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Neuroanatomy of Pain
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Introduction
What is pain? An unpleasant sensory
and emotional experience associated with actual or potential tissue damage, or described in such terms as tissue damage
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Introduction
Pain is subjectiveDoes pain have a purpose?
Types of Pain Acute Pain Chronic Pain Referred Pain Radiating
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Neurophysiology of Pain
Afferent Peripheral Receptor Types Special Receptors Visceral Receptors Deep Receptors Superficial Receptors
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Afferent Peripheral Receptors
Special Transmit taste, sight, smell
Visceral Receptors Transmit hunger, distention, nausea
Deep Kinesthesia, joint position sense, deep pressure and pain Muscle -- GTO’s, muscle spindles Articular Structures – fast and slow adapting
mechanoreceptor and nociceptors
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Afferent Peripheral Receptors
SuperficialWarm/cold, touch, pressure, itch and pain
from skin level
3 categoriesMechanorecptorsThermoreceptorsNociceptors
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Mechanorecepetors
Mechanical stimuli Touch, pressure,
stroking
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Mechanorecpetors
Mechanical stimuli Touch, pressure,
stroking
Fast-adapting Receptors Pacinian Corpuscles Meissner Corpuscles Respond to pressure
and touch very quickly
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Mechanorecpetors
Mechanical stimuli Touch, pressure,
stroking
Fast-adapting ReceptorsSlow-adapting Receptors Merkel Cell Ending Ruffinni Endings Stimulated by
sustained stimuli
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Thermoreceptors
Respond to temp and temp changes
Slow-adapting structures
Warm vs cold receptor firing
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Nociceptors
Transmit pain impulses
Described as free nerve ending
Stimulated by:MechanicalChemical Thermal
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What is the initial response to pain stimulus?
B rad yk in inP ros tag lan d in s
S u b s tan ce P
D eve lop S econ d ary H yp era lg es ia
D eve lop P rim ay H yp era lg es ia
R e lease ch em ica l m ed ia to rs
P a in s tim u lu s
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Release of Chemical Mediators
Pain always begin with chemical response
Cell trauma
Release dopamine and NE from Cell membrane
Activates phospholipase
Release Arachidonic Acid Converted to prostaglandin or bradykinin
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First Order Neurons
Transmit sensory information from receptors to dorsal horn Types of Primary Receptors in Pain Management A-delta A-beta C fibers
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All Types of First-Order Neurons
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Closer Analysis of those Receptors Involved in Pain
Management
A-deltaLarge, lightly myelinatedConduction velocitiesRespond to?Protopathic pain (AKA Primary Hyperalgesia)
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Closer Analysis of those Receptors Involved in Pain
Management
A-delta
A-betaLarge, myelinated Conduction velocitiesRespond to?
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Closer Analysis of those Receptors Involved in Pain
Management
A-delta
A-beta
C-fibersUnmyelinatedConduction velocityRespond toEpicritic pain (AKA Secondary Hyperalgesia)
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Dorsal Horn of the Spinal Cord
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Spinal Cord Level
SC divided into several LaminaeA-delta and C terminate in Laminae I and IIA-delta has input in V also
Laminae ILaminae IILaminae III and IVLaminae V
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Second Order Neurons
Synapse with Laminae I and V cross midline
Synapse with Spinothalmic Tract Immediate warning
of presence, location and intensity of pain
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Second Order Neurons
Spinothalamic Tract Receives info from
A-delta in Laminae I and V
Classification of ST Tract Cells
Low-threshold Wide dynamic range High threshold Thermosensitive
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Spinoreticulothalamic Tract (FYI)
Input from Laminae VII and VIII
Mostly from C-fibers
A bilateral tract
From reticular formation to thalamus
Behavioral and emotional aspects of pain
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Third and Fourth Order Neurons
Second order synapse to higher brain center
3rd = reticular formation to thalamus
4th = between and within higher brain centers
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Higher Brain Centers
Reticular Formation
Thalamus
Cortex
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Structures involved with Descending Control of
Pain Periaqueductal Grey Matter
Nucleus Raphe Magnus
Corticospinal Tract