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Pain, Inflammation and Fever Slide 1 Pain, Inflammation and Fever Slide 2 Pain, Inflammation and Fever Slide 3 Pain, Inflammation and Fever Slide 4 Pain, Inflammation and Fever Slide 5 Pain, Inflammation and Fever Slide 6 Pain, Inflammation and Fever Slide 7 Pain, Inflammation and Fever Slide 8 Pain, Inflammation and Fever Slide 9 Pain, Inflammation and Fever Slide 10 Pain, Inflammation and Fever Slide 11 Pain, Inflammation and Fever Slide 12 Pain, Inflammation and Fever Slide 13 Pain, Inflammation and Fever Slide 14 Pain, Inflammation and Fever Slide 15 Pain, Inflammation and Fever Slide 16 Pain, Inflammation and Fever Slide 17 Pain, Inflammation and Fever Slide 18 Pain, Inflammation and Fever Slide 19 Pain, Inflammation and Fever Slide 20 Pain, Inflammation and Fever Slide 21 Pain, Inflammation and Fever Slide 22 Pain, Inflammation and Fever Slide 23 Pain, Inflammation and Fever Slide 24 Pain, Inflammation and Fever Slide 25 Pain, Inflammation and Fever Slide 26 Pain, Inflammation and Fever Slide 27 Pain, Inflammation and Fever Slide 28 Pain, Inflammation and Fever Slide 29 Pain, Inflammation and Fever Slide 30 Pain, Inflammation and Fever Slide 31 Pain, Inflammation and Fever Slide 32 Pain, Inflammation and Fever Slide 33 Pain, Inflammation and Fever Slide 34 Pain, Inflammation and Fever Slide 35 Pain, Inflammation and Fever Slide 36 Pain, Inflammation and Fever Slide 37 Pain, Inflammation and Fever Slide 38 Pain, Inflammation and Fever Slide 39 Pain, Inflammation and Fever Slide 40 Pain, Inflammation and Fever Slide 41 Pain, Inflammation and Fever Slide 42 Pain, Inflammation and Fever Slide 43 Pain, Inflammation and Fever Slide 44 Pain, Inflammation and Fever Slide 45 Pain, Inflammation and Fever Slide 46 Pain, Inflammation and Fever Slide 47
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Pain, Inflammation and Fever

  1. 1. PAIN, INFLAMMATION AND FEVER FARAZA JAVED PH.D PHARMACOLOGY
  2. 2. PAIN Pain is a distressing feeling often caused by intense or damaging stimuli. In medical diagnosis, pain is regarded as a symptom of an underlying condition.
  3. 3. The International Association for the Study of Pain widely used definition defines pain as: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”
  4. 4. CLASSIFICATION OF PAIN
  5. 5. BASED ON DURATION 1. Acute Pain 2. Chronic Pain a) Chronic Non Cancer Pain b) Chronic Cancer Pain c) Chronic Episodic Pain
  6. 6. BASED ON LOCATION 1. Headache 2. Back Pain 3. Joint Pain 4. Stomach Pain 5. Cardiac Pain
  7. 7. BASED ON INTENSITY 1. Mild Pain (1 to 3) 2. Moderate Pain (4 to 6) 3. Severe Pain (7 to 10)
  8. 8. PAIN SCALE
  9. 9. BASED ON ETIOLOY 1. Nociceptive Pain a) Somatic b) Visceral 2. Neuropathic Pain a) Peripheral Neuropathic Pain b) Central Neuropathic Pain
  10. 10. Pain is usually transitory, lasting only until the noxious stimulus is removed or the underlying damage or pathology has healed, but some painful conditions, such as rheumatoid arthritis, peripheral neuropathy, cancer and idiopathic pain, may persist for years. Pain that lasts a long time is called chronic or persistent, and pain that resolves quickly is called acute.
  11. 11. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time between onset and resolution; the two most commonly used markers being 3 months and 6 months since the onset of pain, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations, is "pain that extends beyond the expected period of healing".
  12. 12. PSYCHOGENIC PAIN Psychogenic pain is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors. Researchers refer psychogenic pain or psychalgia as a form of chronic pain. Causes may be linked to stress, unexpressed emotional conflicts, psychosocial problems, or various mental disorders. Some specialists believe that psychogenic chronic pain exists as a protective distraction to keep dangerous repressed emotions such as anger or rage unconscious.
  13. 13. Headache, back pain, or stomach pain are some of the most common types of psychogenic pain. It may occur in persons with a mental disorder, but more commonly it accompanies or is induced by social rejection or other such emotional events. It remains controversial that chronic pain might arise from emotional causes. Treatment may include psychotherapy, antidepressants, analgesics, and other remedies that are used for chronic pain in general.
  14. 14. MANAGEMENT OF PAIN Pain van be managed through: 1. Pharmacological Intervention 2. Non Pharmacological Intervention
  15. 15. PHARMACOLOGICAL INTERVENTION Pharmacological therapy is given by analgesics. 1. Analgesics may be Opioids or Non Opioids (NSAID) or Adjuvants. 2. Adjuvants are drugs originally developed to treat conditions other than pain but also have analgesic properties.
  16. 16. Adjuvants: Used for analgesic reasons and for sedation and reducing anxiety. 1. Tricyclic Antidepressants 2. Antiepileptics 3. Corticosteriods 4. Local Anesthetics
  17. 17. WHO Pain Management Ladder
  18. 18. WHO Pain Management Ladder Pain Scale Reading WHO Steps 1-3 Step 1 4-6 Step 2 7-10 Step 3
  19. 19. NON PHARMACOLOGICAL THERAPIES 1. Heat and Cold Application 2. Meditation 3. Distraction 4. Imagery 5. TENS Application
  20. 20. 6. Music Therapy 7. Massage 8. Yoga 9. Acupuncture 10.Herbal Therapy e.g. Ginseng
  21. 21. INFLAMMATION
  22. 22. INFLAMMATION Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators.
  23. 23. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and initiate tissue repair.
  24. 24. SIGNS OF INFLAMMATION Cardinal signs are: Heat (Calor) Redness (Rubor) Swelling (Tumor) Pain (Dolor) Loss of Function (Functio Laesa)
  25. 25. TYPES OF INFLAMMATION 1.Acute 2.Chronic
  26. 26. ACUTE INFLAMMATION Acute inflammation is a short-term process occurring in response to tissue injury, usually appearing within minutes or hours.
  27. 27. Acute inflammation has two major components: 1. Vascular Changes 2. Cellular Events
  28. 28. VASCULAR CHANGES The process of acute inflammation is initiated by resident immune cells already present in the involved tissue, mainly macrophages, histocytes and mast cells. These cells possess surface receptors known as pattern recognition receptors (PRRs), which recognize (i.e., bind) two subclasses of molecules: pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs). PAMPs are compounds that are associated with various pathogens, but which are distinguishable from host molecules. DAMPs are compounds that are associated with host- related injury and cell damage.
  29. 29. At the onset of an infection, burn, or other injuries, these cells undergo activation (one of the PRRs recognize a PAMP or DAMP) and release inflammatory mediators responsible for the clinical signs of inflammation. Vasodilation and its resulting increased blood flow causes the redness (rubor) and increased heat (calor). Increased permeability of the blood vessels results in an exudation (leakage) of plasma proteins and fluid into the tissue (edema), which manifests itself as swelling (tumor). Some of the released mediators such as bradykinin increase the sensitivity to pain (dolor).
  30. 30. CELLULAR EVENTS The cellular component involves leukocytes, which normally reside in blood and must move into the inflamed tissue via extravasation to aid in inflammation. Some act as phagocytes, ingesting bacteria, viruses, and cellular debris. Others release enzymatic granules that damage pathogenic invaders. Leukocytes also release inflammatory mediators that develop and maintain the inflammatory response.
  31. 31. Acute inflammation may be regarded as the first line of defense against injury. Acute inflammatory response requires constant stimulation to be sustained. Inflammatory mediators are short-lived and are quickly degraded in the tissue. Hence, acute inflammation begins to cease once the stimulus has been removed.
  32. 32. INFLAMMATORY MEDIATORS Histamine is the main mediator of inflammation. Released from mast cells and basophils and is the primary cause of increased vascular permeability. Prostaglandins are derived by arachidonic acid which can cause vasodilation, fever, and pain. Leukotriene is able to mediate leukocyte adhesion and activation, allowing them to bind to the endothelium and migrate across it and is able to induce the formation of reactive oxygen species and the release of lysosome enzymes by the cells.
  33. 33. Cytokines are polypeptide products of activated lymphocytes and monocytes. The main cytokines participating in acute inflammation are interleukin-1 (IL-1), interleukin-8 (IL-8), and tumor necrosis factor alpha (TNFα). The clotting pathway is responsible for coagulation of blood by formation of fibrin from fibrinogen.
  34. 34. CHRONIC INFLAMMATION Chronic inflammation is also referred to as slow, long-term inflammation lasting for prolonged periods of several months to years. Generally, the extent and effects of chronic inflammation vary with the cause of the injury and the ability of the body to repair and overcome the damage.
  35. 35. Chronic inflammation is characterized by less swelling but presence of more lymphocytes and fibroblasts, which macrophage have been unable to clear the area of foreign substances.
  36. 36. Chronic inflammation can result from the following: Failure of eliminating the agent causing an acute inflammation such as infectious organisms including Mycobacterium tuberculosis that can resist host defenses and remain in the tissue for an extended period. An autoimmune disorder in which the immune system is sensitized to the normal component of the body and attacks healthy tissue giving rise to diseases such as rheumatoid arthritis.
  37. 37. Recurrent episodes of acute inflammation. However, in some cases, chronic inflammation is an independent response and not a sequel to acute inflammation for example diseases such as tuberculosis and rheumatoid arthritis. Exposure to a low level of a particular irritant or foreign materials that cannot be eliminated by enzymatic breakdown or phagocytosis in the body including substances or industrial chemical that can be inhaled over a long period, for example, silica dust.
  38. 38. MANAGEMENT OF INFLAMMATION 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) 2. Steroids 3. Antihistamines
  39. 39. FEVER/ PYREXIA
  40. 40. PYREXIA Pyrexia or fever is a physiologic response triggered by aseptic stimuli or infections which result in elevation of body temperature due to increased concentration of PGE2 within certain areas of the brain.
  41. 41. A fever can be caused by many medical conditions ranging from non-serious to life-threatening. This includes viral, bacterial and parasitic infections such as the common cold, urinary tract infections, meningitis, malaria and appendicitis among others. Non-infectious causes include vasculitis, deep vein thrombosis, side effects of medication, and cancer among others.
  42. 42. Temperature is ultimately regulated in the hypothalamus. A trigger of the fever, called a pyrogen, causes release of prostaglandin E2 (PGE2). PGE2 in turn acts on the hypothalamus, which creates a systemic response in the body, causing heat-generating effects to match a new higher temperature set point. Hypothalamus works like a thermostat. When the set point is raised, the body increases its temperature through both active generation of heat and retention of heat.
  43. 43. Peripheral vasoconstriction both reduces heat loss through the skin and causes the person to feel cold. Norepinephrine increases thermogenesis in brown adipose tissue, and muscle contraction through shivering raises the metabolic rate. If these measures are insufficient to make the blood temperature in the brain match the new set point in the hypothalamus, then shivering begins in order to use muscle movements to produce more heat. When the hypothalamic set point moves back to baseline either spontaneously or with medication, the reverse of these processes (vasodilation) and sweating are used to cool the body to the new, lower setting.
  44. 44. MANAGEMENT OF PYREXIA 1. Conservative Measures (Sponging, Cooling and Proper Hydration) 2. Medication NSAIDs (PCM, Ibuprofen, Aspirin)
  45. 45. THANKYOU
  • AbhishekMeenaRahul

    Apr. 9, 2020

Pain, Inflammation and Fever

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