Warning Sign
Limits Function
Has psychological/emotional affect
Protective
Warning of impending injury
Something is wrong
Modalities
Use to decrease pain
Facilitate return to normal function
RECEPTORS
Reflex loops
Afferent to spinal cord
Efferent back to site (motor); Afferent to brain (signal)
Very Sensitive
Limited Sensitivity
Muscle
Insensitive
type A- myelinated
type C- unmyelinated
FIBERS
DIAMETER
CONDUCTION
VELOCITY
IA
12-20 m 72-120 s
IIA
6-12 m 36-72 s
IIIA
1-6 m
6-36 s
Medulla Oblongata
Controls autonomic functions
Heart Rate
Respiration
Vomitting
Reticular Formation
Located in brain stem
Influences alertness, waking, sleeping, and certain
reflexes
Evokes motor, sensory, and autonomic response to
noxious stimuli (rapid response)
Important relay in pain control mechanisms
Thalamus
Divided into 2 nuclei
Ventral posterior lateral (VPL)
Synapses with fibers from body
Periaqueductal Gray
Significant role in pain modulation
Relay center for ascending and descending tracts
Hormonally controls the release of beta-endorphins and
other pain reducing chemicals
Endorphins increase pain threshold
Trauma
Receptors
A-delta
C fibers
Afferent Pathway
Cortex
Higher centers
ouch
mommy
Thalamus
Reticular Formation
PAG
Pain
Inflammation
Spasm
Pain
Historical
Aristotle: soul is the center of the sensory process; pain
located in the heart
19th century: Germans proved that the brain was
involved with sensory and motor function
Specificity Theory: direct pathway, continuous fiber
Pattern Theory: generic nerve transmits code based on
sensation; various frequency, pattern
Mechanics
Large diameter afferents synapse on enkephalin
interneurons
Release of enkephalins into synapse of nociceptive
pathways
Enkephalins believed to inhibit release of Substance P
Prohibits synaptic transmission of pain
Mechanics
Stimulus is received in Peri-Aqueductal Gray (PAG)
Third-order neurons from Raphe Nucleus are activiated
Dorsolateral tract descends from RN and synapse on
enkephalin interneurons in lamina II releasing
serotonin
Release of enkephalins into 1st and 2nd order afferent nociceptive
pathway
Mechanics
Hypothalamus is stimulated and synapses with PAG
Beta-endorphin released and activates dorsolateral tract
Serotonin released and enkephalin influence
Subjective finding
better, worse, same comparative
Scales, Questionnaires
Regardless of situation, must understand that
individuals experience and respond to pain differently