Chapter 13 Pain- A Fundamental Stress. Pain: Urgent Signals Hunger, Thirst, Breathing Muscles,...
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Transcript of Chapter 13 Pain- A Fundamental Stress. Pain: Urgent Signals Hunger, Thirst, Breathing Muscles,...
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Chapter 13
Pain- A Fundamental Stress
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Pain: Urgent Signals
• Hunger, Thirst, Breathing
• Muscles, Joints, Heart, Stomach
• Wounds, Damage, Swelling
• Headaches,
• Worry, Fret, Anxiety
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Pain
• A signal
• Important information for the brain
• A signal that can’t be ignored
• Localizable
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Pain Signals
• Pain receptors
• Spinal cord
• Nerves
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Pain Stimuli
• Stretch
• Damage
• Reduced blood flow
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Reflex to Pain
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Fast Track Sympathetic Reflex
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Slow track Attention
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Localization
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Referred Pain
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Physiology of Pain Control
Proopiomelanocortin mRNA
ACTH Endorphin
Enkephlin
Message Splicing
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Pain Control
Why?
A Medical Problem
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Pain Control
• Generation of pain signal
• Transmission of pain signal
• Sympathetic response to pain
• Long term stress response
• Perception of pain
• Limbic response to pain
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Non-drug Methods
• Bit the bullet: competition for attention in the reticular core of the brain
• acupuncture
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Local Anesthetics
• Uses– Creams - pain receptors– Inject into the area of the nerve– Spinal block
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Local Anesthetics
• Oily compounds
• Dissolve into membranes
• Disrupt membrane function in the area
• Removed by circulation
• Novocain, lidocain, tetracain
• Penetrance, potency, and metabolism
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anesthetic
Block signal from getting to the central nervous system
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Side Effects
• Spinal block – headaches
• All uses – general depressant
• Other excitable tissues
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Non-Narcotic Analgesics
• Over the counter
• Low level pain
• Do not alter consciousness
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Aspirin-like Compounds
• Prehistory- willow bark tea
• Good for headaches, muscle aches, joint pain
• Not good for internal organ pain due to stretch
• Blocks COX1 and COX2 – prostaglandin synthesis
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Aspirin-like Compounds Side Effects
• Reduces fever
• Reduces inflammation
• Inhibits blood clotting
• Increases respiration
• Irritates stomach
• Reye’s syndrome
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Acetaminophen
• Older drug was phenacetin which was converted by liver to acetaminophen
• Only blocks prostaglandin synthesis in the CNS not peripheral
• Not anti-inflammatory
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Acetaminophenside effects
• Reduces fever
• Liver toxicity
• Kidney toxicity
• Other drug interactions (eg alcohol)
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Ibuprofen and Naproxen
• Formerly prescription (dosage)
• Interferes with prostaglandin synthesis
• Reduces fever
• Reduces inflammation
• Rare toxic amblyopia
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Narcotic Analgesics
• Intense pain
• Opium – from the unripe seed pod of a type of poppy
• Morphine, codeine (natural)
• Heroin, dihydromorphine (semi-synthetic)
• Methadone, meperidine (synthetic)
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Pain Threshold
A Balance
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Opiate Receptors
• Pain paths in spinal cord
• Medulla (breathing)
• Hypothalamus
• Limbic system
• Frontal and temporal lobes
• Reticular core
• Outside CNS – digestive system
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Opiate Use
• Short term intense pain
• Why not long term?– Tolerance– Dependence– Addiction
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Opiate Side Effects
• Suppresses drives – hunger, thirst, sex
• Hypothalamic control of temperature and hormones
• Medulla control of breathing
• Stimulates emetic reflex
• Inhibits cough reflex
• Pin point pupils
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Pain
• Urgent signals
• Balance of important priorities
• Useless pain