care, more manual labor
physiologic consequences-
functional consequences-
psychosocial consequences-
- Treating pain-