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PATHOPHYSIOLOGYOPATHOPHYSIOLOGYOFF
NERVOUS SYSTEMNERVOUS SYSTEM. . PAINPAIN
Professor Yu. I. BondarenkoProfessor Yu. I. Bondarenko
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Kinds of SensitivityKinds of Sensitivity• 1. Painful
• 2. Temperature
• 3. Tactile
• 4. Proprioceptive
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DEFINITION OF PAINDEFINITION OF PAIN
• PAIN – it is typical pathological process, which was generated during evolution and which arise owing to action on an organism painful (nociceptive) irritant or weakening of antipainful (antinociceptive) system
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Components ofComponents of painfulpainful reactionreaction
• 1. Perception, conduction and
realization of pain
• 2. Formation vegetative,emotional and behavioural responses
• 3. Mobilization of antipainful system
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CLASSIFICATION OFCLASSIFICATION OFPAINPAIN
• Physiological pain
• Pathological pain
• Acute pain
• Chronical pain
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PRIMARY ACUTE PAINPRIMARY ACUTE PAIN
• Cause – action of painful agent
• Arise at once after action of painful irritant
• It is not removed morphine
• It has signal meaning
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SECONDARY ACUTE PAINSECONDARY ACUTE PAIN
• Pathogenesis – action of biological active substantces
• It is not located
• It is removed by morphine• It has signal meaning
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Primary andPrimary and secondary painsecondary pain
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BIOLOGICAL ACTIVE BIOLOGICAL ACTIVE SUBSTANCESSUBSTANCES
• Histamine
• Serotonin
• Prostaglandines
• Bradykinin
• Potassium iоns
• Hydrogen iоns
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THEORY OF PAIN PERCEPTIONTHEORY OF PAIN PERCEPTION
• Theory of specificity – pain is perceived only special painful receptors
• Thery of intesity – pain arises due to arritation any one receptors (painful,temperature, tactile), if irritant so powerful that it demages tissue
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KINDS OF PAINFUL RECEPTORSKINDS OF PAINFUL RECEPTORS
• Monomodal – it reacts onto mechanical irritation
• Bimodal – it reacts onto mechanical and temperature irritation
• Polymodal – its excited by mechanical, temperature and chemical irritants
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OrgansOrgans withwith largelarge painful painful receptivenessreceptiveness
• Skin
• Meninges
• Pleura
• Peritoneum
• Periosteum
• Conjunciva
• External sex organs
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Nervous fibres inNervous fibres in skinskin
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Sensitive Sensitive nervesnerves inin the skin ofthe skin of thoraxthorax
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TransferTransfer ofof painful informationpainful information
• 1 Neuron – in spinal node
• 2 Neuron – in posterior horns of spinal cord
• 3 Neuron – in thalamus
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Tractus spinothalamicusTractus spinothalamicus
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Tractus spinothalamicusTractus spinothalamicus
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VENTROBASALVENTROBASAL COMPLEXCOMPLEX
• Ventroposteriolateral nucleus – representation of trunk
• Ventroposteriomedial nucleus – representation of face
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REALIZATION OF PAINREALIZATION OF PAIN
VENTROBASAL COMPLEX
↓
DORSAL CENTRAL GYRUS
↓
Sensory zone S1
↓
Estimate of pain
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BrainBrain
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Connections ofConnections of spinothalamic spinothalamic pathwaypathway withwith subcortical nucleussubcortical nucleus
• Vasomotor center
• Respiratory center
• Center of satiation
• Gіantocellular nucleus of brain stem
• Sphenoid nucleus of midbrain
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VEGETATIVE RESPONSESVEGETATIVE RESPONSES
• Tachycardia
• Increase of stroke volume
• Increase of cardiac output
• Acceleration of blood stream
• Increase of arterial pressure
• Icrease of respiratory rate
• Icrease of sugar level in blood
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EMOTIONALEMOTIONAL RESPONSESRESPONSES
• Psychic excitement• Anger• Fear• Agression• 1. Limbic structures: septum• hippocampus• tonsilla
2. Frontal parts of cortex brain
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BEHAVIOUR REACTIONSBEHAVIOUR REACTIONS
• 1. Estimate of painful stimuli:• а) frontal part of brain cortex• б) hypocampus. • Rеgulation of motor act:• а) tonsilla• б) upper wall of parietal sulcus – • second somatosensory zone S2 •
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MEDIATORS OF PAINMEDIATORS OF PAIN
• Substanse Р
• Glutamic acid
• Cholecystokinin
• Neurotensin
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StructureStructure of chemical synapseof chemical synapse
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Antinociceptive systemsAntinociceptive systems
• Neuronal opiate system – met- and
leuencephalin• Neuronal unopiate system – noradrenalin,
serotonin, dopamine• Hormonal opiate system – hormones of
adenohypophysis • Hormonal unopiate system – vasopressin
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Hormonal unopiate systemHormonal unopiate system
• 1. Adrenocorticotropic hormone• 2. Melanostimulating hormone• 3. β -Lipotropic hormone• 4. Large endorphines: kitorphin β-kosomorphin dinorphin
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SCHEMA OF PORTALSCHEMA OF PORTAL MECHANISMMECHANISM
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CHRONICAL PAINFULCHRONICAL PAINFUL SYNDROMESSYNDROMES
• Phantom pain
• Causalgia
• Neuralgia
• Eccentric pain
• Projectional pain
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Sensitive fibers of heartSensitive fibers of heart
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DermatomesDermatomes, , which reply to radix which reply to radix of spinal cordof spinal cord
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ІІrradiating painrradiating pain
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Projecting painProjecting pain
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METHODS OF ANAESTIZATIONMETHODS OF ANAESTIZATION
• Psycological
• Physical
• Pharmacological
• Surgical
• Neurosurgical
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Psycological methodsPsycological methods 1. Conversation
2. Relaxation
3. Hypnosis
4. Autotraining
5. Correct stereotype of motion
6. Self-removel of pain
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Psycological anaesthetizationPsycological anaesthetization – – ceremony of circuitceremony of circuit “ “by electorby elector ” ”
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PHYSICALPHYSICAL METHODS OF METHODS OF ANAESTHETIZATIONANAESTHETIZATION
• Acupuncture• Electroacupuncture• Laseropuncture• Electrostimulation• Electrophoresis• Ultrasound• Magnetico-laser therapy• Massage• Manual therapy
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PharmacologicalPharmacological anaesthetizationanaesthetization: : blockingblocking of sympatheticof sympathetic plexusplexus
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SurgicalSurgical methodsmethods of of anaesthetizationanaesthetization
• Opening of abscess
• Reposition of fragments
• Splintation of extremity
• Section of scars
• Desympathization
• Gangliectomy