NYERI kuliah.ppt

7/25/2019 NYERI kuliah.ppt

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PATOFISIOLOGI NYERI


2/23

Nociceptive afferent fiber

Normal nerve impulses leadin to pain

No!ious

stimuli

"escendin

modulation

Ascendin

input

Spinal cord

Perceived pain


3/23


4/23

T#e continuum of pain

Serves a protective function

$suall% apparent no!ious insult

Serves no protective function

"erades #ealt# and function

Acute

pain

Insult

ronic

pain

'()* mont#s


5/23

$nderstandin +e% t%pes of pain

Neuropat#ic painPain initiated or caused

b% a primar% lesion or

d%sfunction in t#e

perip#eral or central

nervous s%stem

Nociceptive painPain caused b%

an inflammator% or

non,inflammator%

response to a

no!ious stimulus


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-#at is nociceptive pain.

Painful reion is t%picall% locali/ed at t#e site of in0ur% )

often described as t#robbin1 ac#in or stiffness

$suall% time,limited and resolves 2#en damaed tissue

#eals 3e44 bone fractures1 burns and bruises5

A sensor% e!perience t#at occurs 2#en specific perip#eral

sensor% neurons 3nociceptors5 respond to no!ious stimuli

Responds to conventional analesics

&an also be c#ronic 3e44 osteoart#ritis5


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E!ample of c#ronic nociceptive pain6

osteoart#ritis of t#e +nee


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Activation of

local nociceptors

Perip#eralnerveSpinal cord

Tissue

damae

Ascendin

input

E!ample of c#ronic nociceptive pain6

osteoart#ritis of t#e +nee

Perceived pain

"escendin

modulation


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-#at is neuropat#ic pain.

Pain initiated or caused b% a primar% lesion or d%sfunction in

t#e perip#eral or central nervous s%stem

Pain often described as s#ootin1 electric s#oc+,li+e1

burnin ) commonl% associated 2it# tinlin or numbness

T#e painful reion ma% not necessaril% be t#e same as t#e

site of in0ur%4 Pain occurs in t#e neuroloical territor% of t#e

affected structure 3nerve1 root1 spinal cord1 brain5

Almost al2a%s a c#ronic condition 3e44 post#erpetic

neuralia1 poststro+e pain5

Responds poorl% to conventional analesics


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E!ample of neuropat#ic pain6

ulnar nerve lesion follo2in bone fracture

$lnar nerve


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Perip#eral

nociceptors

Ascendin

input

"escendin

modulation

E!ample of neuropat#ic pain6

ulnar nerve lesion follo2in bone fracture

Trauma

leadinto nerve

lesion

Perceived pain

Impulses enerated

2it#in ulnar nerve

Spinal cord

Lesion


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T#e co,presentation of nociceptive and

neuropat#ic pain

7ot# t%pes ofpain co,e!ist in

man% conditions

Neuropat#ic painNociceptive pain


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&o,e!istence of nociceptive and

neuropat#ic pain

E!amples include lo2 bac+ pain associated 2it#

radiculopat#%1 cancer pain and carpal tunnel s%ndrome

Effective manaement re8uires a broader t#erapeutic

approac# to relieve bot# t#e nociceptive and neuropat#ic pain

components

&o,e!istence of pain t%pes #as been referred to as eit#er

a 9mi!ed: or 9combined: pain state


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E!ample of co,e!istin pain6 #erniated disc

causin lo2 bac+ pain and lumbar radiculopat#%


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Lumbarvertebra

"isc #erniation

Activation of perip#eral nociceptors )

cause of nociceptive pain component

&ompression and inflammation of nerve root )

cause of neuropat#ic pain component




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Lesion

Activation

of local

nociceptors

&onstant ac#e1 t#robbin

pain in t#e lo2 bac+

Patient presents

2it# bot# t%pes

of pain

S#ootin1 burnin

pain in t#e foot

Ectopic disc#ares

from nerve

root lesion




17/23

Nociceptive and neuropat#ic pain ma%

co,e!ist in lo2 bac+ pain conditions

Neuropat#ic pain componentNociceptive pain component


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"ifferentiatin remote pain6

referred or radicular.

Nociceptive pain is usuall% locali/ed; #o2ever1

2#en in0ur% occurs to deep structures1 pain

ma% be referred 3e44 pain follo2in m%ocardial

infarction refers to left arm5

Referred pain is a nociceptive paindescribed

b% patients usin descriptors suc# as dull1

t#robbin or ac#in

In contrast1 radicular pain is a neuropat#icpaindescribed b% patients as s#ootin1

electric s#oc+,li+e or burnin1 often 2it#

tinlin or numbness


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Normal nerve impulses leadin to pain

No!ious

stimuli

"escendin

modulation

Ascendin

input

Spinal cord

Perceived pain


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Ectopic disc#ares

Nerve lesion induces #%peractivit% due to c#anes in ion c#annel function

Ectopic discharges

Nerve lesion

Spinal cord


"escendin

modulation

Ascendin

input

Perceived pain


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Loss of in#ibitor% controls

Loss of descendin modulation causes e!aerated pain due to an imbalance bet2een

ascendin and descendin sinals


No!ious

stimuli

Ascendin

input

Spinal cord

Loss of

descendin

modulation

E!aerated pain

perception


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&entral sensiti/ation

After nerve in0ur%1 increased input to t#e dorsal #orn can induce central sensiti/ation

Perceived pain

Ascendin

input

"escendin

modulation

Nerve lesion


Abnormal disc#ares induce central sensiti/ation


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Pat#op#%siolo% of neuropat#ic pain

Perip#eral neuron

#%pere!citabilit%

NeP

&entral mec#anisms

&entral neuron

#%pere!citabilit%

3central sensiti/ation5

Loss of

in#ibitor% controls

Perip#eral mec#anisms

Abnormal

disc#ares

NYERI kuliah.ppt

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