2. An unpleasant sensory and
emotional experience associated
with actual or potential tissue
damage, or described in term of
such damage.
-International Association For the Study of pain
4. • Aching, often constant
• May be dull or sharp
• Often worse with movement
• Well localized
Eg
– Bone & soft tissue
– chest wall
5. Somatic pain and visceral pain are actually two
very different types of pain. Somatic pain comes
from the skin and deep tissues, while visceral pain
comes from the internal organs. Both somatic pain
and visceral pain are detected the same way:
Nociceptors, or pain-detecting nerves, send an
impulse from the painful site up through the spinal
cord and to the brain for interpretation and
reaction. This is called nociceptive pain, and
differs from neuropathic pain, which is caused by
nerve damage. Though they are detected in similar
ways, somatic pain and visceral pain do not feel
the same
6. How Somatic Pain Feels
Somatic pain is generally described as
musculoskeletal pain. Because many nerves
supply the muscles, bones and other soft
tissues, somatic pain is usually easier to
locate than visceral pain. It also tends to be
more intense. Some chronic pain conditions
caused by somatic pain include:
7. • Constant or crampy
• Aching
• Poorly localized
• Referred
Eg
– CA pancreas
– Liver capsule distension
– Bowel obstruction
8. How Visceral Pain Feels
Visceral pain is internal pain. It comes from
the organs or the blood vessels, which are
not as extensively innervated, or supplied
by, sensory nerves. Unlike somatic pain,
visceral pain may feel dull and vague, and
may be harder to pinpoint. Some common
types of visceral pain include:
9. COMPONENT DESCRIPTORS EXAMPLES
Steady, • Burning, Tingling • Diabetic neuropathy
Dysesthetic • Constant, Aching
• Post-herpetic
• Squeezing, Itching neuropathy
• Allodynia
• Hypersthesia
Paroxysmal, • Stabbing • trigeminal neuralgia
Neuralgic
• Shock-like, electric • may be a component
• Shooting of any neuropathic
pain
• Lancinating
11. ACUTE:
onset is well defined,
response to tissue injury,
responds to pain treatment,
associated with anxiety,
affects the individual
CHRONIC PAIN:
Onset is ill defined,
response to change in nervous system,
less response to medication,
associated with depression,
involves social network
12. MELZACK & WALL,1965- Substentia
Gelatinosa(SG) in dorsal horn of spinal cord acts
as a "gate"- only allows one type of impulses to
connect with the SON
Transmission Cell(T-cell)- distal end of the SON
If A-beta neurons are stimulated- SG is activated
which closes the gate to A-delta & c neurons
If B-delta and C neurons are stimulated- SG is
blocked which closes the gate to A-beta neurons
13. Gate - located in the dorsal horn of the spinal cord
Smaller, slower nerve carry pain impulses
Larger, faster nerve fibers carry other sensations
Impulses from faster fibers arriving at gate 1st inhibit
pain impulses (acupuncture/pressure, cold, heat, chem. skin
irritation).
Brain
Pain
Gate (T
cells/ SG) Heat, Cold,
Mechanical
14. Descending neurons are activated by:
stimulation of A-delta & C neurons, cognitive
processes, anxiety, depression, previous
experiences, expectations which Cause
release of enkephalins (PAG).
Enkephalin interneuron in area of the SG
blocks A-delta & C neurons
15. Least understood of all the theories
Stimulation of A-delta & C fibers causes release of B-
endorphins from the PAG
Mechanism of action – similar to enkephalins to block
ascending nerve impulses
Examples: TENS (low freq. & long pulse duration)
16. Unlike specificity theory, pattern theory
suggests that there are no separate systems for
receiving pain, but instead the nerves are shared
with other senses like touch.
The most important feature of pain is the
pattern of activity in the nervous system. So, too
much stimulation (eg too much touch) will cause
pain.
17. Reduce pain!
Control acute pain!
Improve healing process
Reduce inflammation and edema
Decrease spasm and improve muscle
contraction
18. Use to control pain
Muscle spasm decrease as result of
decrease activity in gamma motor efferent,
decrease excitability of muscle spindle and
increase activity of Golgi tendon organs
19. Moist heat packs and paraffin are examples
of therapeutic conductive heating
Therapeutic convective heating take place
during hydrotherapy
Therapeutic radiant is supplied infrared
20. Cold therapy is the best modality for acute
inflammatory reactions like:
Acute inflammation of the bursa (bursitis)
Epicondylitis (tennis elbow, golfer’s elbow)
Acute trauma
Cold therapy reduce:
Muscle spasm secondary to:
Underlying joint and skeletal pathology
Nerve root irritation
Edema, hyperemia (excess blood in tissue) and pain
Due to its vasoconstrictive (constriction of blood
vessels) effect
21. A local decrease in tissue temperature
Reduction in metabolism
Vasoconstriction (initially)
Reduce blood flow (initially),
Reduce muscle excitability, muscle spindle
activity
Reduce nerve conduction velocity
Reduction in lymphatic and venous drainage
Reduce Decrease formation and accumulation of
edema
Anesthesia
22. After some minutes the vasoconstriction may
give way to a marked vasodilatation which it self
may last some 15minute before being replaced
by another episode of vasoconstriction
This alteration is called the “Lewis hunting
reaction” (Lewis, 1930), in the sense that the
vessels hunts about its mean position
23. Electromagnetic waves that produce heat
Frequency of 27.12 MHz and wavelength > 11 m.
Use in
muscle spasm- pain relief,
Delayed healing
Chronic inflammation- increase blood circulation
Fibrosis- increases extensibility of fibrous tissue
24. Principle effect is production of heat in the tissues
↓
rise temperature of that part
↓
Relaxation of muscle and increase the efficiency
of their action
↓
Increase blood supply ensuring the optimum
condition for the muscle contraction.
25. parameters Chronic condition Acute condition
Intensity comfortable warmth Below sensation of
warmth
Duration 20 minutes 10 minutes
Frequency Daily Twice a day
26. Electromagnetic radiation
Frequency 2450 MHz and wavelength 12.245 cm
Relief pain- in traumatic
and rheumatic condition
Muscle spasm
Inflammation- increase blood supply and resorption
of edema
Delayed healing- promote healing
27. Principle effect is production of heat in the tissues
↓
rise temperature of that part
↓
Relaxation of muscle and increase the efficiency of
their action
↓
Increase blood supply ensuring the optimum
condition for the muscle contraction.
28. To produce deep tissue heat by molecular friction
It helps to:
Decrease the joint pain
Prepare the joint for mobilization/manipulation
It can break adhesions and calcification
(e.g. calcific bursitis)
Combined with deep tissue massage (trigger point
therapy) it is effective for treatment of myofascitis
29. It is impossible to treat C or A fiber
selectively, ultrasound provides both pain
relief and relief from muscle spasm
Sounding of C fibers produce pain relief
whereas sounding of large diameter fibers
bring relief of spasm by changing gamma
fiber activity, making muscle fiber less
sensitive to stretch.
30.
31.
32. Transcutaneous Electrical Nerve stimulation
TYPES
High tens or conventional tens
(high freq:100-150Hz, law intensity:12-30mamp)
Low tens or acupuncture tens
(high intensity:300mamp, law freq:1-5Hz)
Burst tens(50-150Hz)
Brieftens
(high freq:100Hz, law intensity:20-50mamp)
Modulated tens
33.
34. Tens selectively stimulates the low-
threshold, large-diameter A-beta fibers
It resulting in presynaptic inhibition within
the dorsal horns
Tens delivered at low rate is thought to
facilitate elevation of the level of
endogenous opiates in the CNS
35. Pulse shape Rectangular type impulses
Pulse width 100 microsecond, generally 50
microsec- 300 microsec
Inensity 0 – 60 milliamp, satisfactory
intensity till tingling sensation
Frequency range effect
1 – 250 pulse per second decrease pain
50 – 100 pps sensory level (high level)
2 – 3 pps Motor level (low level)
2 pps Increase in the pain threshold
36. short frequency therapeutic current
Types
Plain
Surged faradic
Its use
Muscle contraction that is inhibited by pain
Pumping action which result in increase venous
and lymphatic returns
37. Chemical ions are driven through the skin by small
electrical current
Ionizable compounds are placed on the skin under the
electrode, which when polarized by direct(galvanic)
current, repels the ion of like charge into the tissue
Ions are known to be effective analgesics:
Xylocain
Hydrocortisone
Manesium
Iodine
salicylate
38. Light amplification by stimulated emission of
radiation
A low intensity laser therapy is used
It resolve inflammation and infection
Reduce pain
Increase speed, quality and strength of tissue repair
TYPES:
Rubby laser,
Helium-neon laser,
Diod laser
39. Laser―photons
↓
Visible red light absorbed in the mitochondria,
infrared light absorbed at the cell membrane
↓
Single oxygen production
↓
Formation of proton gradients across cell membrane and
across membrane of mitochondria
↓
Physiological changes
Change in cell membrane permeability
Increase ATP levels-DNA production
Influences cell metabolism
↓
Activation of regulatory process
40. 1) Power Density (W/cm2) =
Laser Output Power (W)/Beam area (cm2)
2) Beam Area (cm2) = Diameter(cm)2 x 0.7854
3) Energy (Joules)=Laser Output Power (Watts) x Time(Sec)
4) Energy Density (Joule/cm2)=Laser Output Power (Watts) x
Time(Sec)/Beam Area (cm2)
5) Treatment Time (Seconds)=Energy Density
(Joules/cm2)/Output Power Density (W/cm2)