Patomechanism of Pain

dr. Henny Anggraini Sadeli SpS(K)

Definition of PAIN
Pain is unpleasent sensory and emotional experience
associated with actual or potential tissue damage, or
discribe in term of such damage
( IASP, 1986 )

HAS/Neuro/2007
 Types of Pain

Nociceptive Inflammatory Neuropathic

Pain Pain Pain

Spontaneous pain
Spontaneous pain and
and hypersensitivity
Transient pain
hypersensitivity to pain
in response to
to pain in association with
a noxious
in response to damage to or
stimulus
tissue damage a lesion of
and inflammation the nervous system

-survival -maladaptive pain

-protecting from injury -pain as disease
-promoting healing
HAS/RSHS/FKUP07
 Types of Pain

Visceral Pain Somatic Pain Neurophatic Pain

Deep,squeesing,pressure Pain from nerve endings in Pain from nerve

Poorly localized tissues/bones irritation/damage
Sometimes referred Aching, gnawing Sharp, electrick shock, burning,
Well localised tingling
Eg. Heart, lung, liver, pancreas,etc Often follow nerve pathway

Eg. Bone metastases, bone fracture

Myofacial pain
Peripheral NeP Central NeP
Eg. Polineuropathy
Mononeuropathy Eg.Post stroke pain
Radicular Pain Spinal cord pain
Trigeminal neuralgia
Post herpetic neuralgia

Mixed Pain
Henny’s
Low Back pain
 Stimulus Evoked Pain/
Spontaneous Pain hypersensitivity to pain

allodynia

HAS/Neuro/RSHS-FKUP
hyperalgesia
Hypersensitivity to pain

HAS/neuro
 PAIN BEHAVIOUR

AFFECTIVE

COGNITIVE

SENSORY

Waddel G, 1992 Biopsychosocial & chronic pain disability model

HAS/Neuro/RSHS-FKUP
Henny’s
Henny’s
Henny’s
 Pain Mechanism
• Nociception : transduction-conduction-
transmission-perception
• Phenotypic switches
• Peripheral sensitization
• Ectopic exitability
• Central sensitization
• Decreased inhibition
• Structural reorganization

HAS/neuro
 Excitability in dorsal horn neurons is determined by
balance between exitatory inputs from primary afferents
Henny’s
and inhibitory inputs (local and descending)
HAS/Neuro/2006
Henny’s
Henny’s
Henny’s
 microglia
Descendens BDNF
Descendens TNFα
exitatory inhibitory IL-1

5HT, NE COX2
Primary PGE2
afferent P2X4
nociceptor

CB1 opioid Central

gly Sensitization
Glutamate GABA
inhibitory

excitatory NMDA
AMPA/kainate
SP Ca++
mGluR
CGRP NK1
Somatostatin(-) VGCC COX2
PGE2
EP

GABA
α2δCC Dorsal horn neuron

apoptosis

HAS/RSHS/FKUP07 interneuron
Henny’s
 Central Sensitization
• A reduction in activation threshold
• An increased responsiveness
• An expansion of receptive field
in dorsal horn neurons

Henny/neuro
Henny’s
Henny’s
 Structural reorganization

henny’s
henny’s