so as I've said ping sucks okay but pain is a very valuable thing because it lets you know something is wrong with your body so this is those free nerve endings firing when you get tissue damage so the function of this is protection so if you have a highlighter I would highlight this kittens by it put little stars by it so there's little or no adaptation to pain because the function of pain is to protect you so you don't want to get used to pain so I know some of you're sitting there saying no I have a bad toothache and I ignore it or I have a headache and I ignore it yeah but you don't like get to the point where you don't feel it completely the whole point of pain is to say hey your tooth hurts you got a problem or hey B broke a bone it's to let you know something's wrong so you don't want to adapt like I can adapt to a smell because who cares this just smell but we don't want to ever completely adapt to pain because the whole point of these pain receptors is to let us know something's wrong so we'll maybe do something about it so these guys are found in your skin and in your internal tissue like obviously you need to know when you're touching a hot stove or when your cat's biting you but you also need to know that when your bladder is so full that it's starting to hurt you do not have pain receptors in the brain the brain doesn't feel Bank feel pain the skull feels pain because it's bone tissue but the brain tissue itself does not different watch brain surgery sometimes they'll do it the person's actually awake they'll have numbed with a local like the area that they cut but when they actually cut into the brain they don't have to use painkillers because the brain does it feel pain because the brain is the one that interprets the pain so he can't feel it so this is stimulated by temperature mechanical forces again like some like you slam your hand in a car door and then chemical concentration you spill lemon juice on a cut there are the only sensory receptors in your viscera in your organs in your gooey squishy parts that produce sensation you don't really feel touch in your stomach like imagine if you did imagine if you ate like a Pringle or you ate cotton candy and you felt that go down your body like tickle tickle tickle tickle tickle he sells food move through your intestine if you could feel the urine sloshing around in your bladder right now I mean that would be creepy right so we we just need to really be aware when the organs are being stretched when there's potential pain so there's no net there's no mapping in the brain for viscera so we can't pinpoint exactly where the pain it's coming from this is why sometimes abdominal pain is hard to diagnose because it's like although the appendix is only like you know an inch or two you feel like this pain and that entire quadrant in your body if your stomach hurts you just kind of feel general abdominal pain so you can't tell exactly where that sensation is whereas if I poked you with a needle on your skin you would be able to tell me exactly where that is so visceral pain receptors your organ pain receptors respond to a lot of things they'll the pain triggers from a lot of things ischemia which you don't have to know that word for this chapter but you eventually will when we do blood and when we talk about the heart ischemia is lack of blood flow so this is why heart attacks hurt it's why if you sit on your foot too long it hurts certain chemicals can cause that like heartburn causes visceral pain and excessive stretch stretching or spasms so like if you're having a baby the labor pains obviously hurt the uterus or if you've eaten too much and your stomach is really really stretched or if you have to be really really sure it's tricky if you're experiencing pain and your left arm is that always the arm that's been hurt well you guys have the note packet so you can read the next slide but no of course not we see this in every movie where someone's having a heart attack right like their their left arm is hurting them it's weak or it's hurting and now they know something's wrong with the heart you this is a phenomenon we call referred pain all I need you to know about referred pain is the definition I went ahead and gave us an Anatomy example that we'll have to know when we get to cardio so I thought might as well but right now for this chapter all you need is the definition so referred pain is this crazy phenomenon where you will describe pain at a different place from where the injury actually occurred so one of the best examples is a heart attack so during ischemia so lack of blood flow to the heart bought brought on by angina pectoris which is heart attack the heart is what's being affected but you'll feel pain in the neck shoulders and back it'll radiate down the left arm so even though the arm is not in pain your body perceives that pain this happens to me a lot at the dentist I will swear one tooth is bothering me they'll x-ray it there like nothing's wrong as tooth but the tooth above it has a cavity and I'm like that's crazy cuz I feel it in this one spot like I would knock it out myself if you gave me a hammer and they're like no my my dentist does this to me all the time he's like let me try to fix the one above it and see if the pain goes away and it does so referred pain is kind of crazy like it makes you feel crazy like you can't even figure out what's going on in your own body freeze if you meet ice cream really really fast I eat ice cream really slow because my teeth are so bad like I have a filling and like every tooth so my teeth are really really like temperature sensitive so the dreaded brain freeze they call it so why would your head hurt why would your skull hurt because you ate ice cream that was cold on your tongue again it's this referred pain we're about to look at and that was my cat Lucy I don't know the animals have gone crazy today so why would you experience prefer pain so why does this happen so again all I need you to know is the definition but why does this happen it happens because the visceral and somatic information travel on the same nerve so again think of an interstate well car and semis travel on the same Road right so professional drivers and lead leisure drivers they're just trying to get home we travel on the same path so during a heart attack you feel pain in the left arm that's because the t1 through t5 segments the vertebrae the spinal nerves are the ones that are receiving input from your heart your chest and your arm so the pain fibers are all traveling on that same pathway information from your heart your chest and your arm so if you hurt yourself on a daily basis your brain has to decide where that pain is coming from so your brain plays the odds which sounds crazy but it's like if I had to choose am I having a heart attack or is my skin hurt did I bump my elbow did my cat scratch me did I burn myself or am I having a heart attack the odds are it was my skin right because you injure your skin so frequently so the brain perceives the pain coming from your arm even though it's not really it's coming from the heart but it just plays the odds it's like if you had to bet that there was a car on 74 or a semi you would probably bet car because although there's a lot of semis there's a lot more cars so the brain just does the same thing it kind of picks the odds which is kind of crazy so it's wrong so it just makes a guess and sometimes it's wrong not to know this diagram I just think it's interesting like some of these make complete sense where you would feel pain but I think like the liver and gallbladder is one of the more interesting so if you have gallbladder pain of course you're feeling it on the right side there in that picture on the right side of your body is the gallbladder so sorry the left picture there so the left picture or I guess the right picture they both kind of are labeling the gallbladder in that same place on his right side that's where the gallbladder is but in your neck that seems crazy right but I don't know about you but I've I've not had heartburn that much thank goodness my husband gets heartburn just from breathing oxygen I swear and so um one time I had heartburn and I actually felt it my clavicle and I was like what the hell like why would I feel that there but then when you look at this picture it makes sense it's just they're sharing the same nerve pathway the heart pain you can see how the red is radiating down his arm I think kidney pain is interesting that although the kidneys are so high up you could feel pain radiating down your outer thighs so it's just kind of interesting that these pathways kind of trick your brain types of pain which we've all experienced this acute pain and chronic pain so acute pain is like real sharp painful and really freakin fast so he's fast conducting 30 meters per second you don't have to know that number I can't even think of that like that's fast right you think of a meter stick 30 of those in a second and I mean that's fast but we need it right we need this to be fast because this is moments like you've stepped on a nail well you want to get off that nail as quickly as possible or something bites you well you want to get your hand out of that that animals mouth as quickly as possible so it's really sharp it's really localized you know exactly what's causing the pain you cut yourself you burnt yourself whatever chronic pain is very different and this one sucks worse like pain sucks like I don't want a cute pain either but chronic pain is awful because acute pain usually doesn't last very long like it's really sharp and awful and then it kind of fades this is slow conducting pain so two meters per second so that's still seems pretty fast but it's you know a lot slower than the acute pain so it's like you get these waves of dull aching pain so we've all felt this we've all felt the difference between us so these are different neurons so what causes chronic pain are the pain neurons that are unmyelinated if you remember from A&P one milan was that fatty substance that makes your nerves fire faster so since these guys are unmyelinated they fire a little slower this is pain that's really hard to pinpoint so this is again like a backache where you go oh my goodness my whole back hurts like you can't exactly figure out where the problem specifically is where if you step on a nail you know exactly where it is it also resists relief so this is pain if you've ever had chronic pain like knee pain or back pain or tooth pain I feel really bad for you because it's just terrible because it doesn't seem like whatever you do makes it better and so weakens you it depresses you it's very disruptive to a person's life and this is one of the reasons why we have the opioid crisis though we do a lot of people just start out with prescription pills because they were in pain and no one wants to be in pain and then unfortunately they're very addictive so pain from the head when you like bonk your skull or something or cut your face these are cranial nerves and so remember from A&P one we had 12 cranial nerves you do not have to know these numbers but cranial nerve 5 7 9 and 10 or what kind of sense what's going on with your head so if you cut your head or hang your head on a Carter pain from the rest to your body is gonna travel to the brain up that spinothalamic tract and then it gets shot to that sensory strip that we saw will also see again in lab that post central gyrus for interpretation of where that pain is coming from how intense it is what should we do about it the lateral or the spinothalamic tract screw us over so all you really need to know about that is if you remember from A&P wander of tracks cross over so like if I touch a stove with my right hand the left side of my brain responds to it so we're like cross wire Payne is a really crazy thing though because not everyone experiences pain the same way like if I could go around and stab each one of you with the scalpel which I would never do if I stabbed you with the same scalpel that's not very sanitary the same depth the same pressure not everyone would respond the same some of you would probably mning before I even cut you that would be me some of you could have to style the scalpel sticking in you and you would look down and be like knit not that big a deal so the crazy thing about pain is we all have a different perception of pain because we're all different so some people don't have the same amount of pain receptors as other people even if we all had the same amount of buttons we wouldn't respond to them being pushed all the same some people have a high tolerance for pain some people their pain receptors don't go as high up in the layers of their dermis and so it takes a lot more for them to feel pain vice-versa some people are very sensitive because their pain receptors go up higher so we all experience pain differently this could be because of physiology like I said some people could have more or less pain receptors but even things like past experience like I've never broke a bone 44 soon to be 45 years old never broke a bone so if I broke a bone I'm sure I would cry I'm sure I would be like whiny and freaking out about it because I would be like oh my god I'm dying because it would be this new thing whereas some people have broke a lot of bones I remember in class once I asked like how many bones people had broke and this one kids like I broke 27 bones he was like 18 years old and I remember we're saying to him I'm like dude whatever you do for fun you should stop doing it because clearly you suck at it like 27 freakin bones by the time you're 18 what the hell are you into cultural experiences there are some cultures that go through intense pain and so they don't see things the same way we do one of the most powerful things I ever did was I went to Poland to go to the concentration camps I'm specifically Auschwitz if you don't know what ash woods is your education has failed you and you really should take the time to learn about it but the Holocaust was the horrible horrible thing that the Nazis did to the Jewish people and I was lucky enough to go on this tour with a Holocaust survivor who had been in Auschwitz and it's like her description of the things these people went through it was very humbling to me like I try to not complain about too many things anymore because my life's been freaking awesome compared to what some people have had to survive so if you take a Holocaust survivor who was tortured if they cut themselves they're probably not gonna react the same the way that I would cut myself because I haven't really had a lot of horrible things happen to me which is great but still I'm not very tough because of that it's sad what we have to do to be tough I'm circumstances again if I cut myself because I'm opening wine that might not bother me as much as if I cut myself like making dinner because wines awesome so the circumstances of your injury you hurt yourself the first time you're trying to serve versus you hurt yourself at home well if I'm on vacation that pain is probably not gonna feel as bad and again pain threshold women have a higher pain tolerance than men and that's because of childbirth lucky us childbirth is the equivalent of breaking 20 bones at the exact same time so those of you that have experienced that you know that some pain right so it's just a fact that women can handle more pain however will why about it oh I will say that we are gonna complain about it another example of cultural differences and kind of things that we do like real men don't cry until the dog dies at the end I don't watch movies where dogs die at the end like I will google it to see if the dog dies and then I won't watch it because I have been burned too many times like that Will Smith movie it was just him and his dog with the virus sorry spoiler alert I was don't mad I shot the movie off and didn't finish it I don't know how that movie turned out but I mean like we do this culturally right like if you go to a playground and like a three-year-old girl falls down we pick her up and we're like kissing her and Oh princess I'm so sorry here's your Barbie band-aid but a three-year-old bull boy falls down and starts crying and we tell him to shake it off and be a man shake it off be a man like why do we do this to our little boys like our little boy should be able to cry men should be able to cry like I've only seen my husband cry a couple of times and I was mostly medical issues with his dad and it's like my cry a lot I cry because I'm mad at cries I'm I'm sad I cry cuz I just need that emotional release I don't know why we allow our boys to feel that because this is a culture thing because if you go to Europe men cry all the time like I've been lucky I've been to Paris I've been to to Rome and it's like when I was in both of those places you would see men crying at restaurants because the food was so good you would see men crying over a piece of artwork we saw tons of people get engaged around the Trevi Fountain in Rome and it was like you could tell the difference between American men and European men because the American men were always like you know smiling and happy when they got engaged when the girls said yes but when the European women said yes the European men would start crying and it was fabulous I'm like just cry dude let it out Oh like I don't know why we expect men to contain their emotions more than women like I don't think I don't see why we think that makes you a real man it's like to me just let it out man but we ruin our voice very unfair to boys so besides referred pain there's this crazy thing called phantom pain and I think this is terrible it's just terrifying I can't imagine having a part of my body amputated but I can't imagine you wake up and you can still feel it like how crazy is that so it's due to the nerve trauma when they amputate it the nerve sometimes keeps firing but I can imagine how awful this would be because you probably got that limb amputated pretty extremely because it was bothering you and now it still bothers you creep so nobody likes to be in pain including the human body so some neurons will actually release pain relieving substances this is to keep you from going into shock and so we have in kelvins and endorphins if you remember these four main key one these are neurotransmitters so neurotransmitters are like keys that fit into locks which are the receptors and so these kind of take away pain so opioids and like morphine they do the same thing they're basically like a key that fits the same lock like you can get a key for your house or you can get like a master key for your all the rooms in your house so they do the same thing as the fake ones serotonin is another neurotransmitter and it's a happy chemical and it increases in Kelvin release so if you're in a good positive mental state that's why I like when people are going through treatment for like cancer or a positive attitude is really really crucial because if you're in a positive frame of mind you're pumping lots of serotonin which helps with your natural pain relievers we don't want to necessary like necessarily rely on these natural painkillers right I want it gone there's a whole aisle at CVS or Walgreens that's dedicated to pain treatment so you don't have to know all these they're just examples so we have analgesics like Tylenol and Advil the reduced pain physical therapy which I was the physical therapy is kind of ironic because you're probably in pain and they're making making you move the part of the body that's in pain so physical therapy really hurts but in the long run it helps with pain massage I always thought massages were really stupid until my friend gave me a gift certificate and after the massage I was so relaxed I ran a stop sign in my own neighborhood like if I got pulled over I would have gone to prison because I look like I was stoned out of my mind I was so relaxed but massage does a lot for like blood flow to injured areas heat her ice depending on the injury liniment it's like icy hot but my grandmother used that little picture there Watkins white liniment if you've ever seen this bad boy oh it's smells terrible it's like icy hot I mean I don't think I see how it smells good either but the goal is it irritates the heat receptors so since your brain is getting a message oh it's hot it's hot it distracts from the nociceptors being able to fire so it's just convincing your body you feel better than you actually do acupuncture triggers and delphine natural pain pain relievers endorphins and a kelvin's so it's like it's irritating the tissue to get the tissue to release natural painkillers big ones and opiates so morphine codeine Vicodin Oxycontin I mean they do the job I've only been on them a couple of times once was after I got my wisdom teeth removed and I just slept for like two days and I'm grateful that I had that because I was on vicodin for that and I don't know how I would have survived it otherwise the pain was so ungodly for me and to histamines so like benadryl a lot of you guys maybe have allergies the reason why antihistamines reduce pain is when you have an allergy response you get very swollen and that pushes on nerves so antihistamines reduce the swelling from the allergy response and then you're not pushing on nerves anymore electric stimulation my chiropractor does this they don't really know why it works they just know it works which is kind of scary I've never actually had it done doesn't look like a good time but again it's probably just interfering with the pain signal cuz it's like you're getting other nerves to fires to the brain probably isn't getting the pain signal like full on a neuro block this is like an epidural so I don't understand women that don't take the epidural cuz it's like what are you gonna get a prize if you don't but so many women are like I don't want to take the drugs take the drugs man it's like it's like okay this is not the 1800s anymore and our babies are bigger than they've ever been because of prenatal care and better nutrition but the female anatomy has not caught up to that so I had an acquaintance she was 95 pounds and she gave birth vaginally to a 13 pound baby without drugs um she had to have the episiotomy it tore everything she had she had to sit on one of those little inflatable doughnuts for three months and she didn't take the epidural I'm like are you freaking kidding me that's crazy so it blocks the nerve message numbs the nerve ana rectum II this is pretty extreme this would be actually removing the nerve so if you're in such extreme pain that this is this is all they can do but the danger that is if you remember from A&P whan nerves are connected to stuff mostly muscles and so you're losing it's like cutting the cord to the back of your TV you're losing connection to that muscle stretching could that can kind of cause the nerves sometimes to roll and antidepressants it goes back to serotonin which is your happy chemical if you have lots of serotonin you can release your natural painkillers well if you're depressed you don't have enough serotonin you're probably going to be in more pain hunson the indoor endorphins again are our natural painkillers so they're mimicking like a key in a lock they're mimicking the exact same key that morphine and other opioids do so they bind to those exact same receptors so these can help with cue pain and chronic pain but serotonin increases both of these so if your a happy place so the Inc elephant's and the endorphins are like a runner's high so people say if they exercise they they feel like this euphoria well that's because if you run like five miles your body's in a lot of pain because we are not designed since we're bipedal we're on two feet we're not designed to run five miles you're these people get addicted to running because they get addicted just like to this drug the runner's high they call it but you get this thing thing for meeting chocolate and I think chocolates way easier than running five miles proprioception this is again knowing where you are in space but this doesn't really produce a sensation it's more of an awareness so again if you close your eyes and put your arms out to the side I don't really feel anything from my arms but I like just know where they are so it's about informing your brain and spinal cord your CNS about body position in response to gravity