پاورپوینت کامل Pain Control: Acute and Chronic Conditions 75 اسلاید در PowerPoint

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پاورپوینت کامل Pain Control: Acute and Chronic Conditions 75 اسلاید در PowerPoint

اسلاید ۴: Pain “unpleasant 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

اسلاید ۵: “Pain is whatever the experiencing person says it is; existing whenever he or she says it does.” McCaffrey, 1980“Pain is now recognized as a complex experience with at least four main componentsnociceptionsensationsuffering or distressbehaviourChampagne and Weisse,1994

اسلاید ۶: Pain threshold refers to the point when stimulation is felt as painful. Pain tolerance refers to “how much” one can bear the pain experience; varies between individuals and cultures.i.e. females vs males pain as a form of punishment pain as a vital experience

اسلاید ۷: Two categories of pain Acute: primarily due to nociceptionshort-lived and reversible;less than six months organic disease or injury is presentChronic: may be due to nociception but in which psychological and behavioral factors often play a major rolebehavior state, initiated by a real injurysix months or longer; that it has itself become the disease

اسلاید ۸: Acute Pain

اسلاید ۹: ACUTE PAIN

اسلاید ۱۰: Chronic Pain

اسلاید ۱۱: Chronic Pain

اسلاید ۱۲: Two Types of PainPhysiologic or nociceptive painIncludes acute, subacute, chronic, and inflammatory painResults from noxious stimuli and inflammation in an otherwise intact tissuePain system is functioning as nature intends it toPathologic or neuropathic painAssociated with frank injury to neural tissue Reflects abnormal functioning of the pain system

اسلاید ۱۳: Nociceptors: special sense receptors in the skin or internal organsreceptors receive noxious (painful) stimuli produced by intense heat, extreme pressure, pricks and cuts, surgery or ischemia Noxious sensation: two components

اسلاید ۱۴: Peripheral Nociceptor SystemSomatic structuresCutaneous nociceptors: pain receptors at the termination of free-nerve endings in the skin(1) A- high- threshold mechanoreceptors (HTM) activated by mechanical noxious stimuli (2) A- myelinated mechanothermal nociceptors activated by noxious mechanical stimuli and noxious heat(3) C polymodal nociceptors activated by mechanical, thermal, and chemical noxious stimuli(4) miscellaneous C mechanical nociceptors and cold nociceptors

اسلاید ۱۵: Deep nociceptors: also supplied by A- and C fibersLess sensitive to noxious stimuli than cutaneous nociceptorsEasily sensitized by inflammation; dull and poorly-localizedMuscle, fascia, tendons, and other deeper somatic structures

اسلاید ۱۶: Visceral structuresSupplied by C afferents and some A- fibersActivated by disease, inflammation, contraction under isometric conditions, ischemia, rapid distention, and other adequate visceral nociceptive stimuli and endogenous algogenic substances

اسلاید ۱۷: Sensitization following Tissue InjuryPeripheral Sensitizationdirect effect: injury > release of algogens – (activate and sensitize nociceptors); indirect effect: (release of a complex soup of inflammatory substances further sensitizing injured tissue and surrounding tissues) – make the nociceptors more sensitive to the painful stimulus, more prone to activation by:- weak touch- thermal stimuli- during movement lowered threshold to stimulation, and prolonged and enhanced response

اسلاید ۱۸: Primary hyperalgesiaSensitization at the site of injuryCharacterized by lowered pain threshold, increased sensitivity to suprathreshold stimuli, and spontaneous pain – peripheral sensitizationSecondary hyperalgesiaRefers to the pain and tenderness felt at the area adjacent to the site of the initial injury including the area without inflammation – central sensitization

اسلاید ۱۹: Central Sensitization – abnormal degree of amplification of the incoming sensory signal in the CNS- amplifies the signal of nociceptors, and amplifies the signal of low-threshold A- sensory fibers (touch-sensitive & vibration) which previously are subliminal- A- touch input is perceived as painful- key involvement of glutamate neurotransmitter and its NMDA receptor

اسلاید ۲۰: Burn – produce tenderness in the burnt area (primary hyperalgesia); due to sensitized nociceptors (peripheral sensitization) also produce tenderness in a substantial zone of intact skin (secondary hyperalgesia)- due to spinal amplification of otherwise normal touch input (central sensitization)

اسلاید ۲۱: Lloyd/Hunt SystemDiameter(m)Letter SystemConduction Velocity (m/s)MyelinReceptor /Ending TypesI-a12-20-70-120+Muscle spindle primary endingsI-b12-20-70-120+Golgi tendon organs-12-20A- 70-120+Muscle efferents (extrafusal)II6-12+A-30-70+Encapsulated endings-2-10A-10-50+Muscle efferents (intrafusal)III1-6A-5-30+A- specific nociceptors/ polymodal receptors, cold, most hair, some visceral re