1. A Painfully Painful Primer On Pain
“TO THE PAIN!”
A Painfully Painful Primer On Pain

2. The Autobiography of Pain
Origin of “pain”
Poine
Ancient cultures believed pain and disease were punishment
Ancient practices  modern practices
Medieval times were big on drugs

3. The Autobiography of Pain
Coca-cola was sold as a “cure” for everything
Contained cocaine
Surgery techniques were bizarre
British royalty popularized childbirth relief
First significant tx in 1846
Use of anesthesia in surgery

4. Pain is Ubiquitous 50 million Americans has persistent pain
1/3 lose > 20 hrs sleep
2nd leading cause work absenteeism
$100 billion cost
High correlation between pain and depression

5. What Is Pain?
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (International Assoc for the Study of Pain)
Nociception
Encompasses all aspects of an individual
Psychological, physical, emotional, physiology

6. First and Second Pain

7. Pain Has Different States
Neuropathic pain
Central sensitization
Two main pathological pain states
Hyperalgesia
Allodynia
Somatic sensation
Affective perception

8. Pain is Painful 2 types: mechanical and polymodal
Different signaling molecules
Different molecules enhance response
Principles of Neural Science

9. Pain Anatomy-Spinal Cord

10. Pain Anatomy-Spinal Cord
Dorsal root and rootlets
Spinal (dorsal root) ganglion
Ventral root and rootlets
Spinal nerve
Dorsal ramus
Ventral ramus
Netter 169

11. Pain Anatomy-Brain Stem

12. Brainstem Nuclei PONS-MEDULLA JUNCTION UPPER PONS RVM LC PAG MIDBRAINX
RVM X LC
PAG
MIDBRAIN

13. Brainstem Inhibition of Pain
1st Order Noc. Neuron
Inhibitory IN
Spinothalamic Tract
2nd Order Noc. Neuron
RVM (Opioids)
RVM (Glutamate)
RVM (5HT)
LC (NE)

14. Brainstem Facilitation of Pain
1st Order Noc. Neuron
Inhibitory IN
Spinothalamic Tract
2nd Order Noc. Neuron
RVM (Glutamate)
RVM (5HT)

15. Gate Control Theory of Pain

16. TREATMENT
Pharmacology
TENS units
Surgery

17. CONCLUSIONS Prevalent Not well understood Encompasses every aspect
$$$$$$$
Treatment options limited