Mellick Pain Lecture

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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 : 

Dr. Gary Mellick & Staff

Chronic Pain : 

Chronic Pain Understanding Chronic Pain What Causes Chronic Pain Chronic Pain Treatments

Chronic Pain : 

Chronic Pain 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

CHRONIC PAIN : 

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 : 

Understanding Chronic Pain Sounding The Alarm Broadcasting The News Censoring The News

Understanding Chronic Pain : 

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

Degree/Type of Noxious Stimuli & Pain Perception : 

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

Ascending Pain Pathways : 

Ascending Pain Pathways

Understanding Chronic Pain : 

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 : 

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

Understanding Chronic Pain : 

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 : 

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

What Causes Chronic Pain : 

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 system : 

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

Pain Neurochemistry : 

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

Images of Acute Pain : 

Images of Acute Pain

Images of Chronic Pain : 

Images of Chronic Pain

Chronic Pain Treatments : 

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 : 

Physician Responsibilities

Slide 21: 

PAIN POEM