Book contents
- Frontmatter
- Contents
- List of contributors
- Preface to the first edition
- Preface to the second edition
- Preface to the third edition
- How to use this book
- Acknowledgements
- List of abbreviations
- Section 1 Clinical anaesthesia
- Section 2 Physiology
- 1 Cellular physiology
- 2 Body fluids
- 3 Haematology and immunology
- 4 Muscle physiology
- 5 Cardiac physiology
- 6 Physiology of the circulation
- 7 Renal physiology
- 8 Respiratory physiology
- 9 Physiology of the nervous system
- 10 Physiology of pain
- 11 Gastrointestinal physiology
- 12 Metabolism and temperature regulation
- 13 Endocrinology
- 14 Physiology of pregnancy
- 15 Fetal and newborn physiology
- Section 3 Pharmacology
- Section 4 Physics, clinical measurement and statistics
- Appendix: Primary FRCA syllabus
- Index
10 - Physiology of pain
from Section 2 - Physiology
- Frontmatter
- Contents
- List of contributors
- Preface to the first edition
- Preface to the second edition
- Preface to the third edition
- How to use this book
- Acknowledgements
- List of abbreviations
- Section 1 Clinical anaesthesia
- Section 2 Physiology
- 1 Cellular physiology
- 2 Body fluids
- 3 Haematology and immunology
- 4 Muscle physiology
- 5 Cardiac physiology
- 6 Physiology of the circulation
- 7 Renal physiology
- 8 Respiratory physiology
- 9 Physiology of the nervous system
- 10 Physiology of pain
- 11 Gastrointestinal physiology
- 12 Metabolism and temperature regulation
- 13 Endocrinology
- 14 Physiology of pregnancy
- 15 Fetal and newborn physiology
- Section 3 Pharmacology
- Section 4 Physics, clinical measurement and statistics
- Appendix: Primary FRCA syllabus
- Index
Summary
Pain has been defined as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage’ by the International Association for the Study of Pain (IASP), which has become the parent organisation for many national pain societies. This definition has arisen from a consideration of some of the features of pain as a multimodal experience. These include:
Pain has a protective function, and may or may not be associated with tissue damage.
Pain should not be equated to nociception. Nociception is usually a component of pain symptoms but not necessarily so.
Intrinsic modulatory mechanisms exist in the body which attenuate the intensity of the pain experience.
Sensitisation mechanisms exist which intensify pain symptoms, resulting in the phenomenon of hyperalgesia.
Pain possesses a subjective and affective element as a result of connections between the pain system, the cortical centres and the limbic system.
Pain levels are also influenced by past experience and anticipation, due to interaction between the pain system and the prefrontal cortex.
Pain can affect visceral and neuroendocrine function as a result of interconnections with medullary centres and the hypothalamus.
Nociception
Nociception is the sensory modality by which noxious stimuli are detected peripherally, and transmitted centrally to the central nervous system (Figure PP1). Noxious stimuli may or may not be associated with tissue damage. The pathway by which nociception is mediated consists of:
Nociceptors
Dorsal root ganglia containing the body of the nociceptor
The dorsal horn of the spinal cord
The primary synapse
Ascending tracts
The thalamus and higher centres
Nociceptors
The primary afferent neurones for pain are referred to as nociceptors, which possess specialised nerve endings existing in almost all tissues of the body.
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- Fundamentals of Anaesthesia , pp. 412 - 432Publisher: Cambridge University PressPrint publication year: 2009
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