Classification of Pain

1. CLASSIFICATION OF PAIN By: Dr. Vahid Nikoui Email: [email protected]

2. DEFINITIONS OF PAIN 2 International Association for the Study of Pain (IASP) (WHO) An unpleasant emotional experience associate with actual or potential tissue damage or described in terms of such damage. Bell The subject’s conscious perception of modulated nociceptive impulses that generate an unpleasant sensory and emotional experiences associated with actual or potential tissue damage or described in terms of such damage. Monheim An unpleasant emotional experience usually initiated by noxious stimulus and transmitted over a specialized neural network to CNS where it is interpreted as such. Mac bryde Pain is a disagreeable sensation produced by the action of stimuli of humoral nature.

3. HISTORICAL NOTE 3 Greek - “ Poin ” meaning penalty . Latin -“ Poena ” meaning punishment from God. Homer - Thought pain was due to arrows shot by God. Aristotle - was the first to distinguish five physical senses, and considered pain to be “passion of the soul” . Plato - pain and pleasure arose from within the body, an idea that perhaps gave birth to the concept that pain is an emotional experience more than a localized body disturbance.

4. Nociception Nociception (synonym: nocioception or nociperception ) is defined as "the neural processes of encoding and processing noxious stimuli. " Nociceptor A nociceptor is a sensory receptor that responds to potentially damaging stimuli by sending nerve signals to the spinal cord and brain. Noxious Noxious stimulus, an actually or potentially tissue damaging event, may be mechanical, chemical or thermal. Algesia Algesia , from the Greek word algesis , is the sensitivity to pain. Analgesia Absence of pain, insensitivity to pain.

5. TYPES OF PAIN 1 . Based on speed of onset, quality & duration 5 (1) Experimental (2) Transient (3) Acute (4) Chronic   1. Experimental: noxious stimuli causes a mild uncomfortable or painful sensation. 2. Transient pain: Short duration Severe Self limiting

6. 3. Acute pathological pain: Sharp, fast, pricking Occurs very rapidly Carried by large diameter myelinated A δ fibers Usually alleviated with the help of professional 4. Chronic pathological pain: Burning, aching Gradually increases Carried by small diameter non-myelinated ‘C’ fibers Experience of persistent pain that lasts many months to years Little apparent cause & not self limiting Pain often increases over time & is aggravated by many factors 6

7. 2.Based on level of stimulation 7 SOMATIC PAIN Associated with skin and musculo -skeletal region Superficial Deep VISCERAL PAIN Associate with viscera and internal organs

8. Inflammatory Pain tissue injury Prostaglandins & Bradykinin Local vasodilatation & Capillary permeability Receptor noxious stimuli Pain Non Inflammatory pain poorly understood psychic chronic 8

9. Referred Pain Referred pain (sometimes referred to as reflective pain) is a term used to describe the phenomenon of pain perceived at a site adjacent to or at a distance from the site of an injury's origin. One of the best examples of this is during ischemia brought on by a myocardial infarction (heart attack) where pain is often felt in the neck, shoulders, and back rather than in the chest, the site of the injury.

10. SPECIFIC PAINS Headache A headache or cephalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. 1- Headache of intracranial origin Meningitis headache, Migraine, Alcoholic headache , Headache due to l ow pressure of CSF, Constipation headache 2- Headache of extracranial origin Headache due to muscular spasm, Headache due to nasal irritation, Headache due to eye disorders

11. Toothache A toothache, also known as odontalgia or, less frequently, as odontalgy , is a pain in or around a tooth. In most cases toothaches are caused by problems in the tooth or jaw, such as cavities, gum disease, the emergence of wisdom teeth, infected dental pulp, jaw disease, or exposed tooth root.

12. Trigeminal neuralgia Trigeminal neuralgia (TN), Tic Douloureux (also known as prosopalgia , the 'Suicide Disease' or 'Fothergill’s disease) is a neuropathic disorder characterized by episodes of intense pain in the face, originating from one of the three trigeminal nerves. It is, "one of the most painful conditions known to humans, yet remains an enigma to many health professionals." This pain may be felt in the ear, eye, lips, nose, scalp, forehead, cheeks, teeth, and/or jaw; some patients also experience pain in their left index finger.

13. ABNORMAL PAINS Hyperalgesia Hyperalgesia is an increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves. Allodynia Allodynia , meaning "other pain", is a pain due to a stimulus which does not normally provoke pain and can be either thermal or mechanical. Hyperpathia Hyperpathia is a clinical symptom of certain neurological disorders wherein nociceptive stimuli evoke exaggerated levels of pain. Phantom Limb Pain A phantom limb is the sensation that an amputated or missing limb is still attached to the body and is moving appropriately with other body parts.

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