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The Anatomy and Physiology of Pain PowerPoint Presentation

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This medical PowerPoint presentation is about pain, a complex experience that involves both the physical and emotional aspects of the body. It is an unpleasant sensation that serves as a warning signal to the brain, indicating that there is something wrong in the body. Pain can be acute or chronic, and can range in intensity from mild to severe.

Anatomy of Pain: The body has specialized structures known as nociceptors, which are responsible for detecting and responding to painful stimuli. These receptors are located throughout the body, including the skin, muscles, joints, and organs. When these nociceptors are stimulated, they send electrical signals to the spinal cord and brain, which are interpreted as pain.

Physiology of Pain: Pain is a complex physiological process that involves many different parts of the body. The process of pain can be divided into three stages: transduction, transmission, and perception.

Tags : pain, acute pain, chronic pain, manage pain, pain management

Published on : Jun 23, 2023 | Views : 3787 | Downloads : 6

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Slide 1-

The Anatomy and Physiology of Pain CO’s CUREHospital Medicine Pilot
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Learning Objectives Gain insight into of the anatomy and physiology of pain Recognize terminology Identify the body’s physiological response to pain Recognize the effects of pain on the different body systems Apply knowledge to assess and treat pain
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Pain THE TEACHING: Medically - pain is a symptom of an underlying condition THE MISSION: Find the source of pain Holistically treat the pain THE GOAL: Return to a realistic, productive life “An unpleasant sensory and emotional experience associated with actual or potential tissue damage.”
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The Purpose of Pain Prevents serious injury A light touch to something hot forces a quick reaction before serious injury occurs Teaches avoidance A painful activity teaches what not to repeat or when to seek help Prevents permanent damage Joint pain limits activity Surgery requires down time for healing
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The Pain Roadmap Pain sensation involves a series of complex interactions between peripheral nerves and the central nervous system Pain is a dynamic, bidirectional process Multiple areas of the nervous system help process pain signals Normal and pathologic processes underlie pain mechanisms
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The Origin of Pain
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The Process of Pain Physiology Pain sensation is modulated by two types of neurotransmitters or neurochemicals: Neurochemicals that excite pain or try to initiate pain Neurochemicals that inhibit or try to stop the pain Pain sensation is composed of four basic processes: Transduction Transmission Modulation Perception
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The Process of Pain Physiology
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The Transmission of Pain: Afferent Axons
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The Transmission of Pain: Timing The thickness of a nerve fiber correlates directly to the speed with which information travels The thicker the nerve fiber, the faster information travels A-alpha, A-beta and A-delta nerve fibers are insulated with a protective covering called the myelin sheath, which helps with nerve conductivity C nerve fibers are unmyelinated A-delta and C fibers are the main fibers responsible for the transmission of pain, however new studies suggest A-beta fibers may have an important role to play in the diagnosis and treatment of pain
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Transmission of Pain: Pull it Together Peripheral Sensory Nerve Spinal Cord Thalamus Cortex Pain! PAG Periaqueductal Gray Matter C A-delta Afferent neurons Modulation Pain Signals Transduction Perception Pain Signals Serotonin Endorphins Enkephalins Dynorphin Neurochemical Pain Inhibitors Descending Inhibition Epinephrine Cortisol ACTH Neurochemical Pain Initiators Glutamate – Central Substance P – Central Bradykinin - Peripheral Prostaglandins - Peripheral Transmission Descending Pathway Ascending Pathway
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Breakout of Pain CO’s CURE Module Five
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Acute Pain Occurs in response to injury or illness Responds well to interventions Resolves well as healing proceeds Short-lived Less than three months Often accompanied by sympathetic nervous system arousal Adaptive pain response Helpful pain response, which produces a behavior that promotes healing Chronic Pain Multiple underlying mechanisms Requires multi-modal and interdisciplinary treatment approaches Pain that persists beyond the “normal” time expected to heal Longer than three months Changes in both peripheral and central nervous system processing If acute pain is not managed well will move into the chronic phase Acute Pain vs. Chronic Pain
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Acute Pain vs. Chronic Pain Nociceptive Pain ACUTE Neuropathic Pain CHRONIC Nociplastic Pain TYPICAL CHRONIC
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Pain: Types of Pain
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Pain: Nociceptive and Neuropathic
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Acute Pain: Nociceptive What is nociceptive pain? Normal response to an injury of tissues Most common type of pain What are nociceptors? Nerves that detect or find noxious stimuli What is nociception? Process whereby signals are sent to the brain by nociceptor receptors What is the cause of nociceptive pain? Injury to body tissue to the skin, muscle and bones Examples: Postoperative pain, bruises, burns, fractures, overused joints Patients will present with dull, heavy, aching pain that spreads over a wide area
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Chronic Pain: Neuropathic What is neuropathic pain? Chronic pain lasts more than six-months What is the cause of neuropathic pain? Pain caused by a primary lesion or disease in the somatosensory nervous system causing varying degrees of pain sensations What is some the cause of neuropathic pain? Nerve damage due to some type of a viral infection or a disease involving the central or peripheral nervous system (neuralgias) Examples: Arthritis, migraines, shingles, multiple sclerosis, shingles Patients will present with a variety of symptoms from numbness to burning to stinging, pins and needles and pricking sensations
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Chronic Pain: Nociplastic What is nociplastic pain? Nonnociceptive and nonneuropathic pain Inflammatory response How does nociplastic pain work? Activation and sensitization of nociceptive pain pathway by a variety of mediators released at a site of tissue What causes nociplastic pain? Abnormal processing in the central nervous system, however the reason for this abnormality is generally unknown Examples: Fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome Patients will present with a variety of symptoms seen in both acute and chronic pain patients
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Mixed Pain What is mixed pain? Mixed pain share common clinical characteristics of all three types of pain nociceptive, neuropathic and nociplastic Potential Examples: Sciatica, cancer pain, lumbar spinal stenosis
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Other Types of Pain
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Chronic Pain Syndrome: CPS “A chronic pain syndrome is the combination of chronic pain and the secondary complications that are making the original pain worse” Institute for Chronic Pain
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Interaction of Complex Pain Nociceptive Pain ACUTE Neuropathic Pain CHRONIC Nociplastic Pain TYPICALLY CHRONIC MIXED PAIN
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Functional Effects of Pain
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Functional Effects of Pain
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Psychological Effects of Pain
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Sustained currents Peripheral Nociceptive Fibers Transient Activation ACUTE PAIN Surgeryorinjurycausesinflammation Impact of Pain: Acute to Chronic Path Sustained Activation Peripheral Nociceptive Fibers Sensitization CHRONIC PAIN CNS Neuroplasticity Hyperactivity Structural Remodeling
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Infants and children Elderly Racial and ethnic groups Women People with current or past history of substance abuse/addiction Cognitively impaired, non-verbal people Groups at High Risk for Pain Management
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Take Home Points The body’s reaction to pains to is complex and multifaceted Pain is transmitted from the site of injury to the brain by electrical signals Physiological changes triggered by pain are helpful in the beginning but become harmful if they continue Understanding the anatomy and physiology of pain helps health professionals to find better ways to treat pain Key interventions to prevent and treat pain begin with holistic pain assessments Check the Society of Hospital Medicine Pain Pathways for treatment guidelines.
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References https://www.ncbi.nlm.nih.gov/books/NBK412/ https://www.researchgate.net/publication/323539036_Epigenetics_as_a_mechanism_linking_developmental_exposures_to_long-term_toxicity/link/5c3b335d458515a4c7226428/download https://www.nursingtimes.net/clinical-archive/pain-management/anatomy-and-physiology-of-pain-18-09-2008/ https://www.nursingtimes.net/clinical-archive/pain-management/understanding-the-effect-of-pain-and-how-the-human-body-responds-26-02-2018/ https://www.ncbi.nlm.nih.gov/books/NBK219252/ Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives https://advances.sciencemag.org/content/5/7/eaaw1297 https://www.pnas.org/content/102/36/12950 The subjective experience of pain: Where expectations become reality Tetsuo Koyama, John G. McHaffie, Paul J. Laurienti, Robert C. Coghill Proceedings of the National Academy of Sciences Sep 2005, 102 (36) 12950-12955; DOI: 10.1073/pnas.0408576102;
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References National Pharmaceutical Council, INC, Joint Commission on Accreditation of Healthcare Organizations. (2001, December). . Barriers to the Appropriate Assessment and Management of Pain. Pain: Current Understanding of Assessment, Management, and Treatments. (15-16). Retrieved from: https://www.npcnow.org/system/files/research/download/Pain-Current-Understanding-of-Assessment-Management-and-Treatments.pdf Niculescu, A. B., Le-Niculescu, H., Levey, D. F., Roseberry, K., Soe K. C., Rogers, J., Khan, F., … White, F. A., (2019, February 12). Towards precision medicine for pain: diagnositic biomarkers and repurposed drugs. Molecular Psychiatry 24:(501–522). Retrieved from: https://www.nature.com/articles/s41380-018-0345-5 Otis, J.A., Macone, A., (2019, April). When to Use Opioids: What I Didn’t Learn in Medical School. Practical Pain Management. Retrieved from: https://www.practicalpainmanagement.com/resource-centers/opioid-prescribing-monitoring/when-use-opioids-what-didnt-learn-medical-school Riberio-Pinho, F. A., Verri Jr., W. A., Chiu, I. M., (2017, January). Nociceptor Sensory Neuron-Immune Interactions in Pain and Inflammation. Trends Immunol. 38(1) 5-19. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5205568/pdf/nihms821842.pdf University of Wisconsin School of Medicine and Public Health: Pain Management (2010). Retrieved from: http://projects.hsl.wisc.edu/GME/PainManagement/index.html Waller C. (2018). Colorado Hospital Association Opioid Safety Summit: The Addiction Treatment Ecosystem. Wilensky, B. Adapted from Woolf CJ. Ann Intern Med. 2004;140:441-451. https://annals.org/aim/article-abstract/717288/pain-moving-from-symptom-control-toward-mechanism-specific-pharmacologic-management?volume=140&issue=6&page=441 Chong MS, Bajwa ZH. J Pain Symptom Manage. 2003;25:S4-S11. Younger J, Aron A, Parke S, Chatterjee N, Mackey S (2010) PLOS ǀ ONE “Viewing Pictures of a Romantic Partner Reduces Experimental Pain: Involvement of Neural Reward Systems. Retrieved from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0013309
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References BBC Horizon (2011). I Cut off My Arm to Save My Life. The Secret World of Pain – BBC Two. Retrieved from: https://www.youtube.com/watch?v=r9YFk7-Dsgw Cox S (2010) Nursing Standard. Basic Principles of Pain Management: assessment and intervention. (Vol 25, Issue 1). Retrieved from: https://pdfs.semanticscholar.org/e7e6/423e73ce5696e2a2f1e2596258736fb2f486.pdf Dmitry, A.M., Fleming, A., (2019, April). Pain Assessment: Review of Current Tools. Practical Pain Management. Retrieved from: https://www.practicalpainmanagement.com/resource-centers/opioid-prescribing-monitoring/list-clinically-tested-validated-pain-scales Fink. R. (2000, July). Pain assessment: the cornerstone to optimal pain management. Baylor University Medical Center Proceedings, 38 (3), 236-239. Retrieved from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317046/ Gereau IV, R. W., Sluka, K. A., Maixner, W., Savage, S. R., Price, T. J., Murinson, B. B., Sullivan, M. D…. Fillingim, R. B. (2014, December). The Journal of Pain 12: 1203-1215. http://americanpainsociety.org/uploads/about/position-statements/APS_Pain_Research_Agenda_White_Paper.pdf Hartman, S. Vietnam veterans honor a fallen soldier 50 years later. (2019, July 19). CBS News. Retrieved from:. https://www.cbsnews.com/news/vietnam-veterans-honor-fallen-soldier-leonard-nitzsche-50-years-later-2019-07-19/ International Association for the Study of Pain: https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698 Macintyre PE, Schug SA (2007) Acute Pain Management." A Practical/Guide. Third edition. Saunders Elsevier, Edinburgh. McCaffery M (1972) Nursing Management of the Patient with Pain. Lippincott, Williams & Wilkins, Philadelphia, PA. Miller, F. H., Choi, M. J., Angeli, L. L., Harland, A. A., Stamos, J. A., Thomas, S. T., . . . Rubin, L. H. (2009). Web site usability for the blind and low-vision user. Technical Communication, 57, 323-335.