This video is the first part of our lesson on analgesics drip medications and pain relief in the ICU. We start this lesson off talking about what are analgesics? These group of medications, which compose many different medications, have many different ways in which they help control our patients pain in the critical care environment. The are distinguishable from anesthetics because instead of blocking all sensation, they work to only block the sensation of pain.
The rest of the lesson we take the time to go over our pain pathophysiology as we talk about the pain pathway. Starting with an example of an injury that would cause pain, our body’s first response is to release prostaglandins which ultimate activate our nociceptors, aka our 1st order neurons. These neurons carry the signal back to the dorsal horn of the spinal cord and synapse with our 2nd order neuron through the use of a chemical messenger called Substance “P”. From here the 2nd order neuron carry the signal to the Thalamus in our brain, synapsing with our 3rd order neuron, who’s job it is to carry the signal to the appropriate part of our somatosensory cortex. The primary job here is to provide us with the perception of pain as well as to provide the location of where the pain is. All of this is thanks to our ascending pathway.
We also have the descending pathway who’s job it is to control and inhibit the descending pathway. From the Midbrain a neuron carries the signal to the Medulla where it synapses with the Serotonergic Neuron. This neuron carries the signal to the dorsal horn of the spinal cord. Here through the release of Serotonin and Noradrenaline it can cause the inhibition of Substance “P” from our presynaptic 1st order neuron. These chemical messengers can also stimulate something we call an interneuron in the dorsal horn, which in turn then releases an endogenous opioid. This opioid, along with other opioids that we can administer does two things. First it also inhibits the release of Substance “P” and second it works to prevent the 2nd order neuron from depolarizing, essentially making it harder to pass a signal along to the brain, essentially raising the pain threshold. Finally we also talk about the NMDA/AMPA receptors which also help to regulate the depolarization of this 2nd order neuron.
Hopefully after watching this lesson you will have a good basis of understanding of what analgesics are and how we control pain through their use by understanding the pain pathway and the different areas in which we can intervene in order to try and prevent this signal from reaching our brain.
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