INTRODUCTION TO

Scope
Definition & Why
Pain Processing
Acute & Chronic Pain
Management
Definition
An unpleasant sensory and emotional experience associated with
actual or potential tissue damage, or described in terms of
such damage.





Identifying and understanding more about the pain
mechanisms can be very empowering for patients
Important Functions
Alerts you of danger, injury and
disease.
Triggers a reflexive withdrawal
from danger before we can
suffer further injury
Protects a damaged body part
while it heals, and to avoid
similar experiences in the future.

Pain makes you move,
think and behave differently
Immobilize or protect an
injured part giving it a
chance to heal.
Lets us know when we
need to seek medical
help.
Teaches us what
behaviours to avoid in
the future.
Pain Processing
The Nervous System
Central Nervous System
Brain
Spinal cord
Peripheral Nervous System
Sensory and motor nerves
Pain Begins with Nerves

Different sensory nerve fibers respond to
different things. Some nerves send signals
associated with light touch, while others respond
to deep pressure.
Special pain receptors called nociceptors
activate whenever there has been an injury, or
even a potential injury,
An impulse heading through the nerve into the
spinal cord, and eventually all the way to your
brain happens within fractions of a second.
Your Spinal Cord: The Middle Man

There is no pain without the brain
Perception is the brains best guess about what is happening in the outside world.


Even though the spinal reflex takes place at the
dorsal horn, the pain signal continues to the
brain. This is because pain involves more than a
simple stimulus and response. Simply removing
the source of the pain does not solve all of your
problems. No matter how mild the damage, the
tissues still needs to be healed. In addition, your
brain needs to make sense of what has
happened. Pain gets catalogued in your brains
library, and emotions become associated with
that pain.
There is no pain without the brain
Perception is the brains best guess about what is happening in the outside world.



When the pain signal reaches the brain it goes
to the thalamus, which directs it to a few different
areas for interpretations. A few areas in the
cortex figure out where the pain came from and
compare it to other kinds of pain with which is it
familiar. Was it sharp? Did it hurt more than
stepping on a tack? Have you ever stepped on a
rock before, and if so was it better or worse?
There is no pain without the brain
Perception is the brains best guess about what is happening in the outside world.


Signals are also sent from the thalamus to
the limbic system, which is the emotional
center of the brain. Ever wonder why
some pain makes you cry? The limbic
system decides. Feelings are associated
with every sensation you encounter, and
each feeling generates a response. Your
heart rate may increase, and you may
break out into a sweat. All because of a
rock underfoot.
Where it Gets Complicated

While it may seem simple, the process of
detecting pain is complicated by the fact
that it is not a one-way system. It isnt
even a two-way system. Pain is more than
just cause and effect: it is affected by
everything else that is going on in the
nervous system. Your mood, your past
experiences and your expectations can all
change the way pain is interpreted at any
given time. How is that for confusing?


Where it Gets Complicated

If you step on that rock after you have a fight
with your wife, your response may be very
different than it would if you had just won the
lottery. Your feelings about the experience may
be tainted if the last time you stepped on a rock,
your foot became infected. If you stepped on a
rock once before and nothing terrible happened
to you, you may recover more quickly. You can
see how different emotions and histories can
determine your response to pain. In fact, there is
a strong link between depression and chronic
pain

Acute & Chronic
Acute pain - occurs almost immediately
upon tissue damage or injury and lasts
only a limited time.
Chronic pain - persists for weeks, months,
or years and is a major source of suffering,
disability, and economic loss.
Chronic Pain
Chronic pain is defined as
pain that extends beyond the expected
healing time of an injury, or can
accompany
chronic illnesses


When Acute Pain Becomes Chronic

Sometimes, however, pain receptors continue to
fire. This can be caused by a disease or
condition that continuously causes damage.
With arthritis, for example, the joint is in a
constant state of disrepair, causing pain signals
to travel to the brain with little down time.
Sometimes, even in the absence of tissue
damage, nociceptors continue to fire. There may
no longer be a physical cause of pain, but the
pain response is the same. This makes chronic
pain difficult to pin down and even more difficult
to treat.
Management

0: Hi. I am not experiencing any pain at all. I dont know why Im even here.
1: I am completely unsure whether I am experiencing pain or itching or maybe I just
have a bad taste in my mouth.
2: I probably just need a Band Aid.
3: This is distressing. I dont want this to be happening to me at all.
4: My pain is not fucking around.
5: Why is this happening to me??
6: Ow. Okay, my pain is super legit now.
7: I see Jesus coming for me and Im scared.
8: I am experiencing a disturbing amount of pain. I might actually be dying. Please
help.
9: I am almost definitely dying.
10: I am actively being mauled by a bear.
11: Blood is going to explode out of my face at any moment.
Too Serious For Numbers: You probably have ebola. It appears that you may also be
suffering from Stigmata and/or pinkeye.
Management

Management

Management
1. Make sure you understand what kind of a problem
pain really is.
2. Acceptance
3. Take Control.
4. Have a good working relationship with your doctor.
5. Never ignore pain.
6. Have a balanced approach to physical activity.
7. Sleep!
8. Make sure you have adequate support.
9. Dont expect people who dont have pain to
understand what its like.
10. Forgive yourself.
Pain Modification
pain inhibiting hormones
Overcoming chronic pain
prescribed medication, pacing,
hydrotherapy, relaxation
training and community outreach.