4 Pain -- 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
5 CHRONIC PAIN The Terrible Triad Suffering, Sadness & Sleeplessness “Chronic Pain is the most costly health problem in America.”HeadacheLower back painCancer painArthritis pain
6 Understanding Chronic Pain Sounding The AlarmBroadcasting The NewsCensoring The News
7 Understanding Chronic Pain Sounding The Pain AlarmNociceptorsNerve fibers in the skin, muscles, or jointsExcited exclusively by intense, potentially harmful stimulationPinprickPainful heatIrritating chemicals
8 Degree/Type of Noxious Stimuli & Pain Perception Nociceptors Sound The Pain Alarm
10 Understanding 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
11 Pain Transmission Broadcasting The News Higher brain centers are alerted by spinal pathways.Different pathways carry different information.
12 Understanding 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
13 Descending Pain Control Pathways Censoring The NewsBuilt-in nervous system mechanisms can block pain messages.
14 What 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”
15 Peripheral 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