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TREATMENT OF NEUROPATHIC PAIN

TREATMENT OF NEUROPATHIC PAIN. GARY A. MELLICK, D.O. American PAIN Specialists, Inc. American SLEEP Disorders Clinic. Dr. Gary Mellick & Staff. Chronic Pain. Understanding Chronic Pain What Causes Chronic Pain Chronic Pain Treatments. Chronic Pain. Pain -- has an Element of Blank --

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TREATMENT OF NEUROPATHIC PAIN

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  1. TREATMENT OF NEUROPATHIC PAIN GARY A. MELLICK, D.O. American PAINSpecialists, Inc. American SLEEPDisorders Clinic

  2. Dr. Gary Mellick & Staff

  3. ChronicPain • Understanding Chronic Pain • What Causes Chronic Pain • Chronic Pain Treatments

  4. ChronicPain Pain -- has an Element of Blank -- It cannot recollect When it begun -- or if there were A time when it was not Emily Dickinson New England Poet

  5. 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

  6. Understanding Chronic Pain • Sounding The Alarm • Broadcasting The News • Censoring The News

  7. Understanding Chronic Pain • Sounding The Pain Alarm • Nociceptors • Nerve fibers in the skin, muscles, or joints • Excited exclusively by intense, potentially harmful stimulation • Pinprick • Painful heat • Irritating chemicals

  8. Degree/Type of Noxious Stimuli & Pain Perception • Nociceptors Sound The Pain Alarm

  9. Ascending Pain Pathways

  10. 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

  11. Pain Transmission • Broadcasting The News • Higher brain centers are alerted by spinal pathways. • Different pathways carry different information.

  12. 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

  13. Descending Pain Control Pathways Censoring The News Built-in nervous system mechanisms can block pain messages.

  14. 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”

  15. Peripheral Nervous system Central Nervous System Normal A-Beta fibers Normal Sensory Processing Touch Pain Normal C-fibers Sensitized A-Beta fibers “Wind-up” (Central Sensitization) Touch-evoked pain Pain & hypersensitivity Sensitized C-fibers

  16. Pain Neurochemistry “Pain Wind-up” “Central Spinal Sensitization” Gate Theory of Pain

  17. Images of Acute Pain

  18. Images of Chronic Pain

  19. 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.)

  20. Physician Responsibilities

  21. PAIN POEM

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