腰椎间盘的针刀治疗.ppt

Content Introduction and Definition Classification The Basic Theropeutics Clinical Application of Local and Nerve Block Chapter 1 Introduction and  Definition Pain as a warning signal ChronicPain CHRONIC PAIN Who Should We Ask To take care of these patients’ Pain Problem Chronic Persistent Pain No longer serves as a Warning But Causes Disability like other Chronic Disease 1950 Dr. John J Bonica 1953 Textbook “pain” By Bonica 1973 International Association for the Study of Pain IASP The Journal is devoted exclusively to subject, and lot of textbooks of pain is published. Pain: Time for Re-Evaluation The Debate Pain as a warning signal Vs Pain as a chronic disease World Congress on Pain q. 3. year Pain as the 5th vital sign JACHO 2000 T, HR, BP, RR, Pain Vital life functions Variations indicate or reflect both physiological and psychological health Nociceptive sensitization of peripheral nervous system Nociceptive sensitization of central nervous system The imprint of pain in CNS Chronic headache Neuralgia and peripheral neuropathy Acute and chronic soft tissue damage Rachiogenous pain Joint pain Viceral pain Painful peripheral vascular disorders Malignant pain Types of Pain I: IASP Nociceptive - consequence of tissue injury Musculoskeletal, Visceral Opioid-responsive e.g., post-op pain, fractures, appendicitis Neuropathic - imprinted/aberrant activity of the PNS/CNS Most chronic pain is neuropathic Opioid-resistant e.g., radiculopathy, CRPS (RSD), PHN Nociceptive Pain (Somatic/Visceral) Results from mechanical, thermal, or chemical excitation of nociceptors Mediated at nociceptors widely distributed in skin, subcutaneous tissue, bone, muscle, connective tissue, vasculature, and viscera Pain described as dull, aching, throbbing, sometimes sharp Opioid-responsive Nociceptive Pain Nerve ending initiated Serves initial protective function May resolve with