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    1. Pain Control Theories

    3. Pain Anatomy Review Primary Afferent Fibers 1st Order Neurons Dorsal Horn

    4. Pain Anatomy Review Primary Afferent Fibers 1st Order Neurons Dorsal Horn Spinothalamic Tract

    5. Gait Control Theory Pain can be altered by blocking impulses within pathways Stimulate A-beta stimulates substantia gelatinosa A-betas are faster than A-delta and C fibers How does this work? Gate Open Gate Closed

    6. Endogenous Pain Control Ascending Influence on Pain Control Similar to Gate Control A-beta triggers release of Enkephalin Inhibits Substance P at junction between 1st and 2nd order neurons

    7. Endogenous Pain Control Descending Influence on Pain Control (Central Biasing) Stipulates that higher brain centers can modulate pain PAG and RN Dorsal Lateral Tracts Enkephalin Interneurons Release of serotonin Past experience, emotional influences and sensory perception

    8. Endogenous Pain Control Beta-Endorphin Mediated Model What is Endorphin? Found in hypothalamus and periaqueductal gey matter Activation of small diameter fibers Release of BEP

    9. Acute vs Chronic Pain Acute Pain Definition Pain of recent or sudden onset Function Primary Hyperalgesia Secondary Hyperalgesia Pain-Spasm-Pain Cycle

    10. Acute vs Chronic Pain Chronic Pain Definition Pain of long duration, often associated with anguish, apprehension, depression, hopelessness Consider neurophysiologic and psychologic factors Four Levels of Chronic Pain Nociception Pain Suffering Pain Behaviors

    11. Other Types of Pain MFPS Chronic Pain No single cause S/S

    12. Pain Management Must consider physiological, behavioral and cognitive Physical Modalities Behavioral Reducing anxiety Explain treatments Cognitive Central Biasing Relaxation techniques, motivation etc