Pembimbing : Dr. dr.

Maria Regina
Rachmawati, PA (K), SpKFR
Presentan : dr Ratna Ekawati
  IASP (International Association for the Study
of Pain)
‘An unpleasant sensory and emotional
experience associated with actual or
potential tissue damage, or described in
terms of such damage’

Squire, et al,. Fundamental Neuroscience. Third Edition. California:

Elsevier. 2008.
 NOXIOUS
• Anything that produce tissue
damage or threathens do so
in immediate future

NOCICEPTORS
• the type of axo that responds
selectively to the noxious
quality of a stimulus
Squire, et al,. Fundamental Neuroscience. Third Edition.
California: Elsevier. 2008.
1. Mechanical nociceptors (ie. cutting,
crushing, pinching)
2. Thermal nociceptors (for extreme
heat)
3. Polymodal nociceptors (all kinds of
iritating stimuli)
Squire, et al,. Fundamental Neuroscience. Third Edition. California: Elsevier. 2008.
 Aδ fibers C fibers

• Fast pain pathway • Slow pain pathway

• Velocity : 3- • Velocity : 0.1 - 2.5
30m/sec m/sec
• For Mechanical & • For Polymodal
Thermal receptor receptor
• Sensitive to : Skin • Sensitive to :
cooling, painful Painful cold
heat (>44 ℃), (<10℃), warm (34-
sharp pinch pain 42℃)
Squire, et al,. Fundamental Neuroscience. Third Edition. California: Elsevier. 2008.
 PAIN RECEPTION
Interaction of noxious stimulus with receptor

PAIN TRANSMISSION
Pheripheral nervous system  spinal cord  ascending impulses (spinothalamic,
spinoreticular as well as other pathways  brain regions involved in nociception

PAIN PROCESSING
Modulation and Perception

Rohkamm. Color Atlas of Neurology. New York : Thieme. 2004.

Squire, et al,. Fundamental Neuroscience. Third Edition. California: Elsevier. 2008.
Squire, et al,. Fundamental Neuroscience. Third Edition. California: Elsevier. 2008.
 -Serotoninergic axons arise
from neurons in the nucleus
raphe magnus and adrenergic
axons from neurons in the
lateral tegmental nucleus.

- Both form excitatory synapses

onto spinal interneurons (E)

- Those interneurons use

opiate-like peptides
(enkephalins) as
neurotransmitters  inhibits
both incoming nociceptive
axons and the spinothalamic
neurons (S)

Squire, et al,. Fundamental Neuroscience. Third Edition. California: Elsevier. 2008.

 Path for pain and temperature in the
trigeminal system. Small-diameter
afferent axons descend in the spinal
trigeminal tract and terminate in
the pars caudalis of the spinal
nucleus. Second-order axons cross
the midline and ascend to the
thalamus

Squire, et al,. Fundamental Neuroscience. Third Edition. California: Elsevier. 2008.

Rohkamm. Color Atlas of Neurology. New York : Thieme. 2004.
 Chronic pain caused by lesion/dysfunction in
CNS
 Constant pain, but sometimes paroxysmal attack
 exacerbated by sensory or emotional stimuli
 Onset: delayed (1-3 mo, possible 3 years)
 Quality: severe burning sensation (most
common)
 Prevalence: SCI 30%, MS 28%, stroke 8%
 Perceptions that an individual
experiences relating the area where
the amputated limb used to be
 Pain experienced can vary from mild
to excruciating, and often feels like
the amputated limb is twisted or
distorted
 It originates from neuromas located
at the stump tip, result from the
abnormal growth of injured nerve
fibers
CLINICAL PRESENTATION
Did the pain start
suddenly or gradually
get
Doesworse?
anything make
the pain better or
worse?
What does the pain
feel like?
Point to where it hurts.
Does the pain go
anywhere
How wouldfrom
you there?
rate
your pain on scale 1
to
How10?long have you had
the pain?
Braddom RL. Physical Medicine and Rehabilitation 4th ed. United States :
Elsevier-Saunders. 2011
Braddom RL. Physical Medicine and Rehabilitation 4th ed. United States :
Elsevier-Saunders. 2011
 VISUAL ANALOGUE SCALE

Pain Assesment and Management Clinical Practical Design. 2012.

Winnipeg Regional Health Authority.
PAIN CHART
 MCGILL PAIN QUESTIONAIRE

 1 – 10 : sensory
 11 – 15 : affective
 16 : evaluative
 17 – 20 :
miscellaneous
http://www.swrwoundcareprogram.ca/Uploads/ContentDocuments/HCPR%20-
G. Vargas-Schaffer. (2010). Is the WHO Analgesic Ladder Still Valid?: Twenty-
four years of Experience. Canadian Family Physician, 56(6), 514-7.
PAIN RECEPTION

PAIN TRANSMISION

PAIN PROCESSING