PATHOLOGY OF PAIN
DR OGBEYE G.B
OUTLINE
• Introduction
• Classification of pain
• Pathophysiology of pain
• Pain transmission
• Factors influencing pain response
LEARNING OBJECTIVE
At the end of the lecture student will be able to:
• Define pain
• Explain classification of pain
• Discuss Pathophysiology of pain
• Discuss pain transmission
• Identify and explain factors influencing pain response
INTRODUCTION
• Pain can be define as "an
unpleasant sensory and emotional
experience associated with actual
or potential tissue damage, or
described in terms of such
damage International Association
for the Study of Pain (IASP
• Its derived from Latin -“Poena”
meaning Penalty/punishment
from God.
• It is the fifth vital sign
INTRODUCTION CONTD.
• Pain plays an important in the survival of all animals.
• It acts as a signal, alerting us to potential tissue damage
• It leads to a wide range of actions to prevent or limit further
damage.
CLASSIFICATION OF PAIN
DURATION
LOCATION INTENSITY ETIOLOGY
BASED ON DURATION
ACUTE CHRONIC
• When pain lasts only through the • Is the pain that lasts longer than 6
expected recovery period. months
• Acute pain is protective, has an • It is constant or recurring with mild
identifiable cause to severe intensity .
• is of short duration and has limited • It does not always have an
tissue damage and emotional identifiable cause. Eg: arithritic pain,
response. headache, peripheral neuropathy
• It eventually resolves with or • Cause may not be easily identified
without treatment, after an injury
area heals
• It is difficult to treat
BASED ON LOCATION
• This is based on the site at which the pain is located eg: headache,
cardiac pain, back pain, joint pain, stomach pain,
• Reffered pain- pain due to problems in other areas manifest in
different body parts. Eg: cardiac pain may be felt in the shoulders or
left arm, with or without chest pain
BASED ON INTENSITY
MILD MODERATE SEVERE
PAIN SCALE
BASED ON INTENSITY
• Mild pain: pain scale reading form 1-3 is considered as mild pain
• Moderate pain: pain scale reading form 4 - 6 is considered as
moderate pain
• Severe pain: pain scale reading from 7 – 10 is considered as severe
pain
BASED ON ETIOLOGY
NORCICEPTIVE
• SOMATIC
PAIN • VISCERAL
NEUROPATHIC
• PERIPHERAL
PAIN • CENTRAL
NORCICEPTIVE PAIN
• Is experienced when an intact, properly functioning nervous system
send signals that tissue are damaged requiring attention and proper
care. Eg: the pain experienced following a cut or broken bone alerts
the person to avoid further damage until it is properly healed.
• Once stabilised or healed the pain goes away
SOMATIC
• This is the pain that is originally from the skin , muscles, bone, or
connective tissues. eg: the sharp sensation of a paper cut or aching of
a sprained ankle
VISCERAL PAIN
• Is the pain that results from the activation of nociceptors of the
thoracic , pelvic, or abnormal viscera (organs).
• Characterised by cramping, throbbing, pressing or aching qualities.
Eg: labor pain, angina pectoris pr irritable bowel
NEUROPATHIC PAIN
• Neuropathic pain is associated with damage or malfunctioning nerve
due to illness, injury or undetermined reason.
• Examples are Diabetic peripheral neuropathy, phantom limb pain,
Spinal cord injury pain
• It is usually chronic.
• It is describe as burning, “electric shock”or tingling, dull and aching.
CLASSIFICATION OF NEUROPATHIC
PAIN
• Peripheral neuropathic pain: Due to damage of peripheral system
• Example: phantom limb pain
• Central neuropathic pain: Results from malfunction nerves in the CNS
• Example: spinal cord injury pain post stroke pain
PATHOPHYSIOLOGY OF PAIN
• Pain occurs when sensory nerve endings called nociceptors (also
referred to as pain receptors) come into contact with a painful or
noxious stimulus.
• It is produced by processes that either damage, or are capable of
damaging, the tissues.
• Such damaging stimuli are called ‘‘noxious’’ and are detected by
specific sensory receptors called ‘‘nociceptor
PATHOPHYSIOLOGY OF PAIN CONTD.
• Nociceptors respond selectively to noxious stimuli.
• They are free nerve endings with cell bodies in the dorsal root ganglia
and terminate in the superficial layers of the dorsal horn of the spinal
cord.
• Here they relay messages by releasing neurotransmitters such as
glutamate, substance P, and calcitonin gene related peptide (CGRP
A- DELTA FIBERS
Nociceptor are identified as:
• A- delta and C-fibers nerve fibers
• A- delta fibers: They are myelinated
• Conduct impulses rapidly
• Produce sensation of acute pain, sharp, localized and fast pain
• Main neurotransmitter is glutamate
• Respond to mechanical (pressure) stimulus
C FIBRES
• The C fibers are small and conduct impulses slowly.
• Main neurotransmitter is substance p
• Less sensitivity to electrical stimulus
• Unmyelinated conduct impulses more slowly
• They respond to thermal, mechanical, and chemical stimuli
• They produce sensation of dull, diffuse, aching, burning, and delayed
pain.
NOCICEPTIVE PATHWAY
• Primary sensory neurons in the peripheral nervous system, which
conduct painful sensations from the periphery to the dorsal root of
the spinal cord
• Secondary sensory neurons in the spinal cord or brainstem, which
transmit the painful sensation to the thalamus
• Tertiary sensory neurons, which transmit the painful sensation from
the thalamus to the somatosensory areas of the cerebral cortex.
MECHANISM OF PAIN
Pain receptors are activated by three noxious stimuli
• Mechanical: Excessive pressure or tension on nerve
• Thermal: Raising skin temperature above 450C or exposure to cold
• Chemical: Endogenous – Histamine, Kinins, prostaglandin released
from damaged tissue.
MECHANISM OF PAIN CONTD.
• The resulting nerve impulse travels from the sensory nerve ending to
the spinal cord
• Where the impulse is rapidly shunted to the brain via nerve tracts in
the spinal cord and brainstem.
• The brain processes the pain sensation and quickly responds with a
motor response in an attempt to cease the action causing the pain
PAIN TRANSMISSION
TRANSDUCTION TRANSMISSION
PERCEPTION MODULATION
TRANSDUCTION
• Afferent pathway
• Activate the release of biochemical mediators e.g prostalgladin
• Sensitized nociceptors
• Stimulation of nociceptors produces impulse transmission through
fibres C fibres and A -delta fibres
• Terminate in dorsal horn of the spinal cord
TRANSMISSION
• The pain impulse travels from the peripheral nerve fibres to the spinal
cord.
• Through spinothalamic tracts, to the brain stem and thalamus
• The 3rd order neuron transfers the signals to the somatic sensory
cortex where pain perception occurs – conscious awareness,
localization of pain, intensity of pain
PERCEPTION
• This dependent on complex neural processing in the spinal cord .
• Pain becomes more than a pattern of nociceptive action potentials
when they reach the brain.
• Action potentials ascending the spinothalamic tract are decoded and
can be perceived as an unpleasant sensation localized to a specific
region of the body
• The psychosocial context of the situation and the meaning of the
pain, based on past experiences and future hopes/dreams, help to
shape the behavioural response that follows
MODULATION
• The neurons in the thalamus and brain stem send signals to the dorsal
horn of the spinal cord
• The descending fibres release substances, such as endogenous
opioids, serotonin and noradrenaline
• This inhibit the ascending noxious (painful) impulses in the dorsal
horn.
• On the other hand, excitatory amino acids (e.g. glutamate, N-methyl-
d-aspartate (NMDA) and the up-regulation of excitatory glial cells, can
facilitate (amplify) these pain signals.
PAIN TRANSMISSION CONTD.
FACTORS INFLUENCING PAIN
RESPONSE
• Anxiety
• Culture
• Age
• Environment
• Fatigue
• Gender
• Meaning of pain
• Past experiences
THANKS
FOR
LISTENING
