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7.2 Pain

This document summarizes key aspects of pain physiology: 1. It describes the different types of pain receptors and fibers that detect pain (nociceptors), including Aδ and C fibers. 2. It outlines the pathways involved in pain processing from the peripheral nerves to the spinal cord and brain, including the neospinothalamic and paleospinothalamic tracts. 3. It discusses the different components of the pain experience, including sensory, emotional, cognitive, and motor responses, and explains how different brain regions are involved in each component.

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Survin Kandhari
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36 views47 pages

7.2 Pain

This document summarizes key aspects of pain physiology: 1. It describes the different types of pain receptors and fibers that detect pain (nociceptors), including Aδ and C fibers. 2. It outlines the pathways involved in pain processing from the peripheral nerves to the spinal cord and brain, including the neospinothalamic and paleospinothalamic tracts. 3. It discusses the different components of the pain experience, including sensory, emotional, cognitive, and motor responses, and explains how different brain regions are involved in each component.

Uploaded by

Survin Kandhari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Physiology of pain

Pain
• unpleasant sensory & emotional
feeling, connected with true or
potential damage of tissue or organ,
which is described in the terms of
such a damage.
International expert commitee
J. “Pain” 6, 248-252, 1979
Pain
• Doesn’t give any info about the external
environment;
• Adequate stimulus – any suprathreshold
stimulus damaging the tissue or causing
the danger of damage:
Mechanical
Thermal (burn or frostbite)
Chemical (metabolism disorders)
pain
• Danger signal that occurs at the damage
or the threat of damage of:
Skin
Peritoneum
Meninx
Pericardithis.
Sponsored
Medical Lecture Notes – All Subjects

USMLE Exam (America) – Practice


Nociception
• Nociception - sensor modality in
animals which causes pain feeling in
man.

• Nociceptors - pain receptors


Types of pain
Pain

Somatic Visceral
deep
superficial
Delayed or
Early or primary
secondary
epicritical
protopatic
Superficial pain
localization - skin
Early or primary –
strictly localized,
Dissapears with the
dissapearence of the
stimulus
(pinch, hit, pin)

Latent period – sec


Superficial pain
localization - skin
Delayed or secondary
- Not localized, dyes out
slowly.
Dull, diffuse

Latent period – 0,5-1,0 sec

diffuse
Deep pain
Localization - connective tissue,
muscles, bones, joints, teeth
Types – muscle cramps, headache,
toothache.
Characteristics - dull, non-localized,
irradiating
Latent period 1-3 min
Acute, sub-active, chronic
Visceral pain

Diffuse pain Pain with irradiation


Visceral pain
• Localization – internal organs
• Types - kidney, liver, intestinal cramps,
gastric ulcer pains, appendicitis, cardiac pain
• Characteristics - dull, non-localized,
irradiating to other organs & tissue. May be
acute but diffuse.
• Reasons – quick & excessive stretching of hollow
organs, cramps, spastic contractions, ischemia
Pain duration
• Acute pain – localized in the damaged area, its
intensity depends on the stimulus intensity, has
signaling function, quickly dissapears.
• Chronic pain – lasts up till half a year, has
stable & recurrent forms. No connections
between pain intensity & level of organic
damage.
• May become a separate syndrome
Other types of pain
• Psycogenic – no peripheral organic
reason – neurosis.
• Itching – caused by the increased
concentration of hystamine in skin
COMPONENTS OF PAIN
1. SENSORY DISCRIMINATIVE
2. AFFECTIVE (EMOTIONAL)
3. VEGETATIVE
4. LOCOMOTOR
5. COGNITIVE (intensity evaluation)
SENSORY DISCRIMINATIVE
• Is enabled by thalamus & cortex.
• When the hand is deepened into the water with
t0>450С skin receptors are excited, they send
info to the cortex about the localization of hot
stimulus, its intensity, the starting point & the
end point of its action.
• Sensation is formed
• This component prevails in superficial pain
Affective or emotional
• Is enabled by limbic system
• Negative emotions are formed
• Is the prevailing component in chronic pain
vegetative
• Is enabled by ANS
• BP elevation, HR increase, pupil dilation,
changed rhythm of respiration
• Sympatho-adrenal system is activated,
vasopressin (АDH) is produced.
• Is the strongest in visceral pain
locomotor

• Is enabled by motor zones of cortex


• Is displayed in flexor reflexes (defence
reflex), abdominal muscles tension,
pscycomotor behavioral reactions
• Accompanies all types of pains
cognitive
• Present pain is evaluated in comparison to
previous pains.
• This evaluation depends on many factors:
Social status
Bringing up in the family
Ethnic origin
Circumstances at which the pain occured
Pain neurophysiology
Pain theories

1. Theory of specificity – M.Frey – end


of XIX century
2. Theory of intensity – Goldshteiner -
end of XIX century
Theory of specificity
• Pain is an independent feeling with
specialized nervous apparatus of receptors,
conducting pathways & centres
• Prof – the correlation between skin pain
dots and the dots of pressure & temperature
is 9:1
Pressure & pain dots on the skin
Pressure dot

Pain dots
Intensity theory
• Pain may be caused by suprathreshold
stimuli of different modality.
• Not proved to be true.
Nociceptors
Free nervous endings of 2 types:
• Non-myelinized fibres of C type – the velocity
of impulse conduction is up to 1 m/sec – are
present everywhere (skin, joints, internal
organs)
• Myelinized fibres of Аδ type –
the velocity of impulse conduction is up to 20
m/sec– only in skin
Nociceptors Аδ
• High threshold receptors;
• May be sencibilized ;
• Have small receptive fields.
• 3 types:
Mechano-
Тhermo-
Mechano-thermo-
Nociceptors of С type fibres
• High threshold, may cause
sencibilization, have big receptive
fields (17mm2).
• Polymodal
Nociceptors blocking
• Local anaestetics in low concentration
block С type fibres
• Pressure – blocks just Аδ fibres. This
activates С fibres
Algogenic substanses
• Substances from damaged cells – potassium,,
АТP.
• From plasma – bradikinins, Н+
• From must cells – hystamine
• From platelets – serotonin
• From nervous afferent fibres – substance Р
• SNS mediators – adrenalin,noradrenalin
Nociceptive system
Receptive fields
Spinal cord
Желатинозная субстанция
5 4 SI-SII 1 –Tr. Neospino-
thalamicus
2 – tr. Paleospino
3 VPL thalamicus
Thalamus 3 – Hypothalamus
Thalamus
4 – Limbic cortex
2 n.medialis 1
5 –Associative cortex.
RF (temporal & frontal)
Asparaginic acid
Аδ skin
Sub. Р С
Аδ
С
С
Internal org.
n. Vagus 70%
Conducting pathways
• Tr. Neospino-thalamicus – in the anterior
funiculus, has somatotypical organization.
Enables primary pain conduction.
• Tr. paleospinothalamicus – non-specific
system (RF) – has many synapses on one
level in the spinal cord, makes diffuse
connections in cortex. Enables emotional
component of pain – secondary pain
First danger (bacterial infection,
inflamation, mechanical influence)

Algogenic substanses formation


Nociceptors Transduction &
transformation
Afferent fibres
Impulse
Spinal cord conduction
Supraspinal centers

Cortex- feeling of pain


Refered pains
Pain irradiation
Pain progection in the cortex (due to
lateral spino-thalamicus tract)
Antinociceptive system
Gigantic-cell nucleus RF
serotonin
Spinal cord neurons
secreting endoopiates

Inhibition of afferent nociceptive


neurons & neurons of posterior
horn ІІ & Y plates
Antinociceptive system
Central grey matter
Noradrenalin, alpha-2
adrenoreceptors
Ruph nuclei
serotonin

Spinal cord neurons


releasing endoopiates
OPIOID ANALGESICS
• Relieve pain as a symptom
• Perception of pain & reaction to it are both
altered
• Opioid receptor activation reduces intracellular
c-AMP formation,opens K-channels or
suppresses voltage-gated Ca- channels,
hyperpolarization of a neuron, decreased
neurotransmitter release by CNS & myenteric
neurons
MECHANISM OF OPIOID ACTION

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