Neuropathic pain幻灯片.pptVIP

How to deal with pain Pain Presentation of Pain States NSAIDs, Steroids and Debridement in Nociceptive Pain Panadol, Narcotics, Steroids, TCA and AEDs in dealing with Pain Causes of Neuropathic Pain  Peripheral causes of neuropathic pain Trauma e.g. surgery, nerve entrapment, amputation Metabolic disturbances e.g. diabetes mellitus, uremia Infections e.g. herpes zoster (shingles), HIV Toxins e.g. chemotherapeutic agents, alcohol Immune disorders e.g. lupus erythematosus, polyarteritis nodosa Nutritional deficiencies e.g. niacin, thyamine, pyridoxine Direct effects of cancer e.g. metastasis, infiltration Central causes of neuropathic pain Stroke Spinal cord lesions Multiple sclerosis Tumors Psychological effect e.g. Depression, phobia, anxiety… Fiber Types in Pain Aβ fibers Large diameter, myelinated, fast conduction velocity Mechanoreceptors normally activated by non-noxious mechanical stimuli (touch) Aδ fibers Large diameter, myelinated, intermediate conduction velocity Normally activated by noxious stimuli (transmit sharp pain) C fibers Small diameter, unmyelinated, slow conduction velocity Normally activated by noxious stimuli (responsible for secondary pain, normally burning, aching pain) In neuropathic pain abnormal sensations may be transmitted along Aβ , Aδ or C fibers Sensory Processing and Neuropathic Pain Signs/Symptoms of Neuropathic Pain Conduction of Pain Loss of Inhibitory Controls The Continuum of Pain1 The Inter-Relationship of Pain, Sleep, and Anxiety / Depression Patients with Peripheral Neuropathic Pain Experience Significant Comorbid Symptoms Comorbidities in Neuropathic Pain Significant comorbid conditions are associated with neuropathic pain Sleep disturbance Mood disorders Anxiety and depression Reduced quality of life and functional impairment are reported in patients with neuropathic pain Prevalence/Incidence of Neuropathic Pain 20-24% of diabetics experience painful DPN1 25-50% of patients 50 years with herpes zoster develop PH