evidence of growth of new tissue. If one presses gently on the line, it will be ten- der. Pressure, which is felt as a light touch on normal skin, is now sufficient to pro- duce pain when it is applied to inflamed tissue. The greater the trauma, the greater the physiologic response. When the skin has been exposed to a
noxious stimuli such as a scratch, the pain receptors in the skin respond to that stim- uli. These pain receptors are called noci- ceptors and exist throughout the body. A nociceptor is specialized nerve tissue sen- sitive to a particular change in the envi- ronment. Nociceptors respond to a range of stimuli including mechanical, thermal and chemical. Nociceptors respond to either tissue damaging or potentially tissue damaging stimuli. The result is a sensation of pain. Using the example of a scratch, when
the injury occurs, the nociceptors are acti- vated. An electrical nerve impulse travels along sensory nerve fibers that run from the area of the scratch to the spinal cord. Cells in the dorsal horns in the spinal cord send their message toward the brain. These somatosensory signals are conveyed along the ascending pathway of the spinal cord.
When the somatosensory signals enter
the brain, many parts of the brain are involved simultaneously. When the pain signal goes to the thalmus, it directs the signal to different areas in the brain for interpretations. Signals are sent to the lim- bic system, which is the emotional center of the brain. A person’s mood, past experi- ences and expectations can change the way pain is interpreted. It is the brain that determines how a person will interpret both the quality and the severity of pain. While the ascending pathway sends
the pain signals to the brain, the descend- ing pathway also plays a role in the per- ception of pain. Fibers that descend from the brain continually modulate the input. Input patterns evoked by injury can be modulated and can affect the quality and intensity of pain. Why does a person continue to expe-
rience pain days or weeks after an injury? As long as the noxious stimuli continue, the somatosensory signals will be sent to the brain and the person will continue to experience pain. The initial injury and the healing response to the injury will continue to cause the nociceptors to be stimulated. Inflammation at the site of the injury will not only cause pressure
that will produce pain, but the chemicals released from the injured tissue will also irritate the nociceptors and cause addi- tional pain. The person will continue to feel pain
as long as the body is injured. This con- cept is not difficult to understand. But why should a person continue to experi- ence pain long after the initial physical injury has healed? The answer can be found in the nervous system. The nervous system is highly adapt-
able. It is elastic. When a person has been in pain for a long period of time, the body actually increases the number of nociceptors in that region. The increase of nociceptors allows more pain signals to travel through the sensory nerve fibers to the spinal cord. The nocicpetors also become hyper excitable. Sensations that would otherwise be interpreted as benign are now interpreted as pain. The spinal cord also undergoes phys-
ical changes in response to prolonged pain. The ascending pathway becomes more sensitive. The information being delivered to the brain no longer reflects the true health and abilities of the tissues at the end of the neurons. The body interprets benign stimulus as noxious
Some Cases Mean More Than Others Life Care Planning, Cost Projections
Certified Nurse Life Care Planner Certified Legal Nurse Consultant
Timeline Chronology Standards of Care
Medical Record Analysis and Interpretation Traumatic Brain Injury Chronic Pain
Birth-Related Injury
Labor & Delivery Analysis
Fetal Heart Tracing Interpretation
Kristen Jones, RN, CLNC, CNLCP
www.KristenJonesConsulting.com 925.855.1956 JULY 2011 The Advocate Magazine — 75
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