PBL 41 Crying spine

Definition
Pain is an unpleasant feeling that is conveyed to
the brain by sensory neurons, signal actual or
potential injury to the body.
Also includes perception, the subjective
interpretation of the discomfort. Perception gives
information on the pain's location, intensity, and
its nature.
The various conscious and unconscious responses
to both sensation and perception, including the
emotional response, add further definition to the
overall concept of pain.

Based on speed of onset, quality and duration

Types of pain

Acute

Subacute

Chronic

<4 weeks

4-12 weeks

> 3 months

Mechanism of chronic pain

Changes in sensitivity of neurons (lower
threshold with peripheral and central
sensitization)
Spontaneous impulses from regenerating
peripheral nerve
Alteration in dorsal root ganglion in response to
peripheral nerve injury and neurotransmitters
Loss of pain inhibition in spinal cord
Up regulation of chemokines and receptors

Based on level of stimulation

Somatic pain

Visceral pain

From connective tissues,

bones, muscles and skin

Pain in internal organs

and abdomen,
transmitted by
sympathetic afferents,
poorly localized (lesser
number of nociceptors)

Either sharp and well

localized or dull, aching
and poorly localized

Ass. with nausea,

vomiting, hypotension,
restlessness and shock
Response to stretching
and distension of internal
organs

Low Back Pain

Most common debilitating conditions for which
patients seek medical care
Affects area between lower rib cage and gluteal
muscles and often radiate to thigh
Can be divided into three, acute back pain,
subacute back pain and chronic back pain
Precise localization is difficult (ability to
discriminate between two points stimuli on skin
of back is less sensitive than other parts of body)

Causes of low back pain

Local process

General
process

- Tension caused by tumor/disc

prolapse
- Bursitis, synovitis
- Rising tissues and venous
pressure, abnormal bone pressure

- Bone disease
- Osteoporosis

- Problem with spinal mobility

- Osteomalacia

- Inflammation caused by infection

- Hyperthyroidism

- Fractures
- Ligament sprain
- Referred pain

Risk factor of getting low back pain

Occupation and daily activities
Genetic predisposition:
Spinal osteochondrosis
Spinal stenosis ass.with achondroplasia
Spondylolisthesis

Causes of back
pain

Uncommon
causes (direct
causes 20%)

Related to spine
Infections
Tumors
TB, Spondylosis tract

Not related to spine

Systemic diseases
involving other systems

Common
causes (Indirect
causes 80%)

Repeated physical and

mental stress
(more to mechanically)

Referred pain
Pain persist in an area removed or distant from
point of origin
Usually but not always originate from viscera

Mechanism: one afferent fibre from this conjoint

area in spinal cord, relaying mistaken perception
that pain arise from referral site, since skin has
more receptors, painful sensation is more
experienced there compared to site of origin

 Right subscapular area- gallbladder pathology

Mid to low thoracic nerves- pulmonary
parietal pleura, GIT, adrenals, kidneys
Lumbar and sacral nerves- pelvic organs, hips,
sacroiliac and lumbar spine region

Differential diagnosis