KINE2495 - Topic 4

Pain

Subjective & Multidimensional, unpleasant sensory and emotional experience associated with actual or potential tissue damage

purpose of pain

signals ongoing or potential tissue damage, protective measure to prevent further injury.

Types of pain

acute and chronic

acute pain

immediately felt, happens when experiencing injury

chronic pain

Pain lasting longer than 3 months

categories of pain

Somatic
Visceral
Psychological

somatic pain

originates from skin or muscoskeletal system (ligaments, tendons, muscle, joints), usually localized pain, can usually pinpoint point in time in which pain is felt (Ex.ankle sprain pain)

visceral pain

pain originating from visceral organs, diffused pain (not pinpointed) or deferred pain (causes pain elsewhere in body), usually have other symptoms like nausea

Psychological pain

sensation of pain but no apparent physical cause of pain ( damage). Psycological/emotional pain, feel pain when anticipate something will hurt

Pain is felt when there is a stimulation of

Afferent nerve endings called nociceptors

types of nociceptors

Mechanosensitive, thermosensitive, chemosesnsitive

Mechanosensitive nociceptors

respond to touch and pressure or stretch

thermosensitive nociceptors

respond to extremes of heat and cold

chemosensitive nociceptors

respond to different chemicals (serotonin- during inflammatory process)

referred pain

pain that is felt in a location other than where the pain originates

What causes referred pain?

mix up of messages where too many afferent nerve signals try to get through at same time and brain confuses areas of spinal cord sending up signals

radiating pain

pain felt at the site of tissue damage and in nearby areas

throbbing pain

vascular circulation

shooting pain

Nerve pain

deep pain

Bone pain

Stiff/achy pain

Chronic inflammation

Question to ask athletes about pain during initial assessment

Subjective assessment with open ended questions (pain scales)

Ex. Can you describe the pain, how long does pain last? Where does it hurt

OPQRST

A mnemonic used in evaluating a patient's pain:
Onset
Provoke/palliative (what makes better/worse)
Quality (describe pain)
radiate/reffered
Severity
Timing.

Pathway of pain

1. Noxious stimulus in peripheral
2. Nociceptors
3. Primary (first-order neurons) to spinal cord synapses and release substance P on dorsal horn
4. 2nd order neuron through ascending spinal tracts to brain
5. Thalamus — sensory relay station
6. Third order neuron
7. Cortex - registered as pain
8. descending spinal tracts

Types of afferent fibers

A beta & A delta or C

Aβ fibers

group 2 - signals travel quickly 35-75m/sec - low threshold for stimulation (doesn't take much to trigger impulse) - large diameter - TOUCH & PRESSURE & TEMPERATURE acute pain

Aδ Fibers (A Delta)

group 3 - medium/large diameter - thinly myelinated 5-30m/sec - pain messages sharp localized pain

C fibers

group 4 - no myelin 0.5-2m/sec - chronic aching pain - smallest diameter

Coping definition

ability to identify, manage and overcome issues that stress one in any capacity

With coping what are we looking to reduce?

reduce threat value of any stimulus and the associated emotions or tissue that may change it with

Can you enhance ability to cope with pain

through education and understand threat

How is perception related to coping with pain?

- painful experience will hurt less not at all if brain thinks you're not in danger / threatened
- perception can dictate outcome response (low threat perception = less pain response)
- kids have dramatic reaction right away to pain as they fear pain overall - quick to settle emotions as we'll

Pain control theories

Gate control theory, descending pain control (central braising) theory, β-Endorphin theory

gate control theory of pain

non painful stimulus blocks painful stimulus spinal cord level
• stimulation of Aβ fibers that blocks c and Aδ carrying fibers
• Substantia geletiosa acts as gatekeeper and determines pain response or afferent sensation through Aβ fibers to be transported through 2nd order neurons
• Gate = substantia geletnosa , is first come first served bases,


Ex When we grab our toe after hitting it we stimulate mechanosensitive receptors along Aβ fibers the fastest, which get to gate first, and therefore brain first. So brain feels touch and blocks pain signals

Descending pain (central braising) theory

???

β-Endorphin theory

noxious stimulus of nociceptors resulting in transmission of pain information along Aδ and C afferent can stimulate release of endogenous opiate like chemical called β-endorphin
• these are our body's natural painkillers
• Not clear why β-endorphins produce analgesic effects
• Can stimulate with exercise and acupuncture
• can help Chronic pain - prescribe exercise!!!!

2 ways to cope with pain

Passive and active coping

Active coping

want to learn about problem, want to explore new ways to move, will explore edges of pain, usually positive person and looks to make further plans

Pasive coping

people who avoid activity, would rather lie there well someone else fixes the

Pin perception psychological factors

- previous pain experience
• pain expectations
• pain tolerance level
• effect of modalities -
• body part / what injury looks like
• situation/ time of seasons/winning/ losing
• status of player

Handeling acute pain situations & techniques

establish control, Establish helping /collaborative relationship , Alter the concentration, Provide information

sense of humour, Patient / pain education, Distraction/ attention, Visualization (pain modalities), Goal setting (reduce swelling to reduce pain), Relaxation skills

Poole it's chronic pain are Lilly to also be dealing with _______

depression as well
• can have dependency on pain medication
• Depression can result from long term use of pain medication

Chronic pain cycle

Increased pain - anxiety - sleeping problems - not coping

(Lack of employment, medication worries, general health worries, work cover worries, relationship worries)