TREATMENT OF NEUROPATHIC PAIN GARY A. MELLICK, D.O. American Specialists, Inc. American PAIN...
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TREATMENT OF NEUROPATHIC PAIN GARY A. MELLICK, D.O. GARY A. MELLICK, D.O. American American PAIN Specialists, Specialists, Inc. Inc. American American SLEEP Disorders Disorders Clinic Clinic
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Transcript of TREATMENT OF NEUROPATHIC PAIN GARY A. MELLICK, D.O. American Specialists, Inc. American PAIN...
TREATMENT OF NEUROPATHIC PAIN
TREATMENT OF NEUROPATHIC PAIN
GARY A. MELLICK, D.O.GARY A. MELLICK, D.O.American American PAIN Specialists, Inc.Specialists, Inc.
American American SLEEP Disorders Disorders ClinicClinic
Dr. Gary Mellick & Staff
Chronic Pain Understanding Chronic Pain What Causes Chronic Pain Chronic Pain Treatments
Chronic PainPain -- has an Element of Blank --
It cannot recollectWhen it begun -- or if there were
A time when it was not
Emily Dickinson New England Poet
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
Understanding Chronic Pain Sounding The Alarm Broadcasting The News Censoring The News
Understanding Chronic Pain Sounding The Pain AlarmSounding The Pain Alarm
NociceptorsNociceptors Nerve fibers in the skin, Nerve fibers in the skin,
muscles, or jointsmuscles, or joints Excited exclusively by intense, Excited exclusively by intense,
potentially harmful stimulationpotentially harmful stimulation• PinprickPinprick• Painful heatPainful heat• Irritating chemicalsIrritating chemicals
Degree/Type of Noxious Stimuli & Pain Perception
Nociceptors Sound The Pain Alarm
Ascending Pain Pathways
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
Pain Transmission
Broadcasting The NewsHigher brain centers are alerted by spinal pathways.
Different pathways carry different information.
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
Descending Pain Control Pathways
Censoring Censoring The NewsThe News
Built-in Built-in nervous nervous system system
mechanisms mechanisms can block can block
pain pain messages.messages.
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”
Peripheral Nervous systemPeripheral Nervous systemPeripheral Nervous systemPeripheral Nervous system
TouchTouch
PainPain
Touch-evoked painTouch-evoked pain
Pain & hypersensitivityPain & hypersensitivitySensitized C-fibersSensitized C-fibers
Sensitized A-Beta fibersSensitized A-Beta fibers
““Wind-up”Wind-up”(Central (Central
Sensitization)Sensitization)
““Wind-up”Wind-up”(Central (Central
Sensitization)Sensitization)
Normal Normal Sensory Sensory
ProcessingProcessing
Normal A-Beta fibersNormal A-Beta fibers
Normal C-fibersNormal C-fibers
Central Nervous SystemCentral Nervous SystemCentral Nervous SystemCentral Nervous System
Pain Pain NeurochemistryNeurochemistry
Pain Pain NeurochemistryNeurochemistry
““Pain Wind-up”Pain Wind-up”““Central Spinal SensitizationCentral Spinal Sensitization””Gate Theory of PainGate Theory of Pain
Images of Acute Pain
Images of Chronic Pain
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.)
Physician Responsibilities
PAIN, PAINTeresa Wexler Garland, D.D.S.
Pain, pain go AwayDon't you come another Day
I am sick and tired of YouAnd you will not make me Blue!
Pain, Pain Disappear!Those two words I hate to Hear
Leave me leave me won't you PleaseAnd take with you this Disease!
Pain, pain don't come Around,One thing is I'll beat you DownYou will see that you will Lose
Because, you see that's what I Choose!!!
And finally "you thing" called Pain,You WILL NOT make me Insane
I will FIGHT you to the End,And I will FIGHT you for my Friends!!!
This is written for all those people that live in painbe it from Ms or for any other reason. I care.
Teresa
