TREATMENT OF NEUROPATHIC PAIN

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TREATMENT OF NEUROPATHIC PAIN

• GARY A. MELLICK, D.O.
• American PAIN Specialists, Inc.
• American SLEEP Disorders Clinic

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Dr. Gary Mellick Staff
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Chronic Pain

• Understanding Chronic Pain
• What Causes Chronic Pain
• Chronic Pain Treatments

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Chronic Pain

• Pain -- has an Element of Blank --
• It cannot recollect
• When it begun -- or if there were
• A time when it was not
• Emily Dickinson
• New England Poet

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CHRONIC PAIN

• The Terrible Triad
• Suffering, Sadness Sleeplessness
• Chronic Pain is the most costly health problem
  in America.
• Headache
• Lower back pain
• Cancer pain
• Arthritis pain

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Understanding Chronic Pain

• Sounding The Alarm
• Broadcasting The News
• Censoring The News

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Understanding Chronic Pain

• Sounding The Pain Alarm
• Nociceptors
• Nerve fibers in the skin, muscles, or joints
• Excited exclusively by intense, potentially
  harmful stimulation
• Pinprick
• Painful heat
• Irritating chemicals

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Degree/Type of Noxious Stimuli Pain Perception
Nociceptors Sound The Pain Alarm
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Ascending Pain Pathways
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Understanding Chronic Pain

• Broadcasting The News
• Higher brain centers are alerted by spinal
  pathways
• Different pathways carry different information
• Where it hurts how bad it is whether the pain
  is sharp or burning
• Fear, anger, anxiety
• Change in pulse rate, blood pressure, dilating
  the pupils

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Pain Transmission
Broadcasting The News Higher brain centers are
alerted by spinal pathways. Different pathways
carry different information.
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Understanding Chronic Pain

• Censoring The News
• Built-in nervous system mechanisms can block pain
  messages
• Pathways come down from the brain to prevent pain
  signals from coming through
• Endorphins - natural opiates

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Descending Pain Control Pathways
Censoring The News Built-in nervous system
mechanisms can block pain messages.
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What Causes Chronic Pain

• Gate Theory of Pain
• A hypothetical gate opens up and allows pain to
  travel to the brain
• Chronic pain results in many opened gates and
  broken fences
• Pain Wind-up
• Centralization

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Peripheral Nervous system
Central Nervous System
Normal A-Beta fibers
Touch Pain
Normal Sensory Processing
Normal C-fibers
Sensitized A-Beta fibers
Wind-up (Central Sensitization)
Touch-evoked pain Pain hypersensitivity
Sensitized C-fibers
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Pain Neurochemistry
Pain Wind-up Central Spinal Sensitization
Gate Theory of Pain
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Images of Acute Pain
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Images of Chronic Pain
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Chronic Pain Treatments

• Pain Medications
• Opiates (morphine, Darvocet, etc.)
• Adjuvant pain medicines (all the others combined)
• TENS (local electrical pain blocks)
• Anesthetic and Cortisone Injections
• Spinal Cord Stimulation and Pumps
• Alternative Medicine Treatments (Acupuncture,
  Chiropractic, etc.)

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Physician Responsibilities
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PAIN POEM