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16
MPharm Programme
Dr Abdel Ennaceur
16
Terminology
•Tract: collection of axons in
the CNS
•Nucleus:(nuclei, plural)
collection of neuron cell bodies
in the CNS
•Ganglion:(ganglia, plural)
collection of neuron cell bodies
in the PNS; There are however
some in the brain (example:
basal ganglia)
•Nerve: collection of axons in
the PNS
– Cranial nerves
– Spinal nerves
• Thermal nociceptors.
• Mechanical nociceptors.
• Chemical nociceptors.
• Polymodal nociceptors.
High
A EAA NMDA Fast pain Allodynia
AMPA
mGlu
Aβ Low EAA AMPA III-VI Touch Mechanical
vibration allodynia
pressure
EAA= Excitatory amino acids; NK= neurokinin (peptide) receptor; NMDA, AMPA, mGlu.
Low threshold afferents are myelinated fibers with specialized nerve endings
that convey innocuous sensations such as light touch, vibration, pressure (all
Aβ) and proprioception (A).
High threshold afferents are thinly-myelinated (A) or unmyelinated (C)
fibers located in the dermis and epidermis, which convey
pain and temperature.
Allodynia is a pain due to a stimulus which does not normally provoke pain
Treatment
• Carbamazepine
Kininogens are proteins that are defined by their role as precursors for kinin.
Kallikrein is a hypotensive protease that liberates kinins from blood plasma
proteins and is used for vasodilation.
Slide 42 of 78 M14 Pain Lecture notes
WEEK
16
WHO's pain ladder
The severity and response to other medication determines the choice
of an analgesic.
To maintain freedom from pain, drugs should be given “by the clock”,
that is every 3-6 hours, rather than “on demand”.
Systems of pain relief. Some agents act at the level of the presynaptic receptor of the
primary afferent fiber, or nociceptor; others operate at the postsynaptic receptor in
the dorsal horn of the spinal cord; and some work at both sites
(SP = substance P; GLU = glutamate; NO = nitrous oxide).
Slide 45 of 78 M14 Pain Lecture notes
WEEK
16
Pain receptor targets
Intrathecal means something introduced into or occurring in the space under the
arachnoid membrane of the brain or spinal cord.
It is used for moderate to strong pain and migraine, and for its
muscle relaxant properties.
There are side effects associated with higher doses which may
warrant dose reduction. These include:
- tachycardia,
- hypertension,
- diplopia [double vision] and
- nystagmus [involuntary eye movements].