Stages of Pain Robert M. Streb, PT, PhD Stages Vs. Categories Stages Normal Suppressed Maintained Sensitized Categories AKA…types of pain Somatic Neuropathic Persistent (sensitized) Autonomic Visceral Pain’s 4 stages Normal Suppressed Maintained Sensitized Stages of Pain Stages of Pain Type of Pain Suppressed What normally hurts but less or not at all Fear induced Medications Exercise Modalities Stages of Pain Maintained Continued afferent barrage Occurs with sensitization Coping mechanisms impaired Leads to changes in SC & Brain Stages of Pain Sensitized Peripheral Spinal Cord • Dorsal Horn • Formally know as central Brain • Central Stages of Pain Peripheral Sensitization Excitation threshold of nociceptors drop Sprouting Enlarged receptive fields Sensitized cutaneous receptors effect thermal receptors most Deep somatic tissue receptors effect mechanical receptors most Inflammation makes nonmechanical receptors mechano-sensitive Peripheral Sensitization Excitation threshold of nociceptors drop Peripheral Sensitization axon Sprouting Free nn endings Peripheral Sensitization Enlarged receptive fields Peripheral Sensitization Mechanical Thermal Chemical Sensitized cutaneous receptors effect thermal receptors most Peripheral Sensitization Mechanical Thermal Chemical Deep somatic tissue receptors effect mechanical receptors most Peripheral Sensitization Inflammation makes nonmechanical receptors mechano-sensitive Spinal Sensitization Membrane excitability Synaptic recruitment Inhibition Uncoupling of pain form peripheral stimuli Spinal Sensitization Spinal Sensitization Membrane excitability Spinal Sensitization Inhibition Spinal Sensitization Synaptic recruitment Spinal Sensitization Uncoupling of pain form peripheral stimuli Central Sensitization Brain Smudging (disinhibition) https://www.youtube.com/watch?v=3QVAY5stO3U Subjects from two experimental groups were connected to a sham stimulator and told to expect a headache. The physical stimulation first group, was exposed to pain induction by ice water and by pressure prior to the sham stimulation. The sham stimulation first group, received the sham stimulation followed by the cold water and pressure pain induction techniques.
