1. TREATMENT OF NEUROPATHIC PAIN
GARY A. MELLICK, D.O.
American PAIN Specialists, Inc.
American SLEEP Disorders Clinic

2. Dr. Gary Mellick & Staff

3. Chronic Pain Understanding Chronic Pain What Causes Chronic Pain
Chronic Pain Treatments

4. 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

5. 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

6. Understanding Chronic Pain
Sounding The Alarm
Broadcasting The News
Censoring The News

7. 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

8. Degree/Type of Noxious Stimuli & Pain Perception
Nociceptors Sound The Pain Alarm

9. Ascending Pain Pathways

10. 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

11. Pain Transmission Broadcasting The News
Higher brain centers are alerted by spinal pathways.
Different pathways carry different information.

12. 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

13. Descending Pain Control Pathways
Censoring The News
Built-in nervous system mechanisms can block pain messages.

14. 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”

15. 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

16. “Central Spinal Sensitization”
Pain Neurochemistry
“Pain Wind-up”
“Central Spinal Sensitization”
Gate Theory of Pain

17. Images of Acute Pain

18. Images of Chronic Pain

19. 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.)

20. Physician Responsibilities

21. PAIN POEM