PATHOPHYSIOLOGY OF PAIN：病理生理疼痛.ppt

PATHOPHYSIOLOGY OF PAIN Prof. J. Haná?ek, MD, PhD Most peripheral neuralgias are the result of trauma or surgery. Such a conditions does not necessary occur as a result of damageing a major nerve trunk but may be caused by an incision involving only small nerve branches (incisional pain) Mechanism: the pain is due to neuroma formation in the scar tissue (?) Peripheral neuralgias after trauma or surgery Common forms of neuropathic pain lumbosacral and cervical rhizotomy, ● peripheral neuralgia Deaferentation pain following spinal cord injury Incidence of severe pain due to spinal cord and cauda equina lesions ranges from 35 to 92 % of patients This pain is ascribed to 3 causes: 1. mechanically induced pain (fracture bones, myofascial pain) 2. radicular pain (compression of nerve root) 3. central pain (deaferentation mechanism) Acute Pain We can distinguish two types of acute pain: 1. Somatic 2. Visceral – referred Somatic pain is superficial coming from the skin or close to the surface of the body. Visceral pain refers to pain in internal organs, the abdomen, or chest. Referred pain is pain that is present in an area removed or distant from its point of origin. The area of referred pain is supplied by the nerves from the same spinal segment as the actual site of pain. Clinical Manifestation of Pain Different types of chronic somatic pain I. Nervous system intact 1. nociceptive pain 2. nociceptive - neurogenic pain (nerve trunk pain) II. Permanent functional and/or morphological abnormalities of the nervous system (preganglionic, spinal - supraspinal) 1. neurogenic pain 2. neuropathic pain 3. deafferentation pain * Technical co-operative: L.?urinová, Ing. M. Vrabec ● Alteration in sensory function ? dysfunctions of the general or special