1. Chapter 13 Pain- A Fundamental Stress

3. Pain: Urgent Signals Hunger, Thirst, Breathing Muscles, Joints, Heart, Stomach Wounds, Damage, Swelling Headaches, Worry, Fret, Anxiety

4. Pain A signal Important information for the brain A signal that can’t be ignored Localizable

5. Pain Signals Pain receptors Spinal cord Nerves

6. Pain Stimuli Stretch Damage Reduced blood flow

7. Reflex to Pain

8. Fast Track Sympathetic Reflex

9. Slow track Attention

10. Localization

11. Referred Pain

13. Physiology of Pain Control Proopiomelanocortin mRNA ACTH Endorphin Enkephlin Message Splicing

14. Pain Control Why? A Medical Problem

15. 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

16. Non-drug Methods Bit the bullet: competition for attention in the reticular core of the brain acupuncture

17. Local Anesthetics Uses –Creams - pain receptors –Inject into the area of the nerve –Spinal block

18. Local Anesthetics Oily compounds Dissolve into membranes Disrupt membrane function in the area Removed by circulation Novocain, lidocain, tetracain Penetrance, potency, and metabolism

19. anesthetic Block signal from getting to the central nervous system

20. Side Effects Spinal block – headaches All uses – general depressant Other excitable tissues

21. Non-Narcotic Analgesics Over the counter Low level pain Do not alter consciousness

22. 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

23. Aspirin-like Compounds Side Effects Reduces fever Reduces inflammation Inhibits blood clotting Increases respiration Irritates stomach Reye’s syndrome

24. Acetaminophen Older drug was phenacetin which was converted by liver to acetaminophen Only blocks prostaglandin synthesis in the CNS not peripheral Not anti-inflammatory

25. Acetaminophen side effects Reduces fever Liver toxicity Kidney toxicity Other drug interactions (eg alcohol)

26. Ibuprofen and Naproxen Formerly prescription (dosage) Interferes with prostaglandin synthesis Reduces fever Reduces inflammation Rare toxic amblyopia

27. 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)

28. Pain Threshold A Balance

29. Opiate Receptors Pain paths in spinal cord Medulla (breathing) Hypothalamus Limbic system Frontal and temporal lobes Reticular core Outside CNS – digestive system

30. Opiate Use Short term intense pain Why not long term? –Tolerance –Dependence –Addiction

31. 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

33. Pain Urgent signals Balance of important priorities Useless pain