pathophysiology of paediatric pain€¦ · paediatric pain maarten o. mensink, md princess máxima...
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![Page 1: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/1.jpg)
Pathophysiology of
paediatric pain
Maarten O. Mensink, MD
Princess Máxima Centre, Utrecht, The Netherlands
![Page 2: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/2.jpg)
case
Patient A. female
14 years
JIA
Affected joints: knees/ankles
℞ methotrexate
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case
decursus Good inflammatory respons
No signs of inflammation
High pain scores (NRS 6-8)
Mother: “Usually doesn't complain about pain,
so yes, I'm verry worried.”
![Page 4: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/4.jpg)
pain anatomy
keywords:
brain
spinal cord
Nerve
Soma
![Page 5: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/5.jpg)
pain anatomy
![Page 6: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/6.jpg)
pain anatomy
axon typeDiameter (μm)Speed (m/s)
Aα13-20
80-120
Aβ6-1235-75
Aδ1-5
5-35
C0.2-1.50.5-2
![Page 7: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/7.jpg)
pain anatomy
![Page 8: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/8.jpg)
pain anatomy
C
Aβ – Aδ
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pain anatomy
![Page 10: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/10.jpg)
pain anatomy
![Page 11: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/11.jpg)
pain anatomy
![Page 12: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/12.jpg)
pain in action
Wei F, Zhuo M. J Physiol, 2001
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pain in action
![Page 14: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/14.jpg)
Pain chronification
keywords:
glutamate
NMDA-receptor
Long Term Potentiation (LTP)
Wide Dynamic Range neuron (WDR)
Central sensitisation
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Pain chronification
Wei F, Zhuo M. J Physiol, 2001
![Page 16: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/16.jpg)
Pain chronification
![Page 17: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/17.jpg)
Chronificatie pijn
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Pain chronification
![Page 19: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/19.jpg)
Pain chronification
Central sensitisation:
Restructuring of synapses
learning:
– memory
– anticipation
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Pain chronification
![Page 21: Pathophysiology of paediatric pain€¦ · paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands m.o.mensink-4@prinsesmaximacentrum.nl. case Patient](https://reader033.vdocument.in/reader033/viewer/2022060506/5f1f1bac2a9c280dfc51a177/html5/thumbnails/21.jpg)
Diagnosing pain
pain-history:
pain-nature
pain-luxerative factors
pain-time factors
pain-related factors
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diagnosing pain
pain-physical examination:
inspection
palpate
neurological examination
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diagnosing pain
integration with system
fear/vigilance
cognition
Parent-child system
contributing somatic factors
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treatment
pharmacological
tissue damage
inflammation
neuropathy
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treatment
psychological
CBT
EMDR
mindfullness
system therapy
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treatment
fysiotherapeutical
musculoskeletal evaluation
muscular training
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6th of february 2020
#beppa@BBeppa