1. dr. Henny Anggraini Sadeli SpS(K)
Patomechanism of Pain
dr. Henny Anggraini Sadeli SpS(K)

2. Definition of PAIN
Pain is unpleasent sensory and emotional experience associated with actual or potential tissue damage, or discribe in term of such damage ( IASP, 1986 )
HAS/Neuro/2007

3. Types of Pain Nociceptive Pain Inflammatory Pain Neuropathic Pain
Transient pain
in response to
a noxious
stimulus
Spontaneous pain
and
hypersensitivity
to pain
in response to
tissue damage
and inflammation
Spontaneous pain
and
hypersensitivity
to pain
in association with
damage to or
a lesion of
the nervous system
-survival
-protecting from injury
-promoting healing
-maladaptive pain
-pain as disease
HAS/RSHS/FKUP07

4. Types of Pain Somatic Pain Neurophatic Pain Visceral Pain Mixed Pain
Pain from nerve endings in tissues/bones
Aching, gnawing
Well localised
Pain from nerve irritation/damage
Sharp, electrick shock, burning, tingling
Often follow nerve pathway
Deep,squeesing,pressure
Poorly localized
Sometimes referred
Eg. Heart, lung, liver, pancreas,etc
Eg. Bone metastases, bone fracture
Myofacial pain
Peripheral NeP
Central NeP
Eg. Polineuropathy
Mononeuropathy
Radicular Pain
Trigeminal neuralgia
Post herpetic neuralgia
Eg.Post stroke pain
Spinal cord pain
Mixed Pain
Low Back pain
Henny’s

5. Spontaneous Pain aauuuw aauuuw Stimulus Evoked Pain/
hypersensitivity to pain
Spontaneous Pain
aauuuw
allodynia
aauuuw
HAS/Neuro/RSHS-FKUP
hyperalgesia

6. Hypersensitivity to pain
HAS/neuro

7. PAIN BEHAVIOUR AFFECTIVE COGNITIVE SENSORY Waddel G, 1992
Biopsychosocial & chronic pain disability model
HAS/Neuro/RSHS-FKUP

8. Henny’s

9. Henny’s

10. Henny’s

11. Pain Mechanism
Nociception : transduction-conduction-transmission-perception
Phenotypic switches
Peripheral sensitization
Ectopic exitability
Central sensitization
Decreased inhibition
Structural reorganization
HAS/neuro

12. Excitability in dorsal horn neurons is determined by
balance between exitatory inputs from primary afferents
and inhibitory inputs (local and descending)
Henny’s

13. HAS/Neuro/2006

14. Henny’s

15. Henny’s

17. Henny’s

18. Central Sensitization interneuron microglia Descendens Descendens
inhibitory
5HT, NE
BDNF
TNFα
IL-1
Descendens
exitatory
COX2
PGE2
Primary
afferent
nociceptor
P2X4
opioid
Central
Sensitization
CB1
gly
Glutamate
GABA
inhibitory
excitatory
NMDA
Ca++
AMPA/kainate SP
CGRP
Somatostatin(-)
mGluR
NK1
COX2
PGE2
VGCC EP
GABA
Dorsal horn neuron
α2δCC
apoptosis
HAS/RSHS/FKUP07
interneuron

19. Henny’s

20. Central Sensitization
A reduction in activation threshold
An increased responsiveness
An expansion of receptive field
in dorsal horn neurons
Henny/neuro

21. Henny’s

22. Henny’s

23. Structural reorganization
henny’s

24. henny’s

25. Thank you