2010疼痛治疗ppt课件.pptxVIP

PainShangrong Li, MDAnesthesiology departmentThird hospitalSun Yat-sen UniversityContentDefinitionsBasic of PainCategories and AssessmentMedicineNerve blockAcute painChronic painDefinition of PainPain is whatever the experiencing person says it is, existing whenever the experiencing person says it does. McCaffery M. (1968)Definition of Pain“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”IASP (1979)Implies emotional componentcan exist without tissue damage.ContentDefinitionsBasic of PainType and AssessmentMedicineNerve blockAcute painChronic painTRPV 辣椒素受体TREK 钾离子通道ASIC 酸敏感离子通道DRASIC ACIC3MDEG退化蛋白通道TRPM8 冷受体8 Somatosensory nerve fibersSomatosensory nerve fibersFiber typeFiber characteristicsSpeed of conductionAssociated withAβLarge, myelinated30-70 m/secMechanical stimuliAδSmall, myelinated12-30 m/secCold, fast pain, mechanical stimuliCSmall, unmyelinated0.5-2 m/secSlow, heat, cold, mechanical stimuliPain PathwaysContentDefinitionsBasic of PainCategories and AssessmentMedicineNerve blockAcute painChronic painCategories of PainSomatic pain Examples: acute postoperative pain, bone fracturesaching, gnawing, and/or sharp in quality, well localized initiated by nociceptor activation in cutaneous and deep tissues. Visceral painExamples: abdominal pain due to constipation dull and aching in quality and poorly localized associated with tissue injury, specifically infiltration, compression, and distention of viscera. .Neuropathic painexamples: trigeminal neuralgia，postherpetic neuralgia (PHN) shooting, electrical, or burning pain often is superimposed on a chronic background of burning and aching sensations. results from injury to the peripheral or CNS. Trigeminal neuralgiaAcute or ChronicAcute pain: Can be resolved quickly, less than 3-6 monthsHighly correlated to damage Example: Postoperative pain, Bone fractureChronic pain: last long time, more than 3-6 months“pain that extends