ANESPARTTWO

SubstantiaGelatinosa(SG)
controlsystemcompoflaminaeII+IIIofthedarsalhornoftheSG;thisisthegate
whichmodulatessensoryinput
propintuitionalstimulationoffastconductinglargediametersnervefibers(inibypress,
vibration,temp)resultsininhibitionoftransmissionofpainsensationbysmallnerve
fibers
transmissionofimpulsesispresentedfromreachingtheTcells(2ndaidin?neuronsthat
transmitimpulsesto9nersyscinles)?
whenTcellstimulationexceedsacriticallevel,actionsystemisactivated
*TENS(transcutaneouselectricalnervestimulation)andacupuncture
PeripheralnervesdiffsizescondimpulsestotheCVSatdiffspeeds

a.)Adelta(fibers)
large(2030diameter),unmyelinated
fastconductors(sharp,localizedpain,100m/sec
b.)Bfibers
3indiameter;conductsat314m/sec
onlyinpreganglionicfibers;noafferentfunction
c.)Cfibers
small,unmyelinated(.051.0diameter)
slowconductor(dull,diffusedpair)0.52m/sec
spinalgatingmechanismisinflucedbynerveimpulsesthatdescendfrombrain
d.Aspecializedsysoflargediameter,rapidlyconductingfibers(Centralcontrol
Trigger)activatesselectivecognitiveprocessthattheninfluencebuwayofdescending
fibers,themodulatingpropertiesofspinalgatingmechanism
e.WhenoutputofSpinalCordTransmission(T)cellsexceedsacriticallevel,it
activatestheActionSystem
thoseneuralareasthat??undulia??thecomplex,seqpatternsatbehaviorandexperience
characteristicsofpain
ActionSystem

Complexintercom.ofTNSC?thatsubserveemotionsattention,memory,spatio
temporalanalysisandeffect,andseveralmotormechanisms
RAS,limbicsystemthathypothal
a.SensorydiscriminativeComponent
??Somato??sensorypathwayswhichrapidlytransmitspatiotemproalintoaborthox.
stim
enablesindivtoIDlocation+dinationofpain

b.Motivationalaffectivecomponent
mainlywithinthereticularformationofthebrainstemthatregvasomotorandautonomic
functions
provfcutheaversivemotivationalcompoofpain,thesufferingaspectassocwithpain
canbealteredwitheffectsofnarcotics
patientbecindifftopain
c.Activationofmotormechanisms
respfaranindivsovertRxntopain
overintegw/spatiotemporalanalysisandaffectiveaspectsofthepainfulexperience,a
seqofresponsesisseeninaninidiv:

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Startleresponse
Flexsionreflex
Posturalreadjustment
Vocalization
Preorientationoftheheadandeyes
Evocationofpastexperiences
Predictionoftheconsequence
OtherpatternsofbehavioraimedatRedthesensation

Hypothalamusandmedullamediateschangesinvitalsigns
sympatheticNSisalsoenhanced

d.Descendingcontrol
controlmechanismsofinhibiting/faceneuraltranslucw/inPAG(PeriaqueductalGray
matter)ofmidbraingoingtowardstheSG
stimofthisareaNS/inprofoundanalgesia
canalsobeactivatedbypharmacological(drugs)andpyschologicalfactors(mindset
oftheperson)
Brainactivesystems
filters,selects,modulatesinput
dorsalhorns,too,werenotmerelypassivetranmissionstations+siteswithdynamicacts
(inh?,exc,mod)
CNS?essentialcompofpainpure
Othertheoriesng?Pain

Painreceptors(nociceptors)=chemoreceptors
Reptides,substanceP15hydroxytriptamine,histamine,bradykinin
Endogeneouspainkillers

Endorphinsandenkephalins
relbycellswithinthePVGmatterandPAGmatter

Neurohormones
precursorsatendorphins
prodanalgesic,euphoric,catatonicandhallucinogenicaffuteandRedatsympsof
schizophrenia

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Musclepain
dullandlimitedtoareaoforigin;movementofafectedpartworsensthepain

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DentalPulp
Theoriesregsensofdentin:
presenceofsensorynerveendingswithinthedentin
odontoblastsactassensorycells
Brannstrom'sHydrodynamictheory
needsstimoffue?NEsinpulpduetorapidplanoffluidalin?thedentinaltubules
TotalEtch:typeI
Stillmoist:typeII!overwetphenomenon
TypesofPAINNSPRV

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Somatogenic
Nociceptive:peripheralnerves
visceralreferredpain
deepsomatic:joints,musc,tendons=dull,difftolozalize
superficialsomaticskin,monburns
Neuropathic
Psychogenicpain
noorganicbasis;doesnotfollowdifanatomicpattern
ReferredPain
expatsitefarawayfromsiteofinjury
deepsomatic
Neurogenicpain
sharp,surprising???,intense
maybeconstant/intermittent
neuropathic
Xnerveinjured
Vascularpain
diffuse,difftolocalize
InternationalAssociationfortheStudyofPain(IASP)classsysdescribespainaccdgto
Scategories=TADB

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deviationandseverity
chronic,subacute,acute
anatomicallocation
lowbarkpain,pelvic,facial
Bodysysteminv
neuropathic,myofascial,rheumatic,vascular
Causesomatogenic,psychogenic
Temporalcharacteristics(intermittent,constant,etc)
!syscriticizedbyWoolfandothersasinadequateforguidingresearchandtreatment,and
anadditionalcategorybasedonneurochemmuchhasbeenproposedChronicpain.
Chronic>malignant.Pain>benign

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Waysonctonrolpain
Removingcause*Exo/Scaling/RCTmustderindale?
Blockthepainpathway=mostcommonusedmethod
Uselocalanesagent
prevdepo
Raisepainthreshold
useanalgesics/NSAIDs
chemicals/drugswithanalgesicprops
painreactiondown
Preventingpainreactionbycorticaldepression
useGAtodownCNS
Usepsychometricmethods
putpatientateaseandinproperframeofmind
gainpatientsconfidenceandtrust
Resinanincreaseofpaintolerance
ModeofactionofLAA
interfereofexcitationprocinthenerveintheffmanner
alterbasicrestingpotentialofnervemembrane
altertresholdpotential(firinglevel)
decreasenale?ofdepolarizationprimaryeffect
prolongingrateatdepolarization
HowdoesLAAwork?
produceaconductionblockbyselectivelydecreasingpeakpermofionchannelstoNa
ions
>Resinaredofsafetyfactor56neededfortheminimumneededforconduction

!spottyanesthesia
>conductionfailure
SeqofmechofLA

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Ca ions displaced from Na chain reception site without permits

Binding of LA mol to receptor sites which thus produces
Blockage of Na channels + Down Na conductance + Down of nale? of
Repo
= failure to achieve threshold potential level + lack of development of
propagated action potentials
= Conduction blockade
Clavial Nerves
Innovation of Maxillo Facial Stores

5th cranial nerve

7 CN
9 CN
12 CN
Trigeminal Nerve - middle cranial fossa
largest CN from side of pons?
2 roots
a. Sensory ( Portio major ; from Gasserian ganglian)
V1 V2 V3
b. Motor (portio minor; from upper pons) masticator nerve -> both
exteroceptive (touch, thermal and pain) + propioceptive ( deep pressure
and kinesthesia)

V1 Ophthalmic nerve
smallest div
leaves MCF and enters thru SOF
Sensory nerve:
scalp, skin forehead, upper eyelid, frontal sinus, conjuctiva, lacrimal gland,

lateral angle of eye

3 branches:
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lacrimal nerve - smallest branch

frontal nerve - largest branch of 2 branches : supra orbital and
supratrochlear
Nasociliary nerve - with branches in the nasal cavity and on face