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Vaibhav Jain
Contents
Introduction
Historical Perspective
Classification of Pain
Pain Pathways
Pain Perception
Pain Modulation
Conclusion
What is Pain?
Pain is a vital function of the nervous system in providing the body with
a warning of potential or actual injury.
It is both a sensory and emotional experience, affected by psychological
factors such as past experiences, beliefs about pain, fear or anxiety.
The International Association for the Study of Pain formulated
definition states: Pain is an unpleasant sensory and emotional
experience associated with actual or potential tissue damage, or
described in terms of such damage.
Historical Views of Pain
Prior to the the scientific renaissance in Europe pain was not well-
understood, and it was thought that pain originated outside the body,
perhaps as a punishment from God.
Hippocrates believed that it was due to an imbalance in vital fluids.
Pain is termed nociceptive and activate nociceptors which are free nerve
endings found in the skin muscle, joints, bone and viscera.
Recently, it was found that nerve endings contain transient receptor
potential (TRP) channels that sense and detect damage.
They transduce a variety of noxious stimuli into receptor potentials, which
in turn initiate action potential in the pain nerve fibers.
The cell bodies of nociceptors are mainly in the dorsal root and trigeminal
ganglia. No nociceptors are found inside the CNS.
Types of Nociceptors
Histamine
Nerve growth factor (NGF)
Substance P
Somatic pain: Pain that arises from the skin, muscles, joints or peripheral
nerves themselves.
Visceral Pain: In the visceral organs, nociceptors respond to mechanical
stimulation such as pressure, tissue damage, and chemical stimulation.
Neuropathic Pain: Pain caused by damage or disease affecting the
somatosensory nervous system may be associated with dysesthesia or
allodynia.
Referred Pain: Referred pain is a painful sensation at a site other than
the injured one.
Psychogenic Pain: Physical pain that is caused, increased, or prolonged
by mental, emotional, or behavioral factors.
Incident Pain: Incident pain is pain that arises as a result of activity,
such as movement of an arthritic joint, stretching a wound, etc.
Phantom Limb Pain
Physical approach
Physical medicine and rehabilitation
Acupuncture
Psychological approach
Mindfulness Meditation
Hypnosis
Cognitive behavioral therapy (CBT)
Interventional approach
Neurolytic Block
Deep brain stimulation (DBS)
Pharmacologic Approach
Conclusion