physiology of pain and nerve injury

Definition: Pain is the subject's conscious perception of modulated nociceptive impulses that generates," an unpleasent sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage" -(International association for the study of pain-1979) Types of Pain: 1. Central pain 2. Heterotrophic pain a.)Central pain b.)Referred pain c.)Projected pain Depends on the site of origin, pain can be classified into, Somatic a.)superficial somatic pain b.)deep somatic -musculoskeletal -visceral Neuropathic pain 1. Continuous -neuritis -deafferantation -sympathetically maintained pain 2. Episodic -neuralgic -neurovascular depends on duration, a)acute b)chronic Types of receptors: 1. 2. 3. 4. 5. Mechanoreceptors-for touch, pressure, stretching Chemoreceptors-changes in O2,CO2 concentration, taste, smell, Nociceptors-for pain Electromagnetic receptors-rods and cone in eye-to sense light Thermoreceptors-change in temperature

Substance released-neurotransmitters, 1. Seratoninis secreted by nuclei that are in the median raphe of the brain stem and project to many areas of the brain and down into the spinal dorsal horn.It is allogenic agent -it relates especially to vascular pain syndrome. It is the neurotransmitter at the primary sensory synapse.It causes mast cell to release histamine and the platelets to release serotonin which further mediates the inflammatory response. It also causes the regional blood vessel to release bradykinin into the site of injury leading to further sensitization. The endorphins are polypeptides that behave like morphine and binds to morphine receptors to suppress pain. Enkephalin is an opioid substance that naturally present in the brain.Acute pain causes the release of endogenous opioid into the CSF and blood which suppresses pain.

2. Substance-P-

3.Endamic opoids-

4.prostaglandins and Histamins Pain Fibers: 1.A-alpha-for proprioception,pressure, heavy touch -beta- for pain ,touch cold -gama-moror to musle spindle -delta-pain 2.B-pre ganglionic spinal nerve fibers 3.C-pain, un myelinated Theories of pain 1.Specific Theory, -states that specific receptors and nerve fibers for specific modality, 2.Pattern Theoty -states that Same nerve conducts all the sensations trasmits according to the reception 3.Gate Control Theory -states that the mechanism of conduction by special gating mechanisms in the spinal nerve afferents.(SGR-substantia gelatinosa ronaldi)which acts like a gate and modulate the in coming pain , here both the nociceptive and the nonnociceptive impulses play a role , such that when an impulse from large myelinated A-beta enters a interneuron is activated and the impulse can not enters in to the spinal cord at the same an impulse from a small unmyelinated C-fiber enters the inter neuron inactivated the pain transmitted into the spinal cord-by-(1965 Melzack and Wall )

Methods of pain perception 1.TrasductionTransduction- free nerve endings with the capacity to distinguish between noxious and innocuous stimuli. When exposed to mechanical (incision or tumor growth), thermal (burn), or chemical (toxic substance) stimuli, tissue damage occurs. Substances are released by the damaged tissue which facilitates the movement of pain impulse to the spinal cord. Sufficient amounts of noxious stimulation cause the cell membrane of the neuron to become permeable to sodium ions, allowing the ions to rush into the cell and creating a temporary positive charge.Then potassium transfers back into the cell, thus changing the charge back to a negative one. With this depolariztion and repolarization, the noxious stimuli is converted to an impulse. This impulse takes just milliseconds to occur. 2.TransmissionImpulse--spinal cord--brain stem--thalamus-- central structures of brain--pain is processed. Neurotransmitters are needed to continue the pain impulse from the spinal cord to the brain. There are three component in the transmission system.FIRST ORDER NEURON which carries the nociceptive input from the sensory organ into the spinal cord.SECOND ORDER NEURON which carries this input into the higher center.INTERACTING NEURONS interaction of neurons in the thalamus,limbic system, and cortical system 3.PerceptionThe end result of the neural activity of pain transmission. It is believed that the pain perception occurs in the cortical structuresbehavioral strategies and therapy can be applied to reduce pain. Brain can accommodate a limited number of signals distraction, imagery, relaxation signals may get through the gate, leaving limited signals (such as pain) to be transmitted to the higher structures. 4.ModulationChanging or inhibiting pain impulses in the descending tract (brain spinal cord).Descending fibers also release substances such as nor-epinephrine and serotonin (referred to as endogenous opioids or endorphins) which have the capability of inhibiting the transmission of noxious stimuli. Helps explain wide variations of pain among people.Cancer pain responds to antidepressants which interfere with the reuptake of serotonin and nor-epinephrine which increases their availability to inhibit noxious stimuli.

Types of nerve injuries: Allodynia Analgesia Anaesthesia Paraesthesia Dysaesthesia Hyperaesthesia Hypoaesthesia Hypo or hypergesia Ageusia Neuritis Neuralgia

Seddons classification of nerve injuries 1. Neuropraxia 2. Axonotmesis 3. Neurotmesis

Nerve Regeneration Schwann cells -Act as phagocytes, as the distal neuronal portion degenerates. Surrounded by basement membrane, form regeneration tube. Which serves as guide for axon, send out chemicals that attract the growing axon and axon tip connected to cell body begins to grow towards destination.