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ATTR 362: Physiology and Psychology of Pain

An examination into the physiology and psychology of pain as it relates to Athletic Training.
by

Jess Edler

on 3 September 2015

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Transcript of ATTR 362: Physiology and Psychology of Pain

PAIN
Understanding
What is pain?
Rene Descartes
In 1664
described a theory of pain
It sounded good, but he was

wrong!
The problem is, we believed this basic principle for
300 years!
What we do know
Physiological
Emotional
Psychological
PAIN
Behavioral
We also know that pain is much more than just a sensation.
Pain
is a process that involves
sensory, motor,
and
emotional responses.
Important Terms To Know:
Pain
-the unpleasant sensation
(must be interpreted by higher
brain centers)
Nociception
-the neural processes of encoding and processing noxious stimuli.
(neurophysiological process that may be interpreted as pain)
You also need to know the 3 dimensions of pain
Sensory-Discriminative
Cognitive-Evaluative
Affective-Motivational
Pain Threshold
Pressure
VS.
A-delta fiber
recruitment
Pain Tolerance
C fibers, limbic system, cortex
Influences on Pain
Perception
Past Experiences
6 Months Ago
Today
This hurts!
This is
going
to hurt!
Expectations
Sociocultural
Age, Personality, and Gender
Now on to the
heavy stuff!
The Somatosensory System:
The link between the outside world
and our brain
What does this..............
have to do with this?
How?
Let's start at the skin and work our way up
Mechanoreceptors
Thermal Receptor
Merkel's disks
Meissner's corpuscles
Pacinian corpuscles
Ruffini corpuscles
Nociceptors
-Temperature
-Pressure, slow adapt
-Pressure, rapid adapt
-Deep pressure, responsive
-Sretching of skin and joints*
-Pain
After you stimulate a mechanoreceptor, where does it go?
Sensory afferent neurons, also known as
first-order neurons.
We'll call them
first-order neurons
All
sensory information (not just pain)
travels on first-order neurons
Classifications of first-order afferent nerve fibers
Erlanger and Gasser
A, B, and C based on size and conduction speed
At this point, you're like
So Let's Talk About Pain
First-Order Neurons Responsible for Transmitting Pain
Mechanical, temperature, ischemic. "Fast pain" Able to pinpoint location. Mylenated.
A-delta
2 Types
C Fibers
Mechanical, temperature, chemical. "Slow pain"
Dull, non-localized, diffuse. Unmylenated
Next Stop: The Dorsal Horn
Fun Fact:
C Fibers are the most abundant first-order neurons in the human body
Up spinal cord
Not Just Anywhere
Rexed Laminae
C
A-delta
IMPORTANT
All nociceptive and thermal signals travel on either A-delta or C fibers. Nothing else!
BOC Practice
Nociceptive neural signals synapse at which of the following laminae of the spinal cord?
A. I, III, VI
B. I, II, V
C. I, II, III
D. V, VII, XI
Second-Order Neurons
The link between the periphery and the higher brain centers
The Higher Centers
Where the magic happens
Thalamus
Cerebral
Cortex
Amygdala
SMH
Extroverts vs. Introverts
Men vs. Women
Young vs. Old
Start
End
Crosses Spinal Cord
Padlet Challenge
Draw a flow chart diagram of the process of pain transmission. Post the pic on Padlet.
Quick Review
How do we control pain?
Ascending - "Periphery" to the brain
Descending - Brain to the "periphery"
Melzack and Wall's
Gate Control Theory
-Example - Rubbing you tibia (shin) after hitting it on the coffee table
Two Components
Ascending Mechanism
Descending Mechanisms
So, what happens when large diameter
"non-pain" stimuli are less frequent than small diameter C fibers?
Two options:
1. You feel the painful stimulus
2. You feel the non-painful stimulus
Evidence Based Practice
Therapeutic modalities applied to assist in tissue healing also activate the Gate Mechanism. For example, ice applied to decrease metabolism and reduce secondary injury also relieves pain by stimulating sensory receptors.
Padlet Challenge
In one sentence, explain ascending control of pain in layperson terms.
Common Pain Syndromes
Chronic Pain
Signs & Sx
Sx > 6 months
Few objective findings
Med. Abuse
Difficulty Sleeping
Depression
Maladaptive Behavior
Somatic Preoccupation
What do ATC's do in these cases?
Refer to Physician >> Pain Specialist
Referred Pain
Myofascial Pain Syndrome
Sore muscles with no indication of arthritis or other injury may be MPS
Also known as
Trigger Points
Mechanism of MPS unknown, but if trigger point is contained in injured area, a cycle of reflexive muscle contractions occur.
Others to read about
Sympathetically maintained pain syndromes
Peripheral Nerve Root and Spinal Cord Pain
The Placebo Effect
Break-up Into 6 Groups
1 = Thermal
2 = US & Shortwave
3 = Electrical
4 = Mech/Exercise
5 = Analgesics/NSAIDS
6. Opiodes
Make sure you read
about assessment of pain!
-McGill Pain Q.
-VAS
-PROMIS
Full transcript