Pain Sleep and Consciousness

Concept of pain
 Pain is an unpleasant and uncomfortable sensation
associated with both physical and psychological
emotions.
 Pain is private sensation because it feels only by the
person experiencing it.
 There is two main concepts of pain
I. Pain threshold
II. Pain tolerance
Pain threshold is a point at which a person perceives
pain.
Pain tolerance is the level of pain a person is willing to
endure.
 Tolerance and threshold differ among patients
because what one patient can endure another cannot.
 How we come to know about the intensity of pain of
a person or patient? Only the person it self is the
main indicator of pain his or her self report can tell
us about the pain or intensity of the pain. it is called
pain assessment.
Types of pain
 There are 2 types of pain acute and chronic pain.
Acute pain is usually temporary and fast pain it
appears quickly and result from tissue injury and
trauma e.g. prickling.
Chronic pain is slow pain, cause is not identified
e.g. burning and lower back pain is most common in
Patient with chronic pain is often depressed .
Assessment and management of
chronic/intractable atypical facial pain
Categories of pain
1. Acute pain
2. Chronic pain
3. Intractable pain
Acute pain
Acute pain is normally associated with a well
defined cause (such as a burned finger or
ruptured appendix) typically has a
characteristic time course and goes away
after the person has healed.
Chronic pain
 Chronic pain is a pain state where there is persistent
pain lasting a minimum of 6 months and usually the
cause of the pain cannot be removed, found or
otherwise treated.
Intractable pain
 Intractable pain is a more severe form of chronic
pain. It is extremely different from acute pain but
differs slightly from chronic pain.
 Intractable pain is pain which is extremely severe in
nature, unremitting incurable and may produce such
depression in the individual that they may wish to
end their lives.
 There are numerous medical conditions, which
commonly cause chronic or intractable pain. Some of
these conditions are: Arachnoids, back injuries, failed
back surgeries, migraine, fibroid, cancer and
neuropathic pain.
chronic/intractable atypical facial pain
 Atypical Facial Pain is a pain disorder of the face which shares
some features with trigeminal neuralgia The pain may be
different most often longer in duration and of a dull burning,
sharp, squeezing, or crushing quality.

 Atypical facial pain may also be caused by an injury to a small

branch of one of the three divisions of the trigeminal nerve.
Trigeminal Neuralgia
Treatment And Assessment
 Each case is unique and is handled individually. Some patients
with atypical facial pain respond well to medication, and
others respond well to local nerve blocks. Generally, the
surgical and radiation treatments that work well for
trigeminal neuralgia do not work as well for atypical facial
pain.
 Trigeminal neuralgia is a very specific kind of facial pain
that involves the trigeminal nerve (or fifth cranial nerve)
 In the case of trigeminal neuralgia, the nerve may be compressed
by a blood vessel at the point where it leaves the brainstem.
 In the case of trigeminal neuralgia, you may need to have a
computerized (CT) scan (MRI) to find out where the nerve is
compressed.
 Surgery
 Medicines
For atypical facial pain.
• tricyclic antidepressants
• serotonin-norepinephrine inhibitors
• gels or creams that include a local anaesthetic such as lidocaine.
Non-drug therapies
 Studies have shown that non-drug therapies can help to
reduce pain these are
 relaxation
 activity pacing
 cognitive behavioural therapy
Stages of sleep
 Usually sleepers pass through five stages: 1, 2, 3, 4 and REM
(rapid eye movement) sleep. These stages progress in a cycle
from 1 through REM then begin again with stage 1. A
complete sleep cycle takes an average of 90 to 110 minutes.
Stage 1
 stage one is light sleep where person drift in and out of sleep
and can be awakened easily. In this stage, the eyes move
slowly and muscle activity slows. During this stage, many
people experience sudden muscle contractions preceded by a
sensation of falling.
Stage 2
 In stage 2, eye movement stops and brain waves become
slower with rapid brain waves.
Stage 3
 When a person enters stage 3, extremely slow brain waves
called delta waves are interspersed with smaller, faster
waves.
Stage 4
In stage 4, the brain produces delta waves almost exclusively.
Stages 3 and 4 are referred to as deep sleep or delta sleep,
and it is very difficult to wake someone from them.
What Is REM Sleep?
 Usually, REM sleep happens 90 minutes after you fall asleep.
The first period of REM typically lasts 10 minutes. Each of
your later REM stages gets longer, and the final one may last
up to an hour.Your heart rate and breathing quickens.
 You can have intense dreams during REM sleep, since
your brain is more active.
Psychological influences on sleep and
consciousness
Effects of Sleep Deprivation

 Impaired memory

 Trouble concentrating

 Impaired creativity

 Increase blood pressure

 Increase food consumption and appetite

Sleep disorders
 Hypopnea syndrome (Abnormally shallow breathing or slow
respiratory rate while sleeping)
 Insomnia( Chronic difficulty in falling a sleep)
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 Hypersomnia( primary neurologic cause of long sleeping)

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 Night terror

 episodic limb movement disorder (Sudden involuntary

movements of arms or legs during sleep)
 Sleep walking (It include walking without the conscious
knowledge of a subject)
 Sleep apnea(Stops in breathing during sleep due to obstruction in
air ways)
 Sleep talking(Sleep talking with out aware of it)
Changes in consciousness
 Consciousness is your awareness of how and why
you react to your surroundings. Our awareness of
ourselves is called consciousness, consciousness is
a concept that refers both to our self-perception and
to our responses to the world around us.
 An altered state of consciousness is a temporary change
in one's normal mental state without being considered
unconscious. Altered states of consciousness can be created
intentionally, or they can happen by accident or due to
illness.
 There are many event that bring changes in once
consciousness for e.g when a person is sick, feeling sleepy or
dreamy due to medication because of that change a person
sometime cannot react in a normal way.
Dreams
• Everyone has experienced dreams and can relate to this
common altered state of consciousness. Although we are not
'awake' during sleep, we are still conscious and can react to
our surroundings.
Hypnosis
Psychologists believe that hypnosis is an altered
state of consciousness that allows a person to be
more open to suggestion.
hypnosis can be use to help and contain unmanageable feelings
or to help a person reach a goal.
Sleep
• At the far end of the consciousness continuum are
unconscious states such as sleep. Sleep, like other states
of consciousness is unique to each individual. Sleep pass
through different stages and REM.
Anesthesia and comma and vegetative state
• Anesthesia have described sudden changes in
consciousness
• the state of complete unconsciousness with no
open eye is called coma, coma is like deep sleep.
• Vegetative state is a disorder of consciousness
in which patient with severe brain damage are in
a state of partial arousal rather than true
awareness.
Non pharmacological method of sleep
induction
 Sleep induction, the deliberate effort to bring on sleep by
various techniques or medication, this practice is done to
prolong periods of sleep, increase the effectiveness of sleep,
and to reduce or prevent insomnia.
 Make sure your bedroom is quiet, dark, and cool

 Stick to a regular sleep schedule

 Avoid naps.
 Avoid stimulating activity and stressful situations before

bedtime. Limit caffeine, alcohol, and nicotine.

 Try Progressive Muscle Relaxation

 Take a warm bath

 Get out of bed when you can’t sleep