1. PAIN AND ITS MANAGEMENT
D. C. MIKULECKY
PROFESSOR OF PHYSIOLOGY

4. SOMATOSENSORY CORTEX SOMATOTOPIC ORGANIZATION
MORE AREA TAKEN BY SENSITIVE REGIONS (GREATER RECEPTOR DENSITY-SMALLER RECEPTIVE FIELDS)
CELLS RESPONDING TO ONE TYPE OF SENSATION IN VERTICLE COLUMNS(FOR EXAMPLE..PACINIAN CORPUSCLES IN A FINGERTIP)

5. THE ANTEROLATERAL PAIN AND TEMPERATURE PATHWAY
SENSORY NEURONS SYNAPSE IN SUBSTANTIA GELATINOSA
SECONDARY NEURONS CROSS MIDLINE AND ASCEND IN ATEROLATERAL COLUMN
BRANCHES GO TO THE RETICULAR FORMATION
TERMINATE IN VENTROBASAL NUCLEUS OF THALMUS
TERTIARY NEURONS GO TO SENSORY CORTEX

6. THE ANTEROLATERAL PATHWAY
SUBSTANTIA
GELITANOSA

8. THE SENSATION OF PAIN FAST PAIN SLOW PAIN MECHANICAL PAIN
CHEMICAL PAIN
THERMAL PAIN

9. PAIN NERVES:

10. FAST PAIN OCCURS IN ABOUT 0.1 SECONDS
SUBJECTIVE DESCRIPTION:SHARP, ACUTE, ELECTRIC OR PRICKING
A FIBERS SYNAPSE ON CELLS IN LAMINA I (LAMINA MARGINALIS) IN THE DORSAL HORNS
SECONDARY NEURONS CROSS AND TRAVEL THROUGH THE ANTEROLATERAL PATHWAY TO THE VENTROBASAL COMPLEX OF THE THALAMUS
TERTIARY NEURONS GO TO THE PRIMARY SENSORY CORTEX

11. FAST PAIN PATHWAY VENTROBASAL NUCLEUS LAMINA MARGINALIS I II IV III VI
SUBSTANTIA
GELITANOSA
ANTEROLATERAL
PATHWAY IX
VIII

12. SLOW PAIN OCCURS AFTER A SECOND OR MORE
OFTEN ASSOCIATED WITH TISSUE DESTRUCTION
SUBJECTIVELY DESCRIBED AS BURNING, ACHING,THROBBING, NAUSEOUS, OR CHRONIC
C FIBERS WHICH SYNAPSE IN THE SUBSTANTIA GELITANOSA
FINAL PROJECTION IS THE FRONTAL CORTEX

13. SLOW PAIN PATHWAY VENTROBASAL NUCLEUS LAMINA MARGINALIS I II IV III VI
SUBSTANTIA
GELITANOSA
ANTEROLATERAL
PATHWAY IX
VIII

14. MECHANICAL, CHEMICAL AND THERMAL PAIN
FAST PAIN IS GENERALLY MECHANICAL OR THERMAL
SLOW PAIN CAN BE ALL THREE
CHEMICAL PAIN RECEPTORS: BRADYKININ, SEROTONIN, HISTAMINE, POTASSIUM IONS, ACIDS, ACETYL CHOLINE AND PROTEOLYTIC ENZYMES
PROSTAGLANDINS ENHANCE PAIN SENSATION

15. BRAIN STRUCTURES AND PAIN
COMPLETE REMOVAL OF THE SENSORY CORTEX DOES NOT DESTROY THE ABILITY TO PERCIEVE PAIN
STIMULATION OF THE SENSORY CORTEX EVOKES A SENSATION OF PAIN

16. PAIN CONTROL (ANALGESIA)
THE ANALGESIA SYSTEM
THE BRAIN’S OPIATE SYSTEM
INHIBITION OF PAIN BY TACTILE STIMULATION
TREATMENT OF PAIN BY ELECTRICAL STIMULATION
REFERED PAIN

17. THE ANALGESIA SYSTEM PREAQUEDUCTAL GRAY RAPHE MAGNUS NUCLEUS
PAIN INHIBITORY COMPLEX IN DORSAL HORNS

18. PAIN INHIBITORY COMPLEX: PRESYNAPTIC INHIBITION
BRAIN STEM.NEURON
ANTEROLATERAL
PATHWAY
INHIBITORY NEURON -
PAIN
RECEPTOR +
DORSAL HORN OF
SPINAL CORD

19. PAIN TRANSMISSION AND INHIBITION
SUBSTANCE P IS THE NEUROTRANSMITTER: BUILDS UP SLOWLY IN THE JUNCTION AND IS SLOWLY DESTROYED
PRESYNAPTIC INHIBITION BY INHIBITORY NEURON BLOCKS THE RELEASE OF SUBSTANCE P (ENKEPHALIN)

20. THE BRAIN’S OPIATE SYSTEM
OPIATE RECEPTORS EXIST IN MANY CENTERS OF THE BRAIN, ESPECIALLY IN THE ANALGESIA SYSTEM
AMONG THE NATURAL SUBSTANCES WHICH ACTIVATE THESE RECEPTORS ARE: ENDORPHINS, ENKEPHALINS, AND MORPHINE

21. INHIBITION OF PAIN BY TACTILE STIMULATION
STIMULATION OF LARGE SENSORY FIBERS FOR TACTILE SENSATION INHIBITS PAIN TRANSMISSION FOR SAME REGION
RUBBING OFTEN EASES PAIN
LINAMENTS, OIL OF CLOVE, ETC.
POSSIBLE EXPLANATION FOR ACUPUNCTURE?

22. TREATMENT OF PAIN BY ELECTRICAL STIMULATION
STIMULATION OF LARGE SENSORY NERVES
ELECTRODES IN SKIN OR SPINAL IMPLANTS
INTRALAMINAR NUCLEUS OF THALAMUS

23. REFERED PAIN
VISCERAL PAIN FIBERS SYNAPSE ON SAME SECONDARY NEURONS AS RECEIVE PAIN FIBERS FROM SKIN

24. CLINICAL ASPECTS OF PAIN
HYPERALGESIA
THE THALAMIC SYNDROME
HERPES ZOSTER (SHINGLES)
TIC DOULOUREUX
THE BROWN-SEQUARD SYNDROME
HEADACHE

25. HYPERALGESIA ENHANCED SENSITIVITY AROUND DAMAGED TISSUE
SENSITIZATION OF NOCICEPTORS BY SUBSTANCES RELEASED WHEN TISSUE IS DAMAGED

26. THE THALAMIC SYNDROME LESION OF SOMATOSENSORY THALMUS
USUALLY A DISTORTED AND EXAGERATED SUBJECTIVE QUALITY
MAY CUT OFF PAIN TRASMISSION FROM PERIPHERY

27. HERPES ZOSTER (SHINGLES)
USUALLY AFFECTS THE DORSAL ROOT
ONE DERMATOME AND ONE SIDE

28. TIC DOULOUREUX CHRONIC NEURALGIA OF TRIGEMINAL NERVE
SOMETIMES DUE TO INFLAMMATION (NEURITIS)
SOMETIMES TREATED SURGICALLY, BUT OFTEN RETURNS

29. THE BROWN-SEQUARD SYNDROME
CHARACTERISTIC PATTERN OF SENSORY LOSS DUE TO LOCALIZED DAMAGE ON ONE SIDE OF SPINE
USUALLY ACCOMPANIED BY MOTOR LOSS AS WELL

30. LESION ON RIGHT HALF OF SPINAL CORD
LOSS OF PAIN SENSATION ON LEFT SIDE BELOW LESION
LOSS OF TOUCH AND VIBRATION ON RIGHT SIDE BELOW LESION
LOSS OF BOTH ON RIGHT SIDE AT SAME LEVEL
NO LOSS ABOVE LESION

31. HEADACHE SELDOM DUE TO BRAIN DAMAGE
NO SENSORY NERVES IN BRAIN LIKE THERE ARE IN PERIPHERY
TENSION INDUCED MUSCLE TIGHTNESS
SWELLING OF THE MUCOUS MEMBRANES
EYE DISORDERS
DILATION OF CEREBRAL BLOOD VESSELS
INCREASED INTERCRANIAL PRESSURE
INFLAMMATION AND SWELLING