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ATTR 362: Physiology and Psychology of Pain
Transcript of ATTR 362: Physiology and Psychology of Pain
What is pain?
described a theory of pain
It sounded good, but he was
The problem is, we believed this basic principle for
The color TV predates our
modern understanding of
What we do know
We also know that pain is much more than just a sensation.
is a process that involves
Important Terms To Know:
-the unpleasant sensation
(must be interpreted by higher
-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
C fibers, limbic system, cortex
Influences on Pain
6 Months Ago
Age, Personality, and Gender
Now on to the
The Somatosensory System:
The link between the outside world
and our brain
What does this..............
have to do with this?
Let's start at the skin and work our way up
-Pressure, slow adapt
-Pressure, rapid adapt
-Deep pressure, responsive
-Sretching of skin and joints*
After you stimulate a mechanoreceptor, where does it go?
Sensory afferent neurons, also known as
We'll call them
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.
Mechanical, temperature, chemical. "Slow pain"
Dull, non-localized, diffuse. Unmylenated
Next Stop: The Dorsal Horn
C Fibers are the most abundant first-order neurons in the human body
Up spinal cord
Not Just Anywhere
All nociceptive and thermal signals travel on either A-delta or C fibers. Nothing else!
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
The link between the periphery and the higher brain centers
The Higher Centers
Where the magic happens
Extroverts vs. Introverts
Men vs. Women
Young vs. Old
Crosses Spinal Cord
Draw a flow chart diagram of the process of pain transmission. Post the pic on Padlet.
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
To higher centers
Opening and closing of the "Gate"
dependent on the activity of the neurons
on 2nd order neurons
So, what happens when large diameter
"non-pain" stimuli are less frequent than small diameter C fibers?
1. You feel the painful stimulus
2. You feel the non-painful stimulus
Dependent on RATE!!
Other Descending Control Factors
Spinal opiods (enkephalin) inhibit
small diameter neurons (C fibers)
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.
In one sentence, explain ascending control of pain in layperson terms.
Common Pain Syndromes
Signs & Sx
Sx > 6 months
Few objective findings
What do ATC's do in these cases?
Refer to Physician >> Pain Specialist
Myofascial Pain Syndrome
Sore muscles with no indication of arthritis or other injury may be MPS
Also known as
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
Make sure you read
about assessment of pain!
-McGill Pain Q.