pain physiology - national university l20 pain... · 2019-01-21 · pain sensation pain is...
TRANSCRIPT
Neuro-PhysiologyKamal Mohammad
Lecturer Of Physiology
Faculty Of Medicine Dept.Of Physiology
PAINPHYSIOLOGY
LECTURE NO (-)
What is Pain?
An unpleasant sensory & emotional experience associated with actual or potential tissue damage.
The International Association for the Study of Pain
Pain sensation
Pain is unpleasant sensation that is characterized by the
following :
1. It has protective function (initiate the withdrawal reflex)
2. It is widely distributed particularly in the skin
3. Its adequate stimulus is not specific i.e. pain can be produced
by mechanical, thermal or chemical stimuli that lead to tissue
damage
4. It is almost a non- adapting sensation
PAIN RECEPTORS
PAIN RECEPTORS (the nociceptors)
These are specific naked free nerve endings of which
there are 3 types called the mechanical, thermal &
chemical pain receptors
These are excited by noxious stimuli
Mechanisms of stimulation
of pain receptors
Thermal
Chemical
Mechanical
Mechanism of stimulation of
pain receptors :
Pain receptors are stimulated chemically by
certain substances released from the damaged
tissues e.g. bradykinin, histamine, serotonin,
acids, excess K+ ions, prostaglandins.
Types of Pain
According to site of origin:
1- Cutaneous pain.
2- Deep pain.
3-Visceral pain
Cutaneous pain
This type of pain is perceived as a result of
stimulation of pain receptors in the skin.
Afferents:
a) Thin myelinated A delta fibers
b) Non myelinated C fibers.
Quality of pain
Slow burningFast pricking
C fibersA delta fibersAfferent
Felt shortly after injury
Felt during the injury
Onset
LongerShortDuration
BurningPrickingNature
Poorly localizedWell localizedLocalization
thalamusSensory cortexCenter
Skin & subcutaneous
tissues.
Substance P
Skin.
Glutamate
Site of receptors
Chemical transmitter
Reaction to cutaneous pain
1-Somatic effects:-In the form of protective withdrawal reflexes
2-Autonomic effects:- Mild or moderate pain results in sympathetic effects in
the form of: Tachycardia & Rise of arterial blood pressure.
Sever pain results in parasympathetic effects produced as bradycardia & hypotension.
3-Emotional effects:- As crying, restlessness & anxiety.
Deep pain
Origin: pain receptors in the deep structures as
muscles , ligaments and joints.
Afferent: non myelinated C- fibers
Nature: dull aching.
Localization: poorly localized.
Associated changes
1- Somatic changes:
spasm of nearby skeletal muscles.
2- Autonomic reactions:
decrease heart rate & blood pressure.
3- Emotional reactions:
anxiety, crying & depression
Visceral Pain
Origin: from internal viscera.
Nature: dull aching.
Afferent: non myelinated C fibers pass mainly
with autonomic fibers.
Localization: poorly localized.
Associated changes
1- Somatic changes: spasm of overlying skeletal
muscles.
2- Autonomic reactions: decrease heart rate & blood
pressure.
3- Emotional reactions: anxiety, crying & depression
Ion Fluxes(H+/ K+)
Mechanism of pain
Tissue Injury
Mast Cell
SensitizedNociceptor
Aspartate, Neurotensin, Glutamate, Substance P
To brain
Histamine
Bradykinin
Leukotrienes
Dorsalhorn
Prostaglandins
Pathways
Spinothalamic tract
(spinothalamic pathway)
Receptor
1th order
neuron
2th order
neuron
thalamus
3th order
neuron
Sensory
cortex
Referred pain
It is pain felt away from site of it’s origin.
It is felt in skin area away from the diseased viscera.
1-Gall bladder pain: is referred to the tip of the right
shoulder.
2-Renal colic: is referred downward to the inguinal region ,scrotum as well as to the back.
3-Cardiac pain: referred to the base of the neck & left
sholder
4-Gastric pain: Usually referred to the surface between the xiphoid process and the umbilicus .
5-Pain from an inflamed appendix: It is referred to the
midline at an area around the umbilicus.
Gall bladder pain
Cardiac pain
Renal painAppendicitis
Referred pain
Examples
Mechanism of referred pain
1-Convergence projection theory: Afferent pain fibers from the skin area and the diseased
viscera converge on the same second order neuron and finally stimulate the same cortical neuron.
Cortex will feel pain as if it is coming from the skin because the sensory cortex is accustomed to receive pain from the skin.
Referred pain mechanism
Convergence projection theory
Spinal cord
spinothalamic Tract
spinothalamic
neuron
skin
viscus
Convergence
2-Facilitation theory
Visceral pain afferent fibers send collaterals to facilitate the second order neuron of pain pathway from the skin area of reference facilitating the pain sensation from this area.
Minor activity in the pain pathway from this area leads
to pain sensation.
Facilitation mechanism of referred pain
Spinal cord
skin
viscus
threshold
Facilitate theory
Any question