DR DUYGU AKTAR

REYHANIOGLU

PAIN
PAIN
PAIN
• Pain is NOT always an unpleasant sensation.

• The feeling of pain can be caused by irritation of pain receptors,

which can be found in the skin, joints and many internal organs.
• The cause of pain may also be damage to the nervous system, both
the peripheral nerves, brain and spinal cord.
• Pain can also occur without damage to tissues, although the patient
refers to it (psychogenic pain).
Source of pain
Pain receptors
• Pain receptors, also called nociceptors, are a group of sensory
neurons with specialized nerve endings widely distributed in the skin,
deep tissues (including the muscles and joints), and most of visceral
organs.

PAİN RECEPTORS ARE AT THE

SKIN
Pain classification
Pain can be broadly divided into three classes.

(A) Nociceptive pain represents the sensation associated with the detection of
potentially tissue-damaging noxious stimuli and is protective.

(B) Inflammatory pain is associated with tissue damage and the infiltration of immune
cells and can promote repair by causing pain hypersensitivity until healing occurs.

(C) Pathological pain is a disease state caused by damage to the nervous system
(neuropathic) or by its abnormal function (dysfunctional).
Pain classification
• Nociceptive pain
• This is the pain we feel when touching something too hot, cold, or
sharp. Because this pain is concerned with the sensing of noxious
stimuli, it is called nociceptive pain
Pain classification
• Inflammatory pain

• The second kind of pain is also adaptive and protective.

• By heightening sensory sensitivity after unavoidable tissue damage, this
pain assists in the healing of the injured body part by creating a situation
that discourages physical contact and movement.
• Pain hypersensitivity, or tenderness, reduces further risk of damage and
promotes recovery, as after a surgical wound or in an inflamed joint, where
normally innocuous stimuli now elicit pain.
• This pain is caused by activation of the immune system by tissue injury or
infection, and is therefore called inflammatory pain
Pain classification
• Pathological pain
• Pain that is not protective, but maladaptive, resulting from abnormal
functioning of the nervous system.
• Which is not a symptom of some disorder but rather a disease state of the
nervous system, can occur after damage to the nervous system
(neuropathic pain),
• In conditions in which there is no such damage or inflammation
(dysfunctional pain). Conditions that evoke dysfunctional pain include
fibromyalgia, irritable bowel syndrome, tension type headache,
temporomandibular joint disease, interstitial cystitis, and other syndromes
in which there exists substantial pain but no noxious stimulus and no, or
minimal, peripheral inflammatory pathology.
The importance of preserving nociceptive
pain
• The importance of preserving nociceptive pain is also revealed when
peripheral neuropathy leads to a sensory denervation of joints, with
severe deformities due to joints damaged because of a lack of pain
sensitivity
• Nociceptive pain is, therefore, a pain essential for maintaining bodily
integrity.
• Although we try to reduce pain we nevertheless need to be careful
that patients’ nociceptive pain is not so blunted by the therapy that
its protective role is lost
Types of Pain
Transmission of Pain
Transmission of inflammatuvar and nociceptive
pain
Transmission of Pain

• Primary afferent conduction: The first neurons of the pathways to the upper
centers originate from two types of afferents
• mechanoreceptor originated: Myelinated, thick fibers of (A-alpha and A-beta
fibers): Neuropathic pain; transmits non-pain stimuli (touch, proprioception, and
vibration).

• specific pain receptors in free nerve endings originated: Thin, myelinated A-delta
and unmyelinated C fibers : Nociceptive pain.
Transmission Of Pain

Neuropathic pain is caused by the direct effect of pain receptors in

the nerves as a result of trauma or a metabolic disease. It is
intermittent, short-term, stabbing, stabbing pain. There isn’t
activation of nociceptor

Activation of nociceptors produces a sharp, stabbing pain that can

be well localized. Its source may be mechanical, thermal or
chemical stimulus. Thus, with the rapid and sharp pain path A-
delta; slow chronic pain is carried over the C fibers
Transmission Of Pain
Pain inhibition systems
• 1-Gate control theory:
• pain sensation can be prevent from traveling to the central nervous
system
• The transmission of pain at the spinal cord level is controlled by the balance between thick fibers (A-alpha,
A-beta) and thin fibers (A-delta, C). The activity of thick fibers at the level of the first synapse can block the
activity of fine fibers and pain transmission. By sending afferent inputs to the CNS via A-alpha and A-beta
fibers, they suppress pain signals from the spinal cord. They block the impulse presynaptically in A-delta and
C fiber axons.
Descending analgesic systems:opioid agonists are potent analgesics. Endogenous opioids are
enkephalin, dynorphin, endorphin. Endogenous opiates produced in the CNS can reduce pain
transmission at different sites through presynaptic inhibition. That is, stimuli from higher centers
close the door and block pain transmission at the posterior horn synapses.
Assesment of Pain
Assesment of Pain
Assesment of Pain
Assesment of Pain
Assesment of Pain