Transcript Can A Woman Give Herpes To A Man

Patomechanism of Pain
dr. Henny Anggraini Sadeli SpS(K)
Definition of PAIN
Pain is unpleasent sensory and emotional experience
associated with actual or potential tissue damage, or
discribe
in
term
of
such
damage
( IASP, 1986 )
HAS/Neuro/2007
Types of Pain
Nociceptive
Pain
Inflammatory
Pain
Neuropathic
Pain
Transient pain
in response to
a noxious
stimulus
Spontaneous pain
and
hypersensitivity
to pain
in response to
tissue damage
and inflammation
Spontaneous pain
and
hypersensitivity
to pain
in association with
damage to or
a lesion of
the nervous system
-survival
-protecting from injury
-promoting healing
-maladaptive pain
-pain as disease
HAS/RSHS/FKUP07
Types of Pain
Visceral Pain
Deep,squeesing,pressure
Poorly localized
Sometimes referred
Neurophatic Pain
Somatic Pain
Pain from nerve endings in
tissues/bones
Aching, gnawing
Well localised
Eg. Heart, lung, liver, pancreas,etc
Pain from nerve
irritation/damage
Sharp, electrick shock, burning,
tingling
Often follow nerve pathway
Eg. Bone metastases, bone fracture
Myofacial pain
Peripheral NeP
Eg. Polineuropathy
Mononeuropathy
Radicular Pain
Trigeminal neuralgia
Post herpetic neuralgia
Mixed Pain
Henny’s
Low Back pain
Central NeP
Eg.Post stroke pain
Spinal cord pain
Spontaneous Pain
Stimulus Evoked Pain/
hypersensitivity to pain
allodynia
HAS/Neuro/RSHS-FKUP
hyperalgesia
Hypersensitivity to pain
HAS/neuro
PAIN BEHAVIOUR
AFFECTIVE
COGNITIVE
SENSORY
Waddel G, 1992
Biopsychosocial & chronic pain disability model
HAS/Neuro/RSHS-FKUP
Henny’s
Henny’s
Henny’s
Pain Mechanism
• Nociception : transduction-conductiontransmission-perception
• Phenotypic switches
• Peripheral sensitization
• Ectopic exitability
• Central sensitization
• Decreased inhibition
• Structural reorganization
HAS/neuro
Henny’s
Excitability in dorsal horn neurons is determined by
balance between exitatory inputs from primary afferents
and inhibitory inputs (local and descending)
HAS/Neuro/2006
Henny’s
Henny’s
Henny’s
Descendens
inhibitory
Descendens
exitatory
microglia
BDNF
TNFα
IL-1
5HT, NE
COX2
PGE2
Primary
afferent
nociceptor
P2X4
opioid
CB1
Central
Sensitization
gly
inhibitory
Glutamate
excitatory
SP
CGRP
Somatostatin(-)
GABA
NMDA
AMPA/kainate
mGluR
NK1
VGCC
EP
Ca++
COX2
PGE2
GABA
Dorsal horn neuron
α2δCC
apoptosis
HAS/RSHS/FKUP07
interneuron
Henny’s
Central Sensitization
• A reduction in activation threshold
• An increased responsiveness
• An expansion of receptive field
in dorsal horn neurons
Henny/neuro
Henny’s
Henny’s
Structural reorganization
henny’s
henny’s