Pain Mechanisms: Difference between revisions
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Revision as of 20:48, 8 August 2018
Original Editor - Tiara Mardosas
Top Contributors - Tiara Mardosas, Carin Hunter, Jess Bell, Admin, George Prudden, Kim Jackson, Rachael Lowe, Scott Buxton, Carina Therese Magtibay, Naomi O'Reilly, Venus Pagare and Tarina van der Stockt
Pain: General Overview[1][edit | edit source]
The most widely accepted and current definition of pain, established by the International Association for the Study of Pain (IASP), is "an unpleasant sensory and emotional experience associated with acutal or potential tissue damage, or described in terms of tissue damage, or both." Although several theoretical frameworks have been proposed to explain the physiological basis of pain, not one theory has been able to exclusively incorporate the entirety of all the aspects of pain perception. The four most influential theories of pain perception include Specificity, Intensity, Pattern and Gate Control theories of pain. However, in 1968, Melzack and Casey described pain as multi-dimensional, where the dimensions are not independent, but rather interactive. The dimensions include sensory-discriminative, affective-motivational and cognitive-evaluate components.
Pain Mechanisms[2][edit | edit source]
Determining the most plausible pain mechanism(s) is crucial during clinical assessments as this can serve as a guide to determine the most appropriate treatment(s) for a patient. Therefore, criteria upon which clinicians may base their decisions for appropriate classifications have been established through an expert consensus-derived list of clinical indicators. The tables below were adapted from Smart et al. (2010) that classified pain mechanisms as 'nociceptive', 'peripheral neuropathic' and 'central' and outlined both subjective and objective clinical indicators for each. Therefore, these tables serve as an adjunct to any current knowledge and provide as an outline that may guide clinical decision-making when determining the most appropriate mechanism(s) of pain.
Furthermore, being cognizant about the factors that may alter pain and pain perception may assist in determining the most appropriate pain mechanism for a patient. The following are risk factors that may alter pain and pain perception:
- Biomedical
- Psychosocial or Behavioural
- Social and Economical
- Professional/ Work-related
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Nociceptive Pain Mechanism[2][edit | edit source]
Nociceptive pain is associated with the activation of peripheral receptive terminals of primary afferent neurons in response to noxious chemical (inflammatory), mechanical or ischemic stimuli.
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1. Clear, proportionate mechanical/anatomical nature to aggravating and easing factors 2. Pain associated with and in proportion to trauma, or pathological process (inflammatory nociceptive), or movement/postural dysfunction (ischemic nociceptive) 3. Pain localized to area of injury/dysfunction (with/without some somatic referral) 4. Usually rapid resolving or resolving in accordance with expected tissue healing/pathology recovery times 5. Responsive to simply NSAIDs/analgesics 6. Usually intermittent and sharp with movement/mechanical provocation; may be more constant dull ache or throb at rest 7. Pain in association with other symptoms of inflammation (i.e., swelling, redness, heat) (inflammatory nociceptive) 8. Absence of neurological symptoms 9. Pain of recent onset 10. Clear diurnal or 24h pattern to symptoms (i.e., morning stiffness) 11. Absence of or non-significantly associated with mal-adaptive psychosocial factors (i.e., negative emotions, poor self-efficacy) 1. Clear, consistent and proportionate mechanical/anatomical pattern of pain reproduction on movement/mechanical testing of target tissues 2. Localized pain on palpation 3. Absence of or expected/proportionate findings of (primary and/or secondary) hyperalgesia and/or allodynia 4. Antalgic (i.e., pain relieving) postures/movement patterns 5. Presence of other cardinal signs of inflammation (swelling, redness, heat) 6. Absence of neurological signs; negative neurodynamic tests (i.e., SLR, Brachial plexus tension test, Tinel’s) 7. Absence of maladaptive pain behaviour Peripheral Neuropathic Pain Mechanism[2][edit | edit source]Peripheral neuropathic pain is initiated or caused by a primary lesion or dysfunction in the peripheral nervous system (PNS) and involves numerous pathophysiological mechanisms associated with altered nerve functioning and responsiveness. Mechanisms include hyperexcitability and abnormal impulse generation and mechanical, thermal and chemical sensitivity.
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