TREATMENT OF NEUROPATHIC PAIN GARY A. MELLICK, D.O. American Specialists, Inc. American PAIN Specialists, Inc. American Disorders Clinic American SLEEP.

TREATMENT OF NEUROPATHIC PAIN

TREATMENT OF NEUROPATHIC PAIN

GARY A. MELLICK, D.O.GARY A. MELLICK, D.O.American American PAIN Specialists, Inc.Specialists, Inc.

American American SLEEP Disorders Disorders ClinicClinic

Dr. Gary Mellick & Staff

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

Chronic PainPain -- has an Element of Blank --

It cannot recollectWhen it begun -- or if there were

A time when it was not

Emily Dickinson New England Poet

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 Sounding The Alarm Broadcasting The News Censoring The News

Understanding Chronic Pain Sounding The Pain AlarmSounding The Pain Alarm

NociceptorsNociceptors Nerve fibers in the skin, Nerve fibers in the skin,

muscles, or jointsmuscles, or joints Excited exclusively by intense, Excited exclusively by intense,

potentially harmful stimulationpotentially harmful stimulation• PinprickPinprick• Painful heatPainful heat• Irritating chemicalsIrritating chemicals

Degree/Type of Noxious Stimuli & Pain Perception

Nociceptors Sound The Pain Alarm

Ascending Pain Pathways

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

Broadcasting The NewsHigher brain centers are alerted by spinal pathways.

Different pathways carry different information.

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

Censoring Censoring The NewsThe News

Built-in Built-in nervous nervous system system

mechanisms mechanisms can block can block

pain pain messages.messages.

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 systemPeripheral Nervous systemPeripheral Nervous systemPeripheral Nervous system

TouchTouch

PainPain

Touch-evoked painTouch-evoked pain

Pain & hypersensitivityPain & hypersensitivitySensitized C-fibersSensitized C-fibers

Sensitized A-Beta fibersSensitized A-Beta fibers

““Wind-up”Wind-up”(Central (Central

Sensitization)Sensitization)

““Wind-up”Wind-up”(Central (Central

Sensitization)Sensitization)

Normal Normal Sensory Sensory

ProcessingProcessing

Normal A-Beta fibersNormal A-Beta fibers

Normal C-fibersNormal C-fibers

Central Nervous SystemCentral Nervous SystemCentral Nervous SystemCentral Nervous System

Pain Pain NeurochemistryNeurochemistry

Pain Pain NeurochemistryNeurochemistry

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

Images of Acute Pain

Images of Chronic Pain

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

PAIN, PAINTeresa Wexler Garland, D.D.S.

Pain, pain go AwayDon't you come another Day

I am sick and tired of YouAnd you will not make me Blue!

Pain, Pain Disappear!Those two words I hate to Hear

Leave me leave me won't you PleaseAnd take with you this Disease!

Pain, pain don't come Around,One thing is I'll beat you DownYou will see that you will Lose

Because, you see that's what I Choose!!!

And finally "you thing" called Pain,You WILL NOT make me Insane

I will FIGHT you to the End,And I will FIGHT you for my Friends!!!

This is written for all those people that live in painbe it from Ms or for any other reason. I care.

Teresa