Because of this convergence and the fact that the spinal neurons are most often activated by inputs from the skin, activity evoked in spinal neurons by input from deep structures is mislocalized by the patient to a place that is roughly coextensive with the region of skin innervated by the same spinal segment
Coronary ischemic pain usually radiates to medial side of arm and fingers, which were supplied by 6th~8th cervical (or T1~T2) over the left side
Referred pain
The convergence-projection hypothesis of referred pain
Pain modulation
Brain circuits modulate the activity of the pain-transmission pathways
One circuit has links in the hypothalamus, midbrain, and medulla
It controls spinal pain-transmission neurons through a desending pathways
It is bidirectional
produce analgesia or increase pain
Transmission system for nociceptive messages
Pathophysiology
ans may respond to different stimuli
GI system: sensitive to inflammation, ischemia, spasm
insensitive to cutting
heart: sensitive to acute ischemia
Integumentary stimuli at lowest level of intensity, evoke sensations of touch, pressure, warmth and cold
Noxious stimuli increased to the point approaching tissue destruction, pain is added
Clinical characteristics
Character of pain
spastic pain: intermittent
inflammatory: persisting
Localization of pain:
usually in the diseased part
it may be referred
Clinical characteristics
Quality and intensity of pain
peptic ulcer: gnawing burning
anginal pain: distress, dull pain whith heavy quality
The following are important:
severity duration frequency
special time of occurrence
Clinical characteristics
Referred pain
Aggravating and relieving factors
anginal pain: provoked by exertion, cold,
emotional upset
relieved by rest, nitroglycerine
ulcer pain: relieved by ingestion of food
Headache
Unpleasant sensations in the regions of cranial vault, usually reflects as a symptomatic expression of disease or some minor tension of fatigue
It may a
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