4Pain -- has an Element of Blank -- When it begun -- or if there were Chronic PainPain -- has an Element of Blank --It cannot recollectWhen it begun -- or if there wereA time when it was notEmily DickinsonNew England Poet
5CHRONIC PAIN The Terrible Triad Suffering, Sadness & Sleeplessness “Chronic Pain is the most costly health problem in America.”HeadacheLower back painCancer painArthritis pain
6Understanding Chronic Pain Sounding The AlarmBroadcasting The NewsCensoring The News
7Understanding Chronic Pain Sounding The Pain AlarmNociceptorsNerve fibers in the skin, muscles, or jointsExcited exclusively by intense, potentially harmful stimulationPinprickPainful heatIrritating chemicals
8Degree/Type of Noxious Stimuli & Pain Perception Nociceptors Sound The Pain Alarm
10Understanding Chronic Pain Broadcasting The NewsHigher brain centers are alerted by spinal pathwaysDifferent pathways carry different informationWhere it hurts; how bad it is; whether the pain is sharp or burningFear, anger, anxietyChange in pulse rate, blood pressure, dilating the pupils
11Pain Transmission Broadcasting The News Higher brain centers are alerted by spinal pathways.Different pathways carry different information.
12Understanding Chronic Pain Censoring The NewsBuilt-in nervous system mechanisms can block pain messagesPathways come down from the brain to prevent pain signals from coming throughEndorphins - natural opiates
13Descending Pain Control Pathways Censoring The NewsBuilt-in nervous system mechanisms can block pain messages.
14What Causes Chronic Pain Gate Theory of PainA hypothetical gate opens up and allows pain to travel to the brainChronic pain results in “many opened gates and broken fences”“Pain Wind-up”“Centralization”
15Peripheral Nervous system Central Nervous SystemNormal A-Beta fibersNormal Sensory ProcessingTouchPainNormal C-fibersSensitized A-Beta fibers“Wind-up”(Central Sensitization)Touch-evoked painPain & hypersensitivitySensitized C-fibers
16“Central Spinal Sensitization” Pain Neurochemistry“Pain Wind-up”“Central Spinal Sensitization”Gate Theory of Pain