Neurology II 2.07 Pain Dr. Camara Chua[1]

!u"#e$t%  &o'i$%  &o'i$% (e$turer% Date%

Neurology II 2.07 – Neurology of Pain Dra. Pia Camara-Chua August 24, 201 OUTLINE

I. Pain II. Anatomy an) Physiology of Pain III. !'inal A*erent &ra$ts for Pain I+. I+. ther !'ino$ere"ral A *erent &ra$ts +. &halami$ &erminus of Pain i"ers +I. Physiologi$ As'e$ts of Pain +II. Clini$al an) Physiologi$ As'e$ts of Pain +III. A''roa$h to the Patient ith Pain as the Pre)ominant !ym'tom

I/. &reatment of Intra$ta"le Pain /. !u''lemental e)i$ation for the &reatment of Pain /I. &reatment of Neuro'athi$ Pain /II. &reatment of ee3 !ym'atheti$ Dystro'hy /III. A"latie !urgery in the &reatment of Pain /I+. Non-e)i$al etho)s for the &reatment of Pain /+. /+. A''en)i3 A'' en)i3

OBJECTIVES At the en) of the le$ture, the stu)ent shoul) "e a"le to% 1. No o"#e o"#e$t $ti ies es er ere e gie gien. n. 2. 5ut to stu)y this &rans, &rans, e 6no 6no it ill "e a "it )ull )ull an) )ry. )ry. 5ut #ust 6no the 6ey 6ey 'oints in ea$h ea$h hea)ing as ell ell as remem"er im'ortant stru$tures an) 'athays inole) in neurology of 'ain. . It ill ill "e hel'f hel'ful ul if you you 6no 6no "y heart heart the 'atha 'athays ys of 'ain 'ain.. 4. Also Also 6no 6no treatm treatment ent mo)a mo)alit litie ies s for 'ain. 'ain. References: 2015 References: 2015 &rans, Dra8s .''t, A)am8s Neurology

I. PAIN • Pain stan)s 're-eminent among all the sensory e3'erien$es "y hi$h humans #u)ge the e3isten$e of )isease ithin themseles o Pain is the most $ommon sym'tom of )isease o Pain is one of the earliest signs of mor"i)ity 9en if the main 'ro"lem or )isease )oes not manifest an) is o"ious, e e3'erien$e this :rst. •  &he 'ainful 'ainful e3'erien$es e3'erien$es of the si$6 si$6 'ose 'ro"lems 'ro"lems in irtually irtually eery eery :el) of me)i$ine me)i$ine o Pain $an hae stru$tural "asis o It $an hae an organi$;un)erlying $ause o Pain $an a''ear to hae little or no stru$tural "asis igraine or trigeminal neuralgia o Pain $an "e 'sy$hiatri$ 

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II. ANATOMY AND PHYSIOLOGY OF PAIN A. His!ric"# Pers$eci%e & '"(!r )e!ries: o S$eci*ci+ T)e!r+: +on rey !6in $onsiste) of a mosai$ of )is$rete sensory s'ots that gie rise to one sensation hen stimulate) su$h as 'ain, 'ressure, armth or $ol) 93am'le, on an area on the forearm, hen a $ertain s'ot is stimulate) oul) illi$it sensation of 'ain, armth or $ol)ness. &hese )is$rete sensory s'ots oul) hae a $orres'on)ing sensation hen triggere) 9a$h sensation has a )istin$t en)-organ in the s6in an) ea$h stimulus-s'e$i:$ en) organ is $onne$te) to its on 'riate 'athay in the "rain  

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P"ern,S-''"i!n P"ern,S-''" i!n T)e!r+: Also 6non as Inensi%i+ T)e!r+ III. ABLATIVE SURGERY IN THE CONTROL OF PAIN Acc!r1in ! Dr" )ese "re n! -s-"##+ 1!ne •  &he least )estru$tie 'ro$e)ure c!nsiss !f s-ric"# e$#!r"i!n f!r " ne-r!'"  if a 'rior in#ury or o'eration may hae 'artially se$tione) a 'eri'heral nere • I'$#"n"i!n !f " s$in"# e#ecric"# si'-#"!r, usually a)#a$ent to the 'osterior $olumns • S$in!)"#"'ic r"c!!'+, in hi$h the anterior half of the s'inal $or) on one si)e is se$tione) at an u''er thora$i$ leel, e*e$tiely reliees 'ain in the o''osite leg an) loer trun6 • Bi#"er"# r"c!!'+  is also feasi"le, "ut ith greater ris6 of loss of s'hin$teri$ $ontrol an), at higher leels, of res'iratory 'aralysis. • Pain in the arm, shoul)er, an) ne$6 is more )i=$ult to reliee surgi$ally o Hi) cer%ic"# r"nsc-"ne!-s c!r1!!'+ o C!''iss-r"# '+e#!!'+  "y longitu)inal in$ision of the anterior or 'osterior $ommissure of the s'inal $or) oer many segments o L"er"# 'e1-##"r+ r"c!!'+  – a"an)one) "y neurosurgeons o L"er"# 'esence$)"#ic r"c!!'+  – a"an)one) "y neurosurgeons • Sere!"cic s-rer+ !n )e )"#"'-s  for one-si)e) $hroni$ 'ain o n're)i$ta"le C!ric"# "6#"i!ns o n're)i$ta"le >IV. NON5MEDICAL METHODS FOR THE Page 21 of 24

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TREATMENT OF PAIN 5iofee)"a$6 an) e)itation are e3am'les of 'sy$hothera'ies Imagery A$u'un$ture !ome forms of s'inal mani'ulation  &rans$utaneous ele$tri$al stimulation

Dra. Chua sai) !tu)y Cha'ter KH it8s all there. 5ut for the interest of time, #ust stu)y this trans

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>V. APPENDI>

Fi-re 4. – Classi:$ation an) fun$tion of sensory 'eri'heral nere :"er ty'es an) sym'toms asso$iate) ith intrinsi$ )ysfun$tion of ea$h ty'e. F!c-s '!re !n A51e#" "n1 C *6ers.

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Fi-re /