pathophysiology of paediatric pain€¦ · paediatric pain maarten o. mensink, md princess máxima...
TRANSCRIPT
Pathophysiology of
paediatric pain
Maarten O. Mensink, MD
Princess Máxima Centre, Utrecht, The Netherlands
case
Patient A. female
14 years
JIA
Affected joints: knees/ankles
℞ methotrexate
case
decursus Good inflammatory respons
No signs of inflammation
High pain scores (NRS 6-8)
Mother: “Usually doesn't complain about pain,
so yes, I'm verry worried.”
pain anatomy
keywords:
brain
spinal cord
Nerve
Soma
pain anatomy
pain anatomy
axon typeDiameter (μm)Speed (m/s)
Aα13-20
80-120
Aβ6-1235-75
Aδ1-5
5-35
C0.2-1.50.5-2
pain anatomy
pain anatomy
C
Aβ – Aδ
pain anatomy
pain anatomy
pain anatomy
pain in action
Wei F, Zhuo M. J Physiol, 2001
pain in action
Pain chronification
keywords:
glutamate
NMDA-receptor
Long Term Potentiation (LTP)
Wide Dynamic Range neuron (WDR)
Central sensitisation
Pain chronification
Wei F, Zhuo M. J Physiol, 2001
Pain chronification
Chronificatie pijn
Pain chronification
Pain chronification
Central sensitisation:
Restructuring of synapses
learning:
– memory
– anticipation
Pain chronification
Diagnosing pain
pain-history:
pain-nature
pain-luxerative factors
pain-time factors
pain-related factors
diagnosing pain
pain-physical examination:
inspection
palpate
neurological examination
diagnosing pain
integration with system
fear/vigilance
cognition
Parent-child system
contributing somatic factors
treatment
pharmacological
tissue damage
inflammation
neuropathy
treatment
psychological
CBT
EMDR
mindfullness
system therapy
treatment
fysiotherapeutical
musculoskeletal evaluation
muscular training
6th of february 2020
#beppa@BBeppa