Applied physiology of nociception
Pamela E Macintyre, Suellen M Walker, David J Rowbotham in Clinical Pain Management, 2008
It is a common observation that, under certain circumstances, pain perception is not necessarily a consequence of tissue injury and nociception. To explain this finding, it is necessary to hypothesize that the “pain pathway” has a more complex role than the mere relaying of sensory information from nociceptor to brain, but can also regulate the passage of nociceptive activity information. There are a number of sites where such modulation might take place, but most is known about the major interface between the peripheral and central nervous systems at the dorsal horn of the spinal cord. The excitability of spinal cord neurons is dependent on the balance of inputs from primary afferent nociceptors, intrinsic spinal cord neurons, and descending systems projecting from supraspinal sites.27, 51
Assessing and managing pain
Nicola Neale, Joanne Sale in Developing Practical Nursing Skills, 2022
We have discussed how a person’s psychological state can have an impact on their pain perception; there are many tools available to assess the psychological components of pain and the ways in which people cope with their pain. These measurements are generally administered by pain experts and tend to be used in people with chronic pain. They include anxiety and depression scales, such as the PHQ-9 which can be found at www.patient.co.uk, coping strategy questionnaires, and impact of pain on function and physical activity profiles. One that tries to capture the wide impact that pain can have is the brief pain inventory, which is a self-assessment of pain: intensity, impact on daily function, location, duration and what medication is being used. Available from: https://static.medicine.iupui.edu/divisions/rheu/content/physicians/BRIEF_PAIN_INVENTORY.pdf (Accessed on 9 June 2021).
Diagnosis and Management of Electrical Injury
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Electrical injury is associated with a high rate of psychiatric morbidity including major depressive disorders, anxiety disorders, and post-traumatic stress disorder (Kelley et al., 1999). These problems are commonplace regardless of whether there is direct brain exposure to the electrical shock current. Anxiety and depression certainly have a significant role in pain perception. These psychiatric issues must be managed simultaneously with establishing various approaches to pain management. This requires considerable coordination of effort. A team approach is recommended so that a scheduled dialogue between treating physicians occurs. The treating physician is unlikely to be successful in managing pain related problems without successfully managing the psychiatric problems.
Placebos Are Pharmacologically Inert Even If They Generate a Placebo Effect
Published in AJOB Neuroscience, 2018
The author presents a review of the peer-reviewed medical literature that supports the physiologic explanation for the placebo theory and the cognitive modulation of pain, beginning with the gate control theory. The gate control theory of pain, introduced in 1965, presents a physiologic explanation for the psychological modulation of pain (Melzack and Wall 1965). Neural impulses in the spinal cord are able to inhibit the transmission of pain signals to the central nervous system, thereby modulating the individual’s experience of pain perception. The gate control theory of pain incorporates not only the sensory but the psychological aspects of pain perception. Pain perception may be modulated by cognitive aspects such as emotions, psychological state, and past experiences (Campbell et al. 2013). It is these cognitive modulators that drive the placebo response.
Treatment of pain following cancer: applying neuro-immunology in rehabilitation practice
Published in Disability and Rehabilitation, 2018
Jo Nijs, Laurence Leysen, Roselien Pas, Nele Adriaenssens, Mira Meeus, Wouter Hoelen, Kelly Ickmans, Niamh Moloney
When providing education to patients following cancer treatment, implementation of contemporary pain neuroscience into the educational programme seems warranted (Table 1 provides key messages). Pain neuroscience education includes explaining to patients that pain is an output product of the brain resulting from input from multiple central and peripheral nervous system processes, and leading to the perception of threat rather than pain being a reflection of current tissue damage.[41] Pain neuroscience education intends to transfer that knowledge to patients, allowing them to understand their pain and hence to effectively cope with their pain.[41] This includes explaining to patients that the pain is the sum of many processes within the nervous system and brain, which may or may not include nociception, and thus frequently poorly reflects current tissue damage. In non-cancer population with pain, pain neuroscience education is welcomed very positively by patients, [42,43] and is effective in changing pain beliefs, and improving health status as well as pain coping strategies.[42–50] However, studies examining the effectiveness of pain neuroscience education in patients following cancer treatment are lacking and are, therefore, an important research priority (Table 2 provides a research agenda).
Evidence of altered pressure pain thresholds in persons with disorders of consciousness as measured by the Nociception Coma Scale–Italian version
Published in Neuropsychological Rehabilitation, 2018
Davide Sattin, Caroline Schnakers, Marco Pagani, Francesca Arenare, Guya Devalle, Fabrizio Giunco, GianBattista Guizzetti, Maurizio Lanfranchi, Ambra M. Giovannetti, Venusia Covelli, Anna Bersano, Anna Nigri, Ludovico Minati, Davide Rossi Sebastiano, Eugenio Parati, MariaGrazia Bruzzone, Silvana Franceschetti, Matilde Leonardi
The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”, and nociception as “the neural process of encoding noxious stimuli” (IASP Task Force on Taxonomy, 1997). In its guidelines on pain management, the WHO highlights that correct diagnosis of pain is a public health concern and that pain treatments should be universally available (World Health Organization, 2007). Over the last few years, several pain assessment tools have been developed, such as the Brief Pain Inventory (Cleeland & Ryan, 1994) and the Numerical Rating Scale (Paice & Cohen, 1997), but these tools are not useful for assessing patients who cannot communicate their perceptions verbally, such as those in vegetative state (VS) and minimally conscious state (MCS). VS (The Multi-Society Task Force on PVS, 1994), also called unresponsive wakefulness syndrome (UWS), and MCS (Giacino, 2005) are disorder of consciousness (DoC) syndromes that encompass a broad spectrum of severity. VS patients are thought to be unaware of themselves and their environment despite having preserved capacity for spontaneous or stimulus-induced arousal, whereas MCS patients exhibit inconsistent but reproducible behaviours. At the upper bound of the DoC spectrum, MCS patients who recover communication skills and/or functional object use are reclassified as having emerged from MCS (eMCS) or as people with severe disability (SD).
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