Discussion 3: Disorders of pain

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Discussion 3: Disorders of pain

Darlene, age 32 years, has been having back pain for a number of years, ever since suffering a compressed L2 disc as the result of a motor vehicle accident that led to surgery and extensive physiotherapy. Now she is missing time from work as a secretary because of constant pain. Darlene has been referred to the chronic pain unit.

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As the nurse working with Darlene, what aspects of disorders of pain are important to understand?
How would you effectively manage Darlene’s pain at this time?
APA STYLE

Pathways from the Spinal Cord to the Thalamic Level of Sensation

The Discriminative Pathway

Crosses at the base of the medulla and the anterolateral pathway

Relays information to the brain for perception, arousal, and motor control

The Anterolateral Pathways

Consist of bilateral multisynaptic slow-conducting tracts

Provide for transmission of sensory information that does not require discrete localization of the signal source or fine discrimination of intensity

Question #1

Which pathway is used for perception, arousal, and motor control?

The anterolateral pathways

The discriminative pathways

Answer to Question #1

B. The discriminative pathways

Rationale: The discriminative pathways relay information to the brain for perception, arousal, and motor control.

Processing Sensory Modalities

Receptors

Adequate stimuli

Ascending pathways

Central integrative mechanisms

Central Processing of Pain Information

Transmission to the somatosensory cortex

Pain information is perceived and interpreted.

The limbic system

Emotional components of pain are experienced.

Brain stem centers

Autonomic nervous system responses are recruited.

Clinical Assessment of Somatosensory Function

Diagnostic analysis of the level and extent of damage in spinal cord lesions involves

Testing of the ipsilateral dorsal column (discriminative touch) system.

Testing of the contralateral temperature projection systems.

Pain Theories

Specificity Theory

Discussion 3: Disorders of pain

Pattern Theory

Gate Control Theory

Pain modulation

Neuromatrix Theory—addresses further the brain’s role in pain

Theories Explaining the Basis for Pain #1

Specificity Theory

Pain as a separate sensory modality evoked by the activity of specific receptors that transmit information to pain centers in the forebrain

Pattern Theory

Pain receptors share endings or pathways with other sensory modalities.

Different patterns of activity of the same neurons can be used to signal painful and nonpainful stimuli.

Theories Explaining the Basis for Pain #2

Gate Control Theory

The presence of neural gating mechanisms at the segmental spinal cord level accounts for interactions between pain and other sensory modalities.

Neuromatrix

The brain contains a widely distributed neural network, called the body–self neuromatrix, that contains somatosensory, limbic, and thalamocortical components that work together to create the individual neural patterns.

Mechanisms of Pain

First-Order Neurons

Detect stimuli that threaten the integrity of innervated tissues

Second-Order Neurons

Process nociceptive information

Third-Order Neurons

Project pain information to the brain

Nociceptors

Aδ Fibers

Fast pain

C Fibers

Slow wave pain

Transmission of Pain #1

Neospinothalamic tract

Provides for rapid transmission of sensory information to the thalamus

Transmission of sharp–fast pain information to the thalamus

Pain is experienced as bright, sharp, or stabbing in nature.

Synapses are made; the pathways continue to the contralateral parietal somatosensory area to provide the precise location of the pain.

Paleospinothalamic tract

Slow-conducting tracts that transmit sensory signals that do not require discrete localization or discrimination of fine gradations in intensity

Projects into the intralaminar nuclei of the thalamus

Diffuse, dull, aching, and unpleasant sensations that commonly are associated with chronic and visceral pain

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Discussion 3: Disorders of pain

Discussion 3: Disorders of pain

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