Pain Pain
Pain Pain
Pain Pain
Overview of
pain
Pain is the most common reason people visit
their doctor. Pain may be sharp or dull,
intermittent or constant, or throbbing or steady.
Neurophat
ic pain
Types
of Pain
Psychoge
nic pain
Nocicepti
ve pain
Neurophatic Pain
Neuropathic pain is caused by damage to or
dysfunction of the nerves, spinal cord, or brain.
Neuropathic pain may be felt as burning or
tingling or as hypersensitivity to touch or cold.
Causes include compression of a nerve (for
example, by a tumor, by a ruptured
intervertebral disk, or as occurs in carpal
tunnel
syndrome),
nerve
damage
(for
example, as occurs in a metabolic disorder
such as diabetes mellitus), and abnormal or
disrupted processing of pain signals by the
Nociceptive Pain
Nociceptive pain is caused by an injury to body
tissues.
The injury may be a cut, bruise, bone fracture,
crush injury, burn, or anything that damages
tissues. This type of pain is typically aching,
sharp, or throbbing. Most pain is nociceptive
pain. Pain receptors for tissue injury (nociceptors)
are located mostly in the skin or in internal
organs.
Nociceptive Pain
The pain almost universally experienced after surgery is
nociceptive pain. The pain may be constant or
intermittent, often worsening when a person moves,
coughs, laughs, or breathes deeply or when the
dressings over the surgical wound are changed.
Most of the pain due to cancer is nociceptive. When a
tumor invades bones and organs, it may cause mild
discomfort or severe, unrelenting pain. Some cancer
treatments, such as surgery and radiation therapy,
can also cause nociceptive pain. Pain relievers
(analgesics), including opioids, are usually effective.
Psychogenic Pain
Psychogenic pain is pain that is mostly related
to psychologic factors.
When people have persistent pain with
evidence of psychologic disturbances and
without evidence of a disorder that could
account for the pain or its severity, the pain
may be described as psychogenic.
However, psychophysiologic pain is a more
accurate term because the pain results from
interaction of physical and psychologic
factors. Psychogenic pain is far less common
than nociceptive or neuropathic pain.
Neuropathic pain
IASP Definitions:
Peripheral Neuropathic and Central
Neuropathic Pain
Neuropathic pain
Pain initiated or caused by a primary
lesion or dysfunction in the nervous system
12
Functional
impairment
Anxiety &
Depression
Nicholson and Verma. Pain Med. 2004;5 (suppl. 1):S9-S27
Sleep
disturbances
15
to
Neuropathic Pain
Pain initiated or caused by a
primary lesion or dysfunction
in the nervous system
(either peripheral or
central nervous system)1
Mixed Pain
Pain with
neuropathic and
nociceptive
components
Examples
Examples
Peripheral
Postherpetic neuralgia
Trigeminal neuralgia
Diabetic peripheral neuropathy
Postsurgical neuropathy
Posttraumatic neuropathy
Central
Poststroke pain
Common descriptors2
Burning
Tingling
Hypersensitivity to touch or cold
Nociceptive Pain
Pain caused by injury to
body tissues
(musculoskeletal,
cutaneous or visceral)2
Examples
Common descriptors2
Aching
Sharp
Throbbing
Improved
Quality of
Sleep
Improved
Physical
Functioning
Reduced pain
Improved
Psychological
State
Improved
Overall Quality
of Life22
Neuropathic Pain
Treatment
Non-drug treatments can help to control
the patient's pain. A multidisciplinary approach
may be required.
Current drug treatments are focused on
dampening the neuronal input to consciousness
by suppressing axonal function (for example
sodium channel blockade) or interfering with
neurotransmission (blockade of excitatory and
inhibitory neurotransmitters and modulators).
Antidepressants
Amitriptyline :
The starting dose is low ( 1012.5 mg at
bedtime) and is increased slowly at intervals
of a few days to a week.
The maximum effective dose is usually 75
mg at night
Anticonvulsants
There is a long tradition of
antiepileptic drugs in neuropathic pain.
Phenytoin
Carbamazepine
Valproate
Lamotrigine
Topiramate
using
Anticonvulsants
Newer drugs :
Gabapentin and Pregabalin
Adverse effect :
Drowsiness
Dizziness
Ataxia
Dry mouth
Edema
Weight gain
Analgesics
Simple analgesics are often ineffective in
neuropathic pain, but frequently there is a
nociceptor component to the patient's pain.
Opioids
Oxycodone
Morphine
Non Opioid:
Tramadol
NSAID
There is no indication for the use of nonsteroidal anti-inflammatory drugs in patients
with neuropathic pain unless there is clear
clinical evidence that a nociceptor pain source
is contributing to the patient's pain.