Beruflich Dokumente
Kultur Dokumente
Dr Raghuveer Choudhary
Damaged tissues release proteolytic enzymes, K+
&histamine .Proteolytic enzymes act on globulins in the
interstitial Fluid to release kinins.
e.g bradykinin, K+ and histamine stimulate pain receptors
Pain is a protective sensation.
Pain receptors . Free nerve endings
Three types
1. Mechanical pain Receptors.: stimulated by
mechanical injurious stimuli.
2. Thermal pain Receptors. : discussed before.
3. Chemical pain Receptors.: stimulated by
chemical stimuli.
Chemical stimuli include:
bradykinin (most important) serotonin, histamine
& K+.
Distribution of pain receptors
- More : Skin, periosteum, arteries, joint surfaces, &
tentorium
cerebelli and cranial sinuses.
- Less : deep tissues.
- Absent : liver parenchyma, lung alveoli and brain.
►Nerve fibres: A delta and C fibres.
►Adaptation: Slowly (static-tonic) or nonadaptive
receptors.
Types of pain
Pain is classified according to the:
(a) Site of pain
1. Cutaneous pain.
2. Deep pain.
3. Visceral pain.
(b) Quality of pain
1. Epicritic i.e sharp pricking pain.
2. Protopathic i.e dull aching pain.
3. Burning pain.
(1) Cutaneous Pain
Bradykinin, Substance P
• Poorly Localized
• REFERRED PAIN
– Visceral Pain Usually Referred
– Deep Pain May Also be Referred
Referred pain
Definition
Pain originating from viscera but felt in somatic
structures which supplied by
the same spinal dorsal root ( the same dermatome)
of the diseased viscus.
Referred pain
• Examples
• 1. Cardiac pain: is felt in left shoulder.
• 2. Gall bladder pain: is felt in tip of right shoulder.
• 3. Appendicular pain: is felt around the umbilicus.
• 4. Gastric pain: is felt between the umbilicus & xiphoid
process.
• 5. Renal pain: is felt in the back, inguinal region &
testicles.
• 6. Teeth pain: referred to other teeth.
REFERRED PAIN
• Superficial Pain Never Referred
• Visceral Pain - Local & Referred
– May also Radiate to Distant Site
– Cardiac Pain
• Inner Aspect of Left Arm, Right Arm, even to Neck &
Abdomen
– Distension of Ureter
• Pain in Testicles
– Irritation of Parietal Plura & Peritoneum
• Pain Referred to Overlying Surface of Body
– Of Diaphragm
• Tip of Shoulder
REFERRED PAIN
• Mechanism
– Dermatome Rule
• Parts Develop from Same Embryonic Segment or
Dermatome
• Diaphragm Migrate from Neck
• Heart & Arm have Same Segmental Origin
• Convergence
– Somatic and Visceral Pain Afferents Converge on
Same Second Order Neuron
– Brain Unable to Differentiate Site of Origin
• Hence Pain Felt at Somatic Sites
Mechanism of referred pain
a. Convergence – projection theory
Afferent pain fibres from the skin and viscous
converge on the same cells of SGR or thalamus
and will finally activate the same cortical
neurons. Whatever the source of pain, the
cortex will project it to the skin being
the commenst source of pain.
b. Facilitation theory
Afferents of diseased viscera, give
facilitation to cutaneous
pain cells in Substantia Gelatinosa of
Rolandi (SGR),
Which leads to facilitation of their
stimulation.
REFERRED PAIN
• Facilitation Effect:
Continuous Pain
PAIN
• Intensity of Pain is Proportional to Degree of Tissue
Damage
• Ischemic Pain → Lactic Acid → Nerve Ending
Stimulation
• Muscle Spasm Mechanoreceptor Stimulation
Ischemia
• Transmission of Pain
– A – Delta Fibers: 6 to 30 M/Sec
– C – Fibers: 0.5 to 2 M/Sec
PAIN
• Mixed Spinal Nerve
• Localization is Good
• Neurotransmitter is Glutamate
• Few Fibers Ascends in Dorsal Column
• Slow pain: C –Fibers Ist Order Neuron
B) At the dorsal horn of the spinal cord: (the first gate of pain
transmission).
The hypothalamus, and other parts of the central analgesia system, activate the
spinal PIC which blocks the transmission of pain signals at the dorsal horn.
Melzack and Wall (1965, 1988) developed a comprehensive
theory of pain (‘gate-control theory’) which has generally
received wide support
Type II Fibers
Spino
Thalamic (-) (+)
Pathway (-)
S.G.Cells
T- Cells