PATHOPHYSIOLOGYOPATHOPHYSIOLOGYOFF

NERVOUS SYSTEMNERVOUS SYSTEM. . PAINPAIN

Professor Yu. I. BondarenkoProfessor Yu. I. Bondarenko

Kinds of SensitivityKinds of Sensitivity• 1. Painful

• 2. Temperature

• 3. Tactile

• 4. Proprioceptive

DEFINITION OF PAINDEFINITION OF PAIN

• PAIN – it is typical pathological process, which was generated during evolution and which arise owing to action on an organism painful (nociceptive) irritant or weakening of antipainful (antinociceptive) system

Components ofComponents of painfulpainful reactionreaction

• 1. Perception, conduction and

realization of pain

• 2. Formation vegetative,emotional and behavioural responses

• 3. Mobilization of antipainful system

CLASSIFICATION OFCLASSIFICATION OFPAINPAIN

• Physiological pain

• Pathological pain

• Acute pain

• Chronical pain

PRIMARY ACUTE PAINPRIMARY ACUTE PAIN

• Cause – action of painful agent

• Arise at once after action of painful irritant

• It is not removed morphine

• It has signal meaning

SECONDARY ACUTE PAINSECONDARY ACUTE PAIN

• Pathogenesis – action of biological active substantces

• It is not located

• It is removed by morphine• It has signal meaning

Primary andPrimary and secondary painsecondary pain

BIOLOGICAL ACTIVE BIOLOGICAL ACTIVE SUBSTANCESSUBSTANCES

• Histamine

• Serotonin

• Prostaglandines

• Bradykinin

• Potassium iоns

• Hydrogen iоns

THEORY OF PAIN PERCEPTIONTHEORY OF PAIN PERCEPTION

• Theory of specificity – pain is perceived only special painful receptors

• Thery of intesity – pain arises due to arritation any one receptors (painful,temperature, tactile), if irritant so powerful that it demages tissue

KINDS OF PAINFUL RECEPTORSKINDS OF PAINFUL RECEPTORS

• Monomodal – it reacts onto mechanical irritation

• Bimodal – it reacts onto mechanical and temperature irritation

• Polymodal – its excited by mechanical, temperature and chemical irritants

OrgansOrgans withwith largelarge painful painful receptivenessreceptiveness

• Skin

• Meninges

• Pleura

• Peritoneum

• Periosteum

• Conjunciva

• External sex organs

Nervous fibres inNervous fibres in skinskin

Sensitive Sensitive nervesnerves inin the skin ofthe skin of thoraxthorax

TransferTransfer ofof painful informationpainful information

• 1 Neuron – in spinal node

• 2 Neuron – in posterior horns of spinal cord

• 3 Neuron – in thalamus

Tractus spinothalamicusTractus spinothalamicus

Tractus spinothalamicusTractus spinothalamicus

VENTROBASALVENTROBASAL COMPLEXCOMPLEX

• Ventroposteriolateral nucleus – representation of trunk

• Ventroposteriomedial nucleus – representation of face

REALIZATION OF PAINREALIZATION OF PAIN

VENTROBASAL COMPLEX

↓

DORSAL CENTRAL GYRUS

↓

Sensory zone S1

↓

Estimate of pain

BrainBrain

Connections ofConnections of spinothalamic spinothalamic pathwaypathway withwith subcortical nucleussubcortical nucleus

• Vasomotor center

• Respiratory center

• Center of satiation

• Gіantocellular nucleus of brain stem

• Sphenoid nucleus of midbrain

VEGETATIVE RESPONSESVEGETATIVE RESPONSES

• Tachycardia

• Increase of stroke volume

• Increase of cardiac output

• Acceleration of blood stream

• Increase of arterial pressure

• Icrease of respiratory rate

• Icrease of sugar level in blood

EMOTIONALEMOTIONAL RESPONSESRESPONSES

• Psychic excitement• Anger• Fear• Agression• 1. Limbic structures: septum• hippocampus• tonsilla

2. Frontal parts of cortex brain

BEHAVIOUR REACTIONSBEHAVIOUR REACTIONS

• 1. Estimate of painful stimuli:• а) frontal part of brain cortex• б) hypocampus. • Rеgulation of motor act:• а) tonsilla• б) upper wall of parietal sulcus – • second somatosensory zone S2 •

MEDIATORS OF PAINMEDIATORS OF PAIN

• Substanse Р

• Glutamic acid

• Cholecystokinin

• Neurotensin

StructureStructure of chemical synapseof chemical synapse

Antinociceptive systemsAntinociceptive systems

• Neuronal opiate system – met- and

leuencephalin• Neuronal unopiate system – noradrenalin,

serotonin, dopamine• Hormonal opiate system – hormones of

adenohypophysis • Hormonal unopiate system – vasopressin

Hormonal unopiate systemHormonal unopiate system

• 1. Adrenocorticotropic hormone• 2. Melanostimulating hormone• 3. β -Lipotropic hormone• 4. Large endorphines: kitorphin β-kosomorphin dinorphin

SCHEMA OF PORTALSCHEMA OF PORTAL MECHANISMMECHANISM

CHRONICAL PAINFULCHRONICAL PAINFUL SYNDROMESSYNDROMES

• Phantom pain

• Causalgia

• Neuralgia

• Eccentric pain

• Projectional pain

Sensitive fibers of heartSensitive fibers of heart

DermatomesDermatomes, , which reply to radix which reply to radix of spinal cordof spinal cord

ІІrradiating painrradiating pain

Projecting painProjecting pain

METHODS OF ANAESTIZATIONMETHODS OF ANAESTIZATION

• Psycological

• Physical

• Pharmacological

• Surgical

• Neurosurgical

Psycological methodsPsycological methods 1. Conversation

2. Relaxation

3. Hypnosis

4. Autotraining

5. Correct stereotype of motion

6. Self-removel of pain

Psycological anaesthetizationPsycological anaesthetization – – ceremony of circuitceremony of circuit “ “by electorby elector ” ”

PHYSICALPHYSICAL METHODS OF METHODS OF ANAESTHETIZATIONANAESTHETIZATION

• Acupuncture• Electroacupuncture• Laseropuncture• Electrostimulation• Electrophoresis• Ultrasound• Magnetico-laser therapy• Massage• Manual therapy

PharmacologicalPharmacological anaesthetizationanaesthetization: : blockingblocking of sympatheticof sympathetic plexusplexus

SurgicalSurgical methodsmethods of of anaesthetizationanaesthetization

• Opening of abscess

• Reposition of fragments

• Splintation of extremity

• Section of scars

• Desympathization

• Gangliectomy