医学Pain management1.pptVIP

Pain management Presented by Mrs.Jayarani Premkumar Professor College of Nursing C M C, Vellore Pain management Definition PAIN PHYSIOLOGY Pain physiology contd.. Pain stimuli is converted to electrical energy. This electrical energy is known as Transduction. This stimulus sends an impulse across a peripheral nerve fiber (nociceptor). Pain physiology contd.. Transmission: A delta fibers (myelinated) send sharp, localized and distinct sensations. C fibers (unmyelinated) relay impulses that are poorly localized, burning and persistent pain. Pain stimuli travel- spinothalamic tracts. Pain physiology contd.. Perception: Person is aware of pain –somatosensory cortex identifies the location and intensity of pain Person unfolds a complex reaction-physiological and behavioral responses is perceived. Physiology contd.. Modulation: Inhibitory neurotransmitters like endogenous opioids work to hinder the pain transmission. This inhibition of the pain impulse is known as modulation Neurophysiology of pain (excitatory) Bradykinin- most potent pain producing chemical Prostaglandins- increase sensitivity to pain experience . Is a potent vasodilator and increase the production of bradykinin resulting edema Neurophysiology contd.. Substance P- transmits pain impulses to brain centers and causes vasodilatation and edema Serotonin- causes pain by altering sodium flow—neuron to fire Histamine,Leukotrienes and nerve growth factor are released Neuromodulators(inhibitory) Endorphins dynorphins- morphine like substances. Located in the brain, spinalcordGIT Produce analgesia when attached with opiate receptors in the brain Effects of pain Sympathetic responses Pallor Increased blood pressure Increased pulse Increased respiration Skeletal muscle tension Diaphoresis Effects of pain Parasympathetic responses Decreased blood pressure Decreased pulse Nausea vomiting Weakness Pallor Loss of consciousness Behavioral characteristics Facial expressions- grimace, clenched tee