TREATMENT OF NEUROPATHIC PAIN GARY A. MELLICK, D.O. American PAIN Specialists, Inc. American SLEEP Disorders Clinic
Dr. Gary Mellick & Staff
Chronic Pain Understanding Chronic Pain What Causes Chronic Pain Chronic Pain Treatments
Pain -- has an Element of Blank -- When it begun -- or if there were Chronic Pain Pain -- has an Element of Blank -- It cannot recollect When it begun -- or if there were A time when it was not Emily Dickinson New England Poet
CHRONIC PAIN The Terrible Triad Suffering, Sadness & Sleeplessness “Chronic Pain is the most costly health problem in America.” Headache Lower back pain Cancer pain Arthritis pain
Understanding Chronic Pain Sounding The Alarm Broadcasting The News Censoring The News
Understanding Chronic Pain Sounding The Pain Alarm Nociceptors Nerve fibers in the skin, muscles, or joints Excited exclusively by intense, potentially harmful stimulation Pinprick Painful heat Irritating chemicals
Degree/Type of Noxious Stimuli & Pain Perception Nociceptors Sound The Pain Alarm
Ascending Pain Pathways
Understanding Chronic Pain Broadcasting The News Higher brain centers are alerted by spinal pathways Different pathways carry different information Where it hurts; how bad it is; whether the pain is sharp or burning Fear, anger, anxiety Change in pulse rate, blood pressure, dilating the pupils
Pain Transmission Broadcasting The News Higher brain centers are alerted by spinal pathways. Different pathways carry different information.
Understanding Chronic Pain Censoring The News Built-in nervous system mechanisms can block pain messages Pathways come down from the brain to prevent pain signals from coming through Endorphins - natural opiates
Descending Pain Control Pathways Censoring The News Built-in nervous system mechanisms can block pain messages.
What Causes Chronic Pain Gate Theory of Pain A hypothetical gate opens up and allows pain to travel to the brain Chronic pain results in “many opened gates and broken fences” “Pain Wind-up” “Centralization”
Peripheral Nervous system Central Nervous System Normal A-Beta fibers Normal Sensory Processing Touch Pain Normal C-fibers Sensitized A-Beta fibers “Wind-up” (Central Sensitization) Touch-evoked pain Pain & hypersensitivity Sensitized C-fibers
“Central Spinal Sensitization” Pain Neurochemistry “Pain Wind-up” “Central Spinal Sensitization” Gate Theory of Pain
Images of Acute Pain
Images of Chronic Pain
Chronic Pain Treatments Pain Medications Opiates (morphine, Darvocet, etc.) Adjuvant pain medicines (all the others combined) TENS (local electrical pain blocks) Anesthetic and Cortisone Injections Spinal Cord Stimulation and Pumps Alternative Medicine Treatments (Acupuncture, Chiropractic, etc.)
Physician Responsibilities
PAIN POEM