International Classification of Pain

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  1. Pain
    An unpleasant sensory AND emotional experience associated w/ actual or potential tissue damage
  2. Nociception
    • The neural process of encoding noxious stimuli
    • Consequences of encoding may be autonomic (i.e. elevated BP) or behavioral (motor withdrawal)
    • *Pain sensation is not necessarily implied
  3. Noxious Stimulus
    A stimulus that is damaging or threatens damage to normal tissues
  4. Sensitization
    Increased responsiveness of nociceptive neurons to their normal input and/or recruitment of a response to normally sub-threshold inputs

    Central Sensitization: increased responsiveness of nociceptive neurons in the CNS to their normal or sub-threshold afferent input

    Peripheral Sensitization: increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields
  5. Acute Pain
    • Short duration w/ sudden onset
    • Easily diagnosed/treated/resolved
    • At/near site of lesion (if referred, in typical referral patterns)
  6. Chronic Pain
    • Starts 3-6 months after injury (lasts 6 months or longer)
    • Difficult to diagnose/identify specific cause for pain
    • Referred far from site of lesion/atypical referral patterns
    • Emergence of illness behaviors not always a physiological sign of warning for the body
    • May be related to physiological changes in the nervous system (reduced thresholds, neurotransmitter imbalance, psychological factors, not an identifiable injury)
  7. Chronic Pain: Common Features
    • Substance abuse/overuse
    • Multiple procedures/surgeries 
    • External locus of control
    • Vegetative signs
    • Physical, emotional, sexual abuse
    • Exaggerated clinical presentation (verbal or nonverbal pain behavior)
  8. Factors Influencing Pain Perception and Behavior
    • Personality
    • Social Context
    • Culture
    • Attitudes of Health Professionals
    • Past Experience
    • State of Mind
    • Avoidance and Cognitive Processes
  9. Medical Model of Pain Management
    • Assumes an underlying injury
    • Remove/alleviate/fix the injury and the pain will go away
  10. Behavioral/Cognitive Behavioral Model
    • Pain perception due to more than just the injury (psychological state, physiological changes in long standing pain states)
    • History of depression --> reduced pain thresholds
    • Chronic pain state: receptor sensitivity is heightened
    • Treating the inure alone won't address pain perception
  11. Somatosensory Receptors
    • A Delta:
    • Small, myelinated
    • Speed = mod fast
    • Location = capsules, ligaments, fat, blood vessels, connective tissue
    • Stimuli = mechanical, thermal 
    • Sensation = sharp, prickling sensation, small areas (increased stimulation --> habituation)

    • C Polymodal
    • Small, unmyelinated
    • Speed = slow
    • Location = capsules, ligaments, fat, blood vessels, connective tissue
    • Stimuli = mechanical, thermal, chemical
    • Sensation = dull aching sensation over larger areas (increased stimulation --> sensitization)
  12. Dorsal Horn
    • Marginal Zone (I)
    • Substantia Gelatinosa (II)
    • Nucleus Proprius (III-VI)

    "Soup at the dorsal horn" = combination of facility and inhibitory transmitters (mix determines transmission)
  13. Intermediate
    Intermediate Gray Matter (VII - VIII)
  14. Anterior/Ventral Horn
    Anterior Horn Cells (IX)
  15. Chemical Stimulants of Nociceptors
    • Protons (H+, acids)
    • Neurotransmitters (serotonin, histamine, ACh)
    • Polypeptides (bradykinin, kallidin)
    • Prostaglandins
    • Cellular metabolites (ATP, ADP, lactic acid, K+)
    • Spicy plants (capsaicin)
  16. Neurotransmitters of Primary Afferent
    • Substance P
    • Vasoactive Intestinal Peptide (VIP)
    • Cholecystokinin
    • Somatostatin
  17. Biomedical Model
    One-to-one relationship between the magnitude of the injure and the pain experience (mind and body = distinct entities)
  18. Biopsychosocial Approach
    • Treatment aimed at changing behavior
    • Pain = unreliable guide
    • Education regarding maladaptive pain = paramount
    • Graded exercise gradually acclimates the pt to function
    • Focus on slow, progressive functional recovery
    • Empower the patient
    • Use of narcotic pain meds can undermine this process
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International Classification of Pain
2014-02-13 16:06:49
International Classification Pain
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