Pathophysiology of paediatric pain Maarten O. Mensink, MD Princess Máxima Centre, Utrecht, The Netherlands [email protected]
Jul 05, 2020
Pathophysiology of
paediatric pain
Maarten O. Mensink, MD
Princess Máxima Centre, Utrecht, The Netherlands
case
Patient A. female
14 years
JIA
Affected joints: knees/ankles
℞ methotrexate
case
decursus Good inflammatory respons
No signs of inflammation
High pain scores (NRS 6-8)
Mother: “Usually doesn't complain about pain,
so yes, I'm verry worried.”
pain anatomy
keywords:
brain
spinal cord
Nerve
Soma
pain anatomy
pain anatomy
axon typeDiameter (μm)Speed (m/s)
Aα13-20
80-120
Aβ6-1235-75
Aδ1-5
5-35
C0.2-1.50.5-2
pain anatomy
pain anatomy
C
Aβ – Aδ
pain anatomy
pain anatomy
pain anatomy
pain in action
Wei F, Zhuo M. J Physiol, 2001
pain in action
Pain chronification
keywords:
glutamate
NMDA-receptor
Long Term Potentiation (LTP)
Wide Dynamic Range neuron (WDR)
Central sensitisation
Pain chronification
Wei F, Zhuo M. J Physiol, 2001
Pain chronification
Chronificatie pijn
Pain chronification
Pain chronification
Central sensitisation:
Restructuring of synapses
learning:
– memory
– anticipation
Pain chronification
Diagnosing pain
pain-history:
pain-nature
pain-luxerative factors
pain-time factors
pain-related factors
diagnosing pain
pain-physical examination:
inspection
palpate
neurological examination
diagnosing pain
integration with system
fear/vigilance
cognition
Parent-child system
contributing somatic factors
treatment
pharmacological
tissue damage
inflammation
neuropathy
treatment
psychological
CBT
EMDR
mindfullness
system therapy
treatment
fysiotherapeutical
musculoskeletal evaluation
muscular training
6th of february 2020
#beppa@BBeppa