How chronic pain can become a problem REDUCE ACTIVITY PHYSICAL DETERIORATION (eg. muscle wating oint stess) UNHELPFU BeeFs S THOUGHTS FEEUNGS OF CHRONIC DE EPRES SION LPLES SNESS EXCESSIVE PAIN REPEATED RRITABUTY SUFFERING TREATMENT SLEEP FAILURES DISTURBANCE LONGTERM USE OF SIDE EFFEC TS ANALGESIC (eg, stom Jch SEDATNE DRUGS problems leth angy. constip ation LOSS OF JOB F|NAc风AL DIFFICULTIES. FAMILY Copyright: M K Nicholas PhD STRESS Pain management Research Insttute Royal North Shore Hospital st Leonards Nsw 2005 Australla
Chronic pain Mechanisms Peripheral input Central sensitization
Mechanisms： Peripheral input Central sensitization Chronic Pain
Table Neuronal mediators and receptors involved in central sensitization 1-1e Neurotransmitter/mediator Target receptors Outcome Glutamate AMPA and nmDa Opening of receptor channels Neuropeptid Substance P NK-1 Enhanced glutamatergic synaptic transmission NKA NK-2 CGRP CGRP Prostaglandin E2 EP(pre-and postsynaptic Enhanced nociceptor sensitivity Pro-inflammatory cytokines IL-1B Type 1IL-1 COX-2 upregulation TNF-a TNF types 1&2 Sensitization of nociceptive neurons Second messenger systems Nitric oxide Sensitization of spinothalamic tract cells AMPA, a-amino-3-hydroxy-5-methyl-isoxazole-4-propionic aad; NMDA, N-methyl-D-aspartate: CGRP, calcitonin gene-related peptide, NK, neurokinin; EP, prostanoid receptors, IL-1B, interleukin-1B: TNF-a, tumour necrosis factor-a COX-2, cydooxygenase-2 Plus dysfunction in inhibitory systems including opioids cannabinoids, norepinephrine adenosine
Plus dysfunction in inhibitory systems, including opioids, cannabinoids, norepinephrine, adenosine…
Analgesics(pain killer) NSAIDs and other anti-inflammatory drugs Opiates and morphinomimetic Some tricyclic antidepressants Some antiepileptic drugs ocal anesthetics a Others ketamine mexiletine, etc
Analgesics (pain killer) ◼ NSAIDs and other anti-inflammatory drugs ◼ Opiates and morphinomimetics ◼ Some tricyclic antidepressants ◼ Some antiepileptic drugs ◼ Local anesthetics ◼ Others: ketamine, mexiletine, etc
3 Antipyretic analgesic) and %h i Antettmmato (Non-sterofdalanti-inflammatory drugs, NSAIDs)
Antipyretic, Analgesic, and Anti-inflammatory Drugs (Non-steroidal anti-inflammatory drugs, NSAIDs)