NYERI kuliah.ppt
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Transcript of NYERI kuliah.ppt
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PATOFISIOLOGI NYERI
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Nociceptive afferent fiber
Normal nerve impulses leadin to pain
No!ious
stimuli
"escendin
modulation
Ascendin
input
Spinal cord
Perceived pain
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T#e continuum of pain
Serves a protective function
$suall% apparent no!ious insult
Serves no protective function
"erades #ealt# and function
Acute
pain
Insult
ronic
pain
'()* mont#s
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$nderstandin +e% t%pes of pain
Neuropat#ic painPain initiated or caused
b% a primar% lesion or
d%sfunction in t#e
perip#eral or central
nervous s%stem
Nociceptive painPain caused b%
an inflammator% or
non,inflammator%
response to a
no!ious stimulus
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-#at is nociceptive pain.
Painful reion is t%picall% locali/ed at t#e site of in0ur% )
often described as t#robbin1 ac#in or stiffness
$suall% time,limited and resolves 2#en damaed tissue
#eals 3e44 bone fractures1 burns and bruises5
A sensor% e!perience t#at occurs 2#en specific perip#eral
sensor% neurons 3nociceptors5 respond to no!ious stimuli
Responds to conventional analesics
&an also be c#ronic 3e44 osteoart#ritis5
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E!ample of c#ronic nociceptive pain6
osteoart#ritis of t#e +nee
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Activation of
local nociceptors
Perip#eralnerveSpinal cord
Tissue
damae
Ascendin
input
E!ample of c#ronic nociceptive pain6
osteoart#ritis of t#e +nee
Perceived pain
"escendin
modulation
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-#at is neuropat#ic pain.
Pain initiated or caused b% a primar% lesion or d%sfunction in
t#e perip#eral or central nervous s%stem
Pain often described as s#ootin1 electric s#oc+,li+e1
burnin ) commonl% associated 2it# tinlin or numbness
T#e painful reion ma% not necessaril% be t#e same as t#e
site of in0ur%4 Pain occurs in t#e neuroloical territor% of t#e
affected structure 3nerve1 root1 spinal cord1 brain5
Almost al2a%s a c#ronic condition 3e44 post#erpetic
neuralia1 poststro+e pain5
Responds poorl% to conventional analesics
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E!ample of neuropat#ic pain6
ulnar nerve lesion follo2in bone fracture
$lnar nerve
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Perip#eral
nociceptors
Ascendin
input
"escendin
modulation
E!ample of neuropat#ic pain6
ulnar nerve lesion follo2in bone fracture
Trauma
leadinto nerve
lesion
Perceived pain
Impulses enerated
2it#in ulnar nerve
Spinal cord
Lesion
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T#e co,presentation of nociceptive and
neuropat#ic pain
7ot# t%pes ofpain co,e!ist in
man% conditions
Neuropat#ic painNociceptive pain
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&o,e!istence of nociceptive and
neuropat#ic pain
E!amples include lo2 bac+ pain associated 2it#
radiculopat#%1 cancer pain and carpal tunnel s%ndrome
Effective manaement re8uires a broader t#erapeutic
approac# to relieve bot# t#e nociceptive and neuropat#ic pain
components
&o,e!istence of pain t%pes #as been referred to as eit#er
a 9mi!ed: or 9combined: pain state
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E!ample of co,e!istin pain6 #erniated disc
causin lo2 bac+ pain and lumbar radiculopat#%
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Lumbarvertebra
"isc #erniation
Activation of perip#eral nociceptors )
cause of nociceptive pain component
&ompression and inflammation of nerve root )
cause of neuropat#ic pain component
E!ample of co,e!istin pain6 #erniated disc
causin lo2 bac+ pain and lumbar radiculopat#%
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Lesion
Activation
of local
nociceptors
&onstant ac#e1 t#robbin
pain in t#e lo2 bac+
Patient presents
2it# bot# t%pes
of pain
S#ootin1 burnin
pain in t#e foot
Ectopic disc#ares
from nerve
root lesion
E!ample of co,e!istin pain6 #erniated disc
causin lo2 bac+ pain and lumbar radiculopat#%
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Nociceptive and neuropat#ic pain ma%
co,e!ist in lo2 bac+ pain conditions
Neuropat#ic pain componentNociceptive pain component
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"ifferentiatin remote pain6
referred or radicular.
Nociceptive pain is usuall% locali/ed; #o2ever1
2#en in0ur% occurs to deep structures1 pain
ma% be referred 3e44 pain follo2in m%ocardial
infarction refers to left arm5
Referred pain is a nociceptive paindescribed
b% patients usin descriptors suc# as dull1
t#robbin or ac#in
In contrast1 radicular pain is a neuropat#icpaindescribed b% patients as s#ootin1
electric s#oc+,li+e or burnin1 often 2it#
tinlin or numbness
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Nociceptive afferent fiber
Normal nerve impulses leadin to pain
No!ious
stimuli
"escendin
modulation
Ascendin
input
Spinal cord
Perceived pain
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Ectopic disc#ares
Nerve lesion induces #%peractivit% due to c#anes in ion c#annel function
Ectopic discharges
Nerve lesion
Spinal cord
Nociceptive afferent fiber
"escendin
modulation
Ascendin
input
Perceived pain
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Loss of in#ibitor% controls
Loss of descendin modulation causes e!aerated pain due to an imbalance bet2een
ascendin and descendin sinals
Nociceptive afferent fiber
No!ious
stimuli
Ascendin
input
Spinal cord
Loss of
descendin
modulation
E!aerated pain
perception
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&entral sensiti/ation
After nerve in0ur%1 increased input to t#e dorsal #orn can induce central sensiti/ation
Perceived pain
Ascendin
input
"escendin
modulation
Nerve lesion
Nociceptive afferent fiber
Abnormal disc#ares induce central sensiti/ation
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Pat#op#%siolo% of neuropat#ic pain
Perip#eral neuron
#%pere!citabilit%
NeP
&entral mec#anisms
&entral neuron
#%pere!citabilit%
3central sensiti/ation5
Loss of
in#ibitor% controls
Perip#eral mec#anisms
Abnormal
disc#ares