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PAIN 1
Ken Matthew M. Villamin, MD 7/10/2018
• Pathogenesis vs Pathophysiology
>Pathogenesis basically how a disease or an
abnormality is brought about. It is from the etiology or the
cause.
>In contrast in pathophysiology we talk more about the
symptoms or the manifestations; in this case, how is PAIN
brought about? Symptom oriented ang pathophysiology
There are two distinct functional categories of axons: Neuropathic Pain – initiated or caused by primary lesion or
➢ Primary afferents with cell bodies in the dorsal root dysfunction in the nervous system
ganglion. ➢ POSTHERPETIC NEURALGIA
➢ Sympathetic postganglionic fibers with cell bodies in
-Associated with herpes zoster or shingles.
the sympathetic ganglion.
Shingles is the reactivation of Chicken Pox
➢ NEUROPATHIC LOW BACK PAIN
Primary Afferent Nociceptor ➢ DISTAL POLYNEUROPATHY -
➢ Primary – first-order neuron -Most common is associated with Diabetes
➢ Afferent – neuron which sends signal Mellitus
from the periphery directed towards the
CNS ➢ CENTRAL POST-STROKE PAIN
➢ Nociceptor – pain receptor ➢ TRIGEMINAL NEURALGIA (or Tic douloureux)
n your peripheral nerve endings, you have -Severe, stabbing pain to one side of the face.
your peripheral nerves. It stems from one or more branches of the
➢ A-beta nerve that supplies sensation to the face, the
➢ A-delta trigeminal
➢ C fibers
➢ CRPS - Complex regional pain syndrome (CRPS)
REMEMBER! -Chronic (lasting greater than six months)
• A-beta (Aβ) fibers – transmit light touch pain condition that most often affects one limb
• A-delta (Aδ) and C fibers – transmit pain (arm, leg, hand, or foot) usually after an injury.
impulses, SOMATIC VS VISCERAL PAIN
both afferent nociceptors
SOMATIC PAIN VISCERAL PAIN
PAIN CLASSIFICATION • Pain receptors are located • If due to obstruction of a
in the skin, subcutaneous hollow organ, pain is
tissues, fascia, other poorly localized, deep, and
PAIN
connective tissues, cramping, and may be
periosteum, endosteum, referred to remote
and joint capsules. cutaneous sites.
Nociceptive Neuropathic
• Stimulation of these ➢ Example is appendicitis:
receptors usually produces Pain begins in the
sharp or dull localized pain. periumbilical area, or
Somatic Visceral Multifactorial • “Burning” pain is not sometimes in the
uncommon if the skin or epigastric area.
subcutaneous tissues are ➢ Pathophysiology of pain
We will go through this one by one:
involved. in appendicitis: the
NOCICEPTIVE VS. NEUROPATHIC PAIN appendix has visceral
Phrase “not uncommon” innervation which extends
means that it is not an to the periumbilical area.
expected finding but it is also ➢ For the first 6 hours of
not surprising. It is not rare or appendicitis it will be
not seldom encountered. It’s painful only in the
right in the middle. periumbilical area, after 6-
8 hours, the somatic
nerves overlying the
appendix will be activated
• If due to injury of organ
capsules or other deep
connective tissues, it may
be more localized and
sharp.
➢ When the appendicitis
Nociceptive Pain – caused by activity in neural pathways in
raptures, the first structure
response to potentially tissue-damaging stimuli
that would be affected is
➢ POSTOPERATIVE PAIN – immediately after an operation
the peritoneum. This time
➢ MECHANICAL LOW BACK PAIN – excessive stretching
the pain will be diffused.
or excessive bending
➢ SPORTS/ EXERCISE INJURIES
➢ SICKLE CELL CRISIS – innervation to a type of anemia
➢ ARTHRITIS
VIRATA, TRINIDAD Checked by: VIRATA Page 2 of 6
INTERNAL MEDICINE TOPIC MODULE #, LECTURE #
PHARMACOLOGIC ANALGESIA
• Acetaminophen (aka Paracetamol)
WIND-UP PHENOMENON AND REMODELING
• Acetylsalicylic Acid / ASA (aka Aspirin)
• Repetitive stimulation (e.g. from a prolonged
• NSAIDS
painful condition) can sensitize neurons in the o Nonselective
dorsal horn of the spinal cord so that a lesser o Selective
peripheral stimulus causes pain • Opioid Analgesic
• Peripheral nerves and nerves at other levels of the
CNS may also be sensitized, producing long- term
synaptic changes in the cortical receptive fields
that maintain exaggerated pain perception
Drug Examples
Antidepressants Floxac
Anticonvulsants Phenobarbital, phenytoin,
carbamzepine
Anxiolytics Diazepam
Muscle relaxants Myonal
Topical local anesthetics andLidocaine
other agents
Amphetamines Phenylpropanolamine
Phenothiazines Thorazine
Biphosphonates Alendronate
Corticosteroids Prednisone
• Adjuvants- supplement drugs, not drugs that cannot
address pain in their own but has effect in the nervous
system or peripheral receptors that complement those of • Garlic- lower cholesterol levels
main pain medication
References:
o Powerpoint
o Harrison’s Principles of Internal Medicine, 16th edition
o Voice notes
o Batch 2020 Trans