Aspectos generales del dolor

General Aspects of Pain

• Pain has affected human behavior since ancient times, impacting all aspects of life.
• Modern healthcare professionals need up-to-date knowledge of pain physiology and pathophysiology for better patient care.
• The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
• Pain perception protects the organism from tissue injury, triggering avoidance responses as an adaptive mechanism.
• Pain perception is influenced by cognitive-evaluative judgments, sociocultural knowledge, and emotional/affective motivation, supporting the biopsychosocial concept of pain perception.
• Pain assessment involves considering intensity, tolerance, and behavioral responses to pain.

Nociception

• Nociception is a set of physiological processes that allow the nervous system to transmit pain information when tissue damage occurs.
• This includes the sensation and perception of pain.
• Sensation of pain arises from the stimulation and transmission of nerve signals along nociceptive pathways.
• Perception of pain is the brain's interpretation and processing of nociceptive sensory information.
• Nociception occurs in response to noxious stimuli, potentially harmful stimuli.
• Threshold for pain is the minimum intensity of a stimulus required to produce a pain sensation.
• Threshold varies and is a reflection of the nervous system's adaptability.

Interoception

• This is a system that constantly monitors the body's internal state, not only regarding tissue damage.
• It also monitors the body for other conditions or threats.

Emotional Homeostasis

• This reaction protects the body's integrity by maintaining internal balance.
• It is triggered in the presence of potential threats.

Pain Terminology

• Nociceptive stimulus: A noxious agent, condition, or energy able to cause tissue damage.
• Pain threshold: The minimum stimulus intensity perceived as painful.
• Tolerance level: The maximum pain a person can endure.

Pain Evaluation

• Pain should be evaluated by considering location, distribution, quality, intensity, duration, patterns, origin, and cause.
• Pain intensity is a critical aspect for patient assessment and treatment seeking.
• Pain intensity measures include visual analog scales and verbal reports (mild, moderate, intense, unbearable).

Temporal Characteristics of Pain

• Duration can be acute or chronic, distinct from acute pain, which is brief, lasting less than three months, chronic pain lasts more than three months.
• Pain onset can be gradual or sudden.

Pain Origin

• Pain originates from various sources:
• Peripheral: From skin or superficial tissues.
• Deep: From deeper structures, such as muscles or joints.
• Visceral: Originating from organs.
• Central: A result of damage to the central nervous system.

Types of Pain

• Nociceptive: From tissue damage.
• Inflammatory: Caused by tissue inflammation.
• Neuropathic: Resulting from damage/dysfunction to the nervous system.

Pain Pathways

• Pain signals are transmitted through specific neural pathways to the brain for processing.
• This includes A delta fibers and C fibers.

Pain Mediators

• Chemical substances released by damaged cells and tissues that influence the experience of pain.
  • E.g., histamine, serotonin, prostaglandins.

Pain Perception Models

• Rapid, Localized, and Short-Duration Pain: This model is associated with fast, sharp pain signals that originate from tissue injury.
• Slow, Intense, and Prolonged Pain: This model highlights the mechanisms related to persistent or chronic pain caused by tissue injury.