← Older revision
Revision as of 10:36, 1 April 2016
(2 intermediate revisions not shown)
Line 1:
Line 1:
-
<div class="noeditbox">Welcome to [[PPA Pain Project]]. This page is being developed by participants of a project to populate the Pain section of Physiopedia. The project is supervised and co-ordinated by the [[The Physiotherapy Pain Association]].
+
<div class="editorbox">
-
*Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
+
-
*If you would like to get involved in this project and earn accreditation for your contributions, [mailto:letmetalktojo@gmail.com please get in touch]!
+
-
</div> <div class="researchbox">
+
-
'''Tips for writing this page:'''
+
-
+
-
Define acute and chronic pain terms of a multidimensional pain experience.'''<br>'''
+
-
+
-
*Anatomical, physiological, and psychological basis of pain and pain relief, including pain as an 'output' from the brain
+
-
*Definition of pain and evidence of the multidimensional nature of the pain experience e.g. social and psychological infleuncing factors
+
-
</div>
<div class="editorbox">
+
'''Original Editor '''- [[User:Alberto Bertaggia|Alberto Bertaggia]].
'''Original Editor '''- [[User:Alberto Bertaggia|Alberto Bertaggia]].
Line 34:
Line 24:
Nociceptors (from the latin ''nocere = ''to hurt) are sensory receptors which detect signals from damaged tissue or the threat of damage and indirectly also respond to chemicals released from the damaged tissue. There are free nerve endings present in many types of tissues, and cell bodies located in the dorsal root ganglions or in the cranial nerve ganglia.<br>
Nociceptors (from the latin ''nocere = ''to hurt) are sensory receptors which detect signals from damaged tissue or the threat of damage and indirectly also respond to chemicals released from the damaged tissue. There are free nerve endings present in many types of tissues, and cell bodies located in the dorsal root ganglions or in the cranial nerve ganglia.<br>
-
[[Image:Nociceptors.jpg|thumb|center|200px|(A) Somatosensory neurons are located in peripheral ganglia (trigeminal and dorsal root ganglia) located alongside the spinal column and medulla. Afferent neurons project centrally to the brainstem (Vc) and dorsal horn of the spinal cord and peripherally to the skin and other organs. Vc, trigeminal brainstem sensory subnucleus caudalis. (B) Most nociceptors are unmyelinated with small diameter axons (C-fibers, red). Their peripheral afferent innervates the skin (dermis and/or epidermis) and central process projects to superficial laminae I and II of the dorsal horn. (C) A-fiber nociceptors are myelinated and usually have conduction velocities in the Aδ range (red). A-fiber nociceptors project to superficial laminae I and V. from: Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest. 2010 Nov 1;120(11):3760–72. Copyright © 2010, American Society for Clinical Investigation.]] <br> Nociceptors have unmyelinated (C-fiber) or thinly myelinated (A-fiber) axons<ref name="McCleskey 1999">McCleskey EW, Gold MS. Ion channels of nociception. Annu Rev Physiol. 1999;61:835–56.</ref>. C-fibers support conduction velocities of 0.4–1.4 m/s, while A-fibers support conduction velocities of approximately 5–30 m/s<ref name="Dubin 2010">Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest. 2010 Nov 1;120(11):3760–72.</ref>.<br>
+
[[Image:Nociceptors.jpg|thumb|center|200px|(A) Somatosensory neurons are located in peripheral ganglia (trigeminal and dorsal root ganglia) located alongside the spinal column and medulla. Afferent neurons project centrally to the brainstem (Vc) and dorsal horn of the spinal cord and peripherally to the skin and other organs. Vc, trigeminal brainstem sensory subnucleus caudalis. (B) Most nociceptors are unmyelinated with small diameter axons (C-fibers, red). Their peripheral afferent innervates the skin (dermis and/or epidermis) and central process projects to superficial laminae I and II of the dorsal horn. (C) A-fiber nociceptors are myelinated and usually have conduction velocities in the Aδ range (red). A-fiber nociceptors project to superficial laminae I and V. from: Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest. 2010 Nov 1;120(11):3760–72. Copyright © 2010, American Society for Clinical Investigation.]] <br> Nociceptors have unmyelinated (C-fiber) or thinly myelinated (A-fiber) axons<ref name="McCleskey 1999">McCleskey EW, Gold MS. Ion channels of nociception. Annu Rev Physiol. 1999;61:835–56.</ref>. C-fibers support conduction velocities of 0.4–1.4 m/s, while A-fibers support conduction velocities of approximately 5–30 m/s<ref name="Dubin 2010">Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest. 2010 Nov 1;120(11):3760–72.</ref>.<br>
=== Nociception<br> ===
=== Nociception<br> ===
Line 53:
Line 43:
#''Pathological pain''. This type of pain is uncoupled from noxious stimulii and even from tissue damage, it is not protective, and results from abnormal functioning of the nervous system (peripheral or central). To note, this is a low-threshold pain. This time pain is not a symptom, but rather a disease itself. It occurs with peripheral sensitization and central sensitization.
#''Pathological pain''. This type of pain is uncoupled from noxious stimulii and even from tissue damage, it is not protective, and results from abnormal functioning of the nervous system (peripheral or central). To note, this is a low-threshold pain. This time pain is not a symptom, but rather a disease itself. It occurs with peripheral sensitization and central sensitization.
-
[[Image:Pain classification.jpg|thumb|center|200px|Pain can be broadly divided into three classes. (A) Nociceptive pain represents the sensation associated with the detection of potentially tissue-damaging noxious stimuli and is protective. (B) Inflammatory pain is associated with tissue damage and the infiltration of immune cells and can promote repair by causing pain hypersensitivity until healing occurs. (C) Pathological pain is a disease state caused by damage to the nervous system (neuropathic) or by its abnormal function (dysfunctional). From: Woolf CJ. What is this thing called pain? J Clin Invest. 2010 Nov 1;120(11):3742–4. Copyright © 2010, American Society for Clinical Investigation.]]
+
[[Image:Pain classification.jpg|thumb|center|200px|Pain can be broadly divided into three classes. (A) Nociceptive pain represents the sensation associated with the detection of potentially tissue-damaging noxious stimuli and is protective. (B) Inflammatory pain is associated with tissue damage and the infiltration of immune cells and can promote repair by causing pain hypersensitivity until healing occurs. (C) Pathological pain is a disease state caused by damage to the nervous system (neuropathic) or by its abnormal function (dysfunctional). From: Woolf CJ. What is this thing called pain? J Clin Invest. 2010 Nov 1;120(11):3742–4. Copyright © 2010, American Society for Clinical Investigation.]]
== Acute and chronic pain<br> ==
== Acute and chronic pain<br> ==
Line 59:
Line 49:
'''Acute pain''' is caused by a noxious stimuli ad is mediated by nociception. It has early onset and serve to prevent tissues damages. It is also useful to learn to avoid threat of damage, because certain categories of noxious stimulii become linked to the sensation of pain. This is why this type of pain is defined as adaptive, it helps to survive and to heal<ref name="Woolf 2004" />
'''Acute pain''' is caused by a noxious stimuli ad is mediated by nociception. It has early onset and serve to prevent tissues damages. It is also useful to learn to avoid threat of damage, because certain categories of noxious stimulii become linked to the sensation of pain. This is why this type of pain is defined as adaptive, it helps to survive and to heal<ref name="Woolf 2004" />
-
'''Chronic pain''' is pain continuing beyond 3 months or after healing is complete<ref name="Merskey 1994" />. It may arise as a consequence of tissue damage or inflammation or have no identified cause<ref name="Chronic Pain NIH">Chronic Pain: Symptoms, Diagnosis, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Treatment | NIH MedlinePlus the Magazine [Internet]. [cited 2016 Mar 28]. Available from: https://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/articles/spring11pg5-6.html</ref>. It can affect a specific body part (i.e. Complex Regional Pain Syndrome (CRPS), low back pain (LBP), pelvic pain) or be widespread (i.e. fibromyalgia). Chronic pain is a complex condition embracing physical, social and psychological factors, consequently leading to disability, loss of independence and poor quality of life (QoL)<ref name="Breivik 2006">Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006 May;10(4):287–333.</ref>.
+
'''Chronic pain''' is pain continuing beyond 3 months or after healing is complete<ref name="Merskey 1994" />. It may arise as a consequence of tissue damage or inflammation or have no identified cause<ref name="Chronic Pain NIH">Chronic Pain: Symptoms, Diagnosis, &
amp;amp;amp;
amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Treatment | NIH MedlinePlus the Magazine [Internet]. [cited 2016 Mar 28]. Available from: https://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/articles/spring11pg5-6.html</ref>. It can affect a specific body part (i.e. Complex Regional Pain Syndrome (CRPS), low back pain (LBP), pelvic pain) or be widespread (i.e. fibromyalgia). Chronic pain is a complex condition embracing physical, social and psychological factors, consequently leading to disability, loss of independence and poor quality of life (QoL)<ref name="Breivik 2006">Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006 May;10(4):287–333.</ref>.
== Psychological factors in pain<br> ==
== Psychological factors in pain<br> ==
Line 72:
Line 62:
=== Depression<br> ===
=== Depression<br> ===
+
There are strong evidencies of an established comorbidity of pain and depression<ref name="Miller 2009">Miller LR, Cano A. Comorbid chronic pain and depression: who is at risk? J Pain. 2009 Jun;10(6):619–27.</ref><ref name="Blair 2003">Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003 Nov 10;163(20):2433–45.</ref>. Furthermore, when patients with pain have comorbid depression, they have greater pain, a worse prognosis, and more functional disability<ref name="Borsbo 2009">Börsbo B, Peolsson M, Gerdle B. The complex interplay between pain intensity, depression, anxiety and catastrophising with respect to quality of life and disability. Disabil Rehabil. 2009;31(19):1605–13.</ref>. Additionally, chronic pain patients with co-morbid depression have higher health care costs compared to pain patients who do not have depression<ref name="Baumeister 2012">Baumeister H, Knecht A, Hutter N. Direct and indirect costs in persons with chronic back pain and comorbid mental disorders--a systematic review. J Psychosom Res. 2012 Aug;73(2):79–85.</ref>.<br>
There are strong evidencies of an established comorbidity of pain and depression<ref name="Miller 2009">Miller LR, Cano A. Comorbid chronic pain and depression: who is at risk? J Pain. 2009 Jun;10(6):619–27.</ref><ref name="Blair 2003">Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003 Nov 10;163(20):2433–45.</ref>. Furthermore, when patients with pain have comorbid depression, they have greater pain, a worse prognosis, and more functional disability<ref name="Borsbo 2009">Börsbo B, Peolsson M, Gerdle B. The complex interplay between pain intensity, depression, anxiety and catastrophising with respect to quality of life and disability. Disabil Rehabil. 2009;31(19):1605–13.</ref>. Additionally, chronic pain patients with co-morbid depression have higher health care costs compared to pain patients who do not have depression<ref name="Baumeister 2012">Baumeister H, Knecht A, Hutter N. Direct and indirect costs in persons with chronic back pain and comorbid mental disorders--a systematic review. J Psychosom Res. 2012 Aug;73(2):79–85.</ref>.<br>
-
Pain and depression are associated by neurobiological, cognitive, affective and behavioral factors, thus the optimal treatment approach for comorbid pain and depression should simultaneously address both physical and psychological symptoms<ref name="Goesling 2013">Goesling J, Clauw DJ, Hassett AL. Pain and Depression: An Integrative Review of Neurobiological and Psychological Factors. Curr Psychiatry Rep. 2013 Nov 10;15(12):1–8.</ref>.<br>
+
Pain and depression are associated by neurobiological, cognitive, affective and behavioral factors, thus the optimal treatment approach for comorbid pain and depression should simultaneously address both physical and psychological symptoms<ref name="Goesling 2013">Goesling J, Clauw DJ, Hassett AL. Pain and Depression: An Integrative Review of Neurobiological and Psychological Factors. Curr Psychiatry Rep. 2013 Nov 10;15(12):1–8.</ref>.<br>
=== Expectation<br> ===
=== Expectation<br> ===
Line 96:
Line 87:
These concepts are explained by the Fear-Avoidance (FA) model, which was largely hypothetical in the beginning, but currently there is ample evidence to support the validity of the original FA model<ref name="Crombez 2012">Crombez G, Eccleston C, Van Damme S, Vlaeyen JWS, Karoly P. Fear-avoidance model of chronic pain: the next generation. Clin J Pain. 2012 Jul;28(6):475–83.</ref>.<br>
These concepts are explained by the Fear-Avoidance (FA) model, which was largely hypothetical in the beginning, but currently there is ample evidence to support the validity of the original FA model<ref name="Crombez 2012">Crombez G, Eccleston C, Van Damme S, Vlaeyen JWS, Karoly P. Fear-avoidance model of chronic pain: the next generation. Clin J Pain. 2012 Jul;28(6):475–83.</ref>.<br>
-
As of today, the FA model is considered to be a component in the development of disability in a variety of conditions, such as low back pain, chronic headache, whiplash disorder, osteoarthritis, knee injury pain, chronic-fatigue syndrome, fibromyalgia and neuropathic pain <ref name="Wertli 2014">Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. The Spine Journal. 2014 May 1;14(5):816–36.e4.</ref><ref name="Nijs 2013">Nijs J, Roussel N, Oosterwijck JV, Kooning MD, Ickmans K, Struyf F, et al. Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice. Clin Rheumatol. 2013 May 3;32(8):1121–9.</ref><ref name="Leeuw 2007">Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007 Feb;30(1):77–94.</ref> <br>
+
As of today, the FA model is considered to be a component in the development of disability in a variety of conditions, such as low back pain, chronic headache, whiplash disorder, osteoarthritis, knee injury pain, chronic-fatigue syndrome, fibromyalgia and neuropathic pain <ref name="Wertli 2014">Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. The Spine Journal. 2014 May 1;14(5):816–36.e4.</ref><ref name="Nijs 2013">Nijs J, Roussel N, Oosterwijck JV, Kooning MD, Ickmans K, Struyf F, et al. Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice. Clin Rheumatol. 2013 May 3;32(8):1121–9.</ref><ref name="Leeuw 2007">Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007 Feb;30(1):77–94.</ref> <br>
== Social and cultural factors in pain<br> ==
== Social and cultural factors in pain<br> ==
Line 137:
Line 128:
*[http://www.iasp-pain.org/ International Asociation for the Sudy of Pain (IASP)] site<br>
*[http://www.iasp-pain.org/ International Asociation for the Sudy of Pain (IASP)] site<br>
-
*[https://www.painscience.com/ Pain Science] site
+
*[https://www.painscience.com/ Pain Science] site
-
*[http://www.pain-ed.com/ Pain-ed] site
+
*[http://www.pain-ed.com/ Pain-ed] site
-
*[[
www
.bodyinmind.org|Body in mind]] site
+
*[[
Www
.bodyinmind.org|Body in mind]] site
*[http://www.paincommunitycentre.org/professional-issues/multidimensional-nature-pain Pain community centre] page on multidimensional nature of pain
*[http://www.paincommunitycentre.org/professional-issues/multidimensional-nature-pain Pain community centre] page on multidimensional nature of pain