Referred pain Because of this convergence and the fact that the spinal neurons are most often activated by inputs from the skin activity evoked in spinal neurons by input from deep structures is mislocalized by the patient to a place that is roughly coextensive with the region of skin innervated by the same spinal segment Coronary ischemic pain usually radiates to medial side of arm and fingers, which were supplied by 6th-8th cervical (or T1 T2)over the left side
• Because of this convergence and the fact that the spinal neurons are most often activated by inputs from the skin, activity evoked in spinal neurons by input from deep structures is mislocalized by the patient to a place that is roughly coextensive with the region of skin innervated by the same spinal segment • Coronary ischemic pain usually radiates to medial side of arm and fingers, which were supplied by 6th~8th cervical (or T1~T2) over the left side Referred pain
The convergence-projection hypothesis of referred pain Skin Viscus Anterolateral Tract Axon
The convergence-projection hypothesis of referred pain
Pain modulation .Brain circuits modulate the activity of the pain transmission pathways One circuit has links in the hypothalamus midbrain and medulla It controls spinal pain-transmission neurons through a desending pathways eIt is bidirectional produce analgesia or increase pain
Pain modulation •Brain circuits modulate the activity of the paintransmission pathways •One circuit has links in the hypothalamus, midbrain, and medulla •It controls spinal pain-transmission neurons through a desending pathways •It is bidirectional produce analgesia or increase pain
Transmission system for nociceptive messages F Cx Hyp Cx Thalamus MIDBRAIN Spinothalamic Reticulothalamic MEDULLA SPINAL CORD
Transmission system for nociceptive messages
Pathophysiology Different organs may respond to different stimuli GI system: sensitive to inflammation, ischemia, spasm Insensitive to cutting heart sensitive to acute ischemia Integumentary stimuli at lowest level of intensity, evoke sensations of touch, pressure, warmth and cold Noxious stimuli increased to the point approaching tissue destruction, pain is added
Pathophysiology •Different organs may respond to different stimuli GI system: sensitive to inflammation, ischemia, spasm insensitive to cutting heart: sensitive to acute ischemia •Integumentary stimuli at lowest level of intensity, evoke sensations of touch, pressure, warmth and cold •Noxious stimuli increased to the point approaching tissue destruction, pain is added
Clinical characteristics character of pain spastic pain Intermittent inflammatory persisting Localization of pain usually in the diseased part it may be referred
Clinical characteristics •Character of pain spastic pain: intermittent inflammatory: persisting • Localization of pain: usually in the diseased part it may be referred
Clinical characteristics Quality and intensity of pain peptic ulcer: gnawing b urine anginal pain: distress, dull pain whith heavy quality The following are important severit duration frequency special time of occurrence
Clinical characteristics •Quality and intensity of pain peptic ulcer: gnawing burning anginal pain: distress, dull pain whith heavy quality The following are important: severity duration frequency special time of occurrence
Clinical characteristics Referred pain aggravating and relieving factors anginal pain: provoked by exertion, cold emotional upset relieved by rest, nitroglycerine ulcer pain: relieved by ingestion of food
Clinical characteristics •Referred pain •Aggravating and relieving factors anginal pain: provoked by exertion, cold, emotional upset relieved by rest, nitroglycerine ulcer pain: relieved by ingestion of food
Headache e Unpleasant sensations in the regions of cranial vault, usually reflects as a symptomatic expression of disease or some minor tension of fatigue It may also reflect serious disease intracranially 90%of individuals have at least one headache per year
Headache •Unpleasant sensations in the regions of cranial vault, usually reflects as a symptomatic expression of disease or some minor tension of fatigue •It may also reflect serious disease intracranially • 90% of individuals have at least one headache per year
Etiology Intracranial disease Extracranial disease ° Systemic disease neurosis
Etiology •Intracranial disease •Extracranial disease •Systemic disease •Neurosis
