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Definition:Pain
An unpleasant sensory and/or emotional experience.
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What are the two components of pain?
- Physical:sensation of pain - nociceptors are pain receptors involving PNS and CNS.
- Psychological:emotional response to pain sensation.
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What is pain influenced by?
- Age
- Gender
- Culture
- Previous experience of pain and pain management
- Personality
- Peer influence
- Stress
- Anxiety
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Classifications of pain?
- Acute
- Chronic
- Nociceptive pain
- Neurogenic pain
- Neuropathic neurogenic pain
- Psychogenic pain
- Breakthrough pain
- Referred pain
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What are the four basic processes involved in nocicpetion
- Transmission
- Transduction
- Perception
- Modulation
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What is transduction?
- Begins when nerve endings (nocicpeotors) of C fibres and A-delta fibres of primary afferent neurons respond to noxious stimuli.
- Nociceptors are exposed to noxious stimuli when tissue damage and inflammation occurs.
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What is transmission?
- Pain impulse is generated by depolarisation and repolarisation at the cell membranes
- Resulting in an action potential and generation of a pain impulse.
- This stimulation causes a release of neurotransmitters/chemical mediators from the damaged cell.
- The pain impulse is transmitted from the site of transduction along the nocicpetors fibres to the dorsal horn in the spinal cord.
- This is then transmitted to the the brain stem and thalamus via two main pathways: spinothalamic pathway and spinoparabrachial pathway. Then they are processed.
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What is perception?
- Is the result of pain transmission where pain becomes a conscious experience.
- Multiple cortical areas are activated: The reticular system-autonomic and and motor response, Somatosensory cortex-perception and interpretation of sensations, identifies the intensity, relates to past experiences; Limbic system-emotional and behavioural response to pain.
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What is modulation?
- Involves changing or inhibiting transmission of pain impulses.
- Multiple pathways erferred to as: descending modulatory pain pathway and these can either increase or decrease the transmission of pain impulses.
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What are the three types opioid receptors?
Mu, kappa and delta
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What is the aim of pain assessment?
To help determine the course of the pain, the impact on quality of life, the best treatments and the effectiveness of current treatment.
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What does the acronym OPQRSTU stand for?
- Onset
- Provoking/palliating
- Quality
- Region and radiating
- Severity
- Treatment
- Understanding
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