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21/10/20092PainWhat is the real definition of pain?

And what is pain management??

How can this information help me???

221/10/20093

321/10/20094PainDefinitions:An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is whatever the experiencing person says it is.May not be directly proportional to amount of tissue injury. Highly subjective, leading to undertreatment

421/10/20095Classification of Pain1.Acute2.Cancer3.Chronic non-malignant521/10/20096Acute PainInjury, trauma, spasm or disease to skin, muscle, somatic structures or viscera;Perceived and communicated via peripheral mechanisms (pathways) A delta and C fibersUsually with autonomic response as well (tachycardia, blood pressure, diaphoresis, pallor, mydriasis (pupil dilation);621/10/20097Acute PainUsually subsides quickly as pain producing stimuli decreases Associated with anxiety-(decreases rapidly)Can be understood or rationalized as part of the healing process.721/10/20098Chronic PainNon-malignantPain persists beyond the precipitating injuryRarely accompanied by autonomic symptomsSufferers often fail to demonstrate objective evidence of underlying pathology.Characterized by location-visceral, myofacial, or neurologic causes.821/10/20099Chronic PainMalignantHas characteristics of chronic pain as well as symptoms of acute pain (breakthrough pain).Has a definable cause, e.g. tumor recurrenceIn treatment, narcotic habituation isgenerally not a concern.921/10/200910Types of PainSomaticVisceralReferredBoneNeuropathicEmotional/Spiritual1021/10/200911Somatic Pain Aching, often constant May be dull or sharp Often worse with movement Well localized Skin, Muscle, Joints, superficial or deep.Eg: Bone & soft tissue chest wall

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Visceral Pain Constant or crampy Aching, burning Poorly localized Referred Organs of Thorax & Abdominal Cavity. Usually as a result of stretching, infiltration and compressionEg/ CA pancreas Liver capsule distension Bowel obstruction

1221/10/200913Types of PainBoth Somatic & Visceral pain travel along the same pathways. Pain stimuli arising from the viscera is perceived as somatic in origin. This can be confused by the brain and is often described as referred pain. 1321/10/200914

LiverSmall IntestineAppendixRight Ureter

LiverHeartStomach

GallbladderOvaryColonKidneyBladder1421/10/200915Types of PainBone PainPoorly localised, aching, deep, burning.Common with Breast, Lung, Prostate, Bladder, Cervical, Renal, Colon, Stomach and OesophagusCan lead to pathological fractures.Vertebral Metastases can lead to cord compression.1521/10/200916Bone PainOsteoblasts, Osteoclasts and Osteocytes are involved in remodelling bone.In healthy individuals bone remodelling is carefully regulated.Normally Osteoblasts replace the same amount of bone which has been resorbed by the Osteoclasts.In malignancy process not balanced, resulting in a loss of bone mass.1621/10/200917Types of PainNeuropathic PainCaused by disturbance of function or pathological changes in a nerve.May arise from a lesion or trauma, infection, compression or tumour invasion.Described as burning, shooting, tingling.Does not respond well to standard analgesics. 1721/10/200918Neuropathic PainAbnormal SensationsHyperaesthesia - an increased sensitivity to stimulation.Hyperalgesia increased response to a stimulus that is normally painful.Allodynia pain caused by a stimuli that is not normally painful 1821/10/200919NeuralgiaPain in the distribution of the nerve, lancing, shooting, jumping, electricity.Parasthesia An abnormal sensation, tingling, pins and needles.Tight FeelingVice like tightness, gripping, cramping.1921/10/200920Major Categories of PainClassified by inferred pathophysiology:

Nociceptive pain (stimuli from somatic and visceral structures)Neuropathic pain (stimuli abnormally processed by the nervous system)CRPS 1 AND 2

2021/10/200921 Effects of painSympathetic responsesPallorIncreased blood pressureIncreased pulseIncreased respirationSkeletal muscle tensionDiaphoresis

2121/10/200922FACTORS INFLUENCING PAINPHYSIOLOGICALSOCIALSPIRITUALPSYCHOLOGICALCULTURAL22