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Encyclopedia > Pain and nociception
Look up pain, nociception, painful, hurting, dolor in Wiktionary, the free dictionary.

Pain (from Ancient Greek ποινή - poine) is defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Suffering, or pain in this sense,[1] is a basic affective experience of unpleasantness and aversion associated with harm or threat of harm in an individual. ... Look up pain in Wiktionary, the free dictionary. ... Wikipedia does not have an article with this exact name. ... Wiktionary (a portmanteau of wiki and dictionary) is a multilingual, Web-based project to create a free content dictionary, available in over 151 languages. ... Beginning of Homers Odyssey The Ancient Greek language is the historical stage of the Greek language[1] as it existed during the Archaic (9th–6th centuries BC) and Classical (5th–4th centuries BC) periods in Ancient Greece. ... The International Association for the Study of Pain (IASP) is an international professional organisation for doctors and other health professionals involved in the diagnosis, treatment and scientific study of pain, as well as education and training in the field of pain medicine. ...


Pain may originate from four sources: stimulation of a pain nerve sensor at the end of a nerve, actual damage to a pain nerve, damage in the brain where the nerve travels, and/or psychogenic causes that originate in the brain but the mechanism is not understood. The stimulation of pain nerve sensors is called nociception;[1] and the sensors are called nociceptors. The stimulation is carried to the brain by the spinal cord, in order to convey information about possible damage of body tissues. The second type is called neuropathic pain and it involves actual damage to the nerve due to disease or trauma, not just stimulation. Third is central pain, which is generated by a brain lesion like cancer, and is often difficult to treat. Psychogenic pain caused entirely by mental illness is exceedingly rare. A nociceptor is a sensory receptor that responds only after a high level of stimuli or a level enough to hurt the individual. ... Human brain In animals, the brain (enkephale) (Greek for in the skull), is the control center of the central nervous system, responsible for behavior. ... The Spinal cord nested in the vertebral column. ... With regard to living things, a body is the integral physical material of an individual. ... Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ... Psychology is an academic and applied field involving the study of the human mind, brain, and behavior. ... A mental illness or mental disorder refers to one of many mental health conditions characterized by distress, impaired cognitive functioning, atypical behavior, emotional dysregulation, and/or maladaptive behavior. ...


Pain is part of the body's defense system, triggering mental and physical behavior to end the painful experience. It promotes learning so that repetition of the painful situation will be less likely.

Contents

Description

Intensity

Pain may range in intensity from slight through severe to agonizing and can appear as permanent or intermittent. It may be experienced as sharp, throbbing, dull, nauseating, burning, shooting or a combination of these. The threshold of pain varies widely between individuals. Pain may be quantified on a pain numeric rating scale (NRS) that ranges from 1-10 points; the accuracy of such as scale (using a cut point of 4 or more) for predicting pain that interferes with functioning is:[2] Look up Threshold in Wiktionary, the free dictionary. ...

The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ...

Localization

Localization is not always accurate in defining the problematic area. Some pain sensations may be diffuse or referred. Referred pain usually happens when sensory fibres from the viscera enter the same segment of the spinal cord as somatic nerves i.e. those from superficial tissues. The sensory nerve from the viscera stimulates the nearby somatic nerve so that the pain localization in the brain is confused. A well-known example is when heart damage is felt to radiate down the left shoulder.[3]


This subjective localization of pain to an area of the body defines some kind of pain as neck pain, cutaneous pain, kidney pain, or the painful uterine contractions occurring during childbirth. This common usage of pain is not entirely consistent with the scientists' model of pain being a subjective experience. This article is about skin in the biological sense. ... The kidneys are the organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... In medicine (obstetrics), a contraction is a forceful motion of the uterus, generated by the release of oxytocin (quick labor) by the pituitary gland, culminating in childbirth. ... Parturition redirects here. ...


Insensitivity to pain

Inability to experience pain, as in the rare condition congenital insensitivity to pain or congenital analgesia, can lead to physical damage because of unawareness. Insensitivity to pain may also be caused by Hansen's disease or other forms of nerve damage. Image File history File links Question_book-3. ... Congenital insensitivity to pain (or congenital analgia) is a rare condition where a person cannot feel (and has never felt) physical pain. ... Congenital insensitivity to pain (or congenital analgia) is a rare condition where a person cannot feel (and has never felt) physical pain. ... Father Damien was a Roman Catholic missionary who helped lepers on Hawaii and also died of the disease. ...


CIP presents in early childhood, with children frequently getting injuries such as broken bones and bruises because they fail to develop the normal avoidance of pain, thus taking risks others would not.


Management and therapy of pain

Pain can be acute or chronic. The distinction between acute and chronic pain is not based on its duration of sensation, but rather the nature of the pain itself. Management and therapy is adequated to this distinction.


Acute pain

In general, physicians are more comfortable treating acute pain, which usually is caused by soft tissue damage, infection and/or inflammation among other causes. It is usually treated simultaneously with pharmaceuticals or appropriate techniques for removing the cause and pharmaceuticals or appropriate techniques for controlling the pain sensation, commonly analgesics. Acute pain serves to alert after an injury or malfunction of the body. Pharmacology (in Greek: pharmacon is drug, and logos is science) is the study of how chemical substances interfere with living systems. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ...


Chronic pain

Main article: Chronic pain

General physicians have only elementary training in chronic pain management and patients suffering from it are referred to specialists. Chronic pain was originally defined as pain that has lasted 6 months or longer. ... Pain management (also called pain medicine) is the discipline concerned with the relief of pain. ...


Chronic pain may have no apparent cause or may be caused by a developing illness or imbalance. This disorder can trigger multiple psychological problems that confound both patient and health care provider, leading to various differential diagnoses and to patient's feelings of helplessness and hopelessness. Sometimes chronic pain can have a psychosomatic or psychogenic cause.[4] Chronic pain is sometimes refered to as the "disease of pain" This article or section is in need of attention from an expert on the subject. ... A psychogenic disease is a physical disease that originates in the mind or in mental or emotional conflict. ...


The failure to treat acute pain properly may lead to chronic pain in some cases.[5]


Other therapies

Hypnosis as well as diverse perceptional techniques provoking altered states of consciousness have proven to be of important help in the management of all types of pain.[6] Some kinds of physical manipulation or exercise are showing interesting results as well.[7] For the novel by Lucas Hyde, see Hypnosis (novel). ...


Sources of pain

The experience of physiological pain can be grouped according to the source and related nociceptors (pain-detecting neurons). A nociceptor is a sensory receptor that sends signals that cause the perception of pain in response to potentially damaging stimulus. ... This article is about cells in the nervous system. ...

  • Cutaneous pain is caused by injury to the skin or superficial tissues. Cutaneous nociceptors terminate just below the skin, and due to the high concentration of nerve endings, produce a well-defined, localized pain of short duration. Examples of injuries that produce cutaneous pain include paper cuts, minor cuts, minor (first degree) burns and lacerations.
  • Somatic pain originates from ligaments, tendons, bones, blood vessels, and even nerves themselves. It is detected with somatic nociceptors. The scarcity of pain receptors in these areas produces a dull, poorly-localized pain of longer duration than cutaneous pain; examples include sprains and broken bones. Myofascial pain usually is caused by trigger points in muscles, tendons and fascia, and may be local or referred.
  • Visceral pain originates from body's viscera, or organs. Visceral nociceptors are located within body organs and internal cavities. The even greater scarcity of nociceptors in these areas produces pain that is usually more aching and of a longer duration than somatic pain. Visceral pain is extremely difficult to localize, and several injuries to visceral tissue exhibit "referred" pain, where the sensation is localized to an area completely unrelated to the site of injury. Myocardial ischaemia (the loss of blood flow to a part of the heart muscle tissue) is possibly the best known example of referred pain; the sensation can occur in the upper chest as a restricted feeling, or as an ache in the left shoulder, arm or even hand. The popularized term "brain freeze" is another example of referred pain, in which the vagus nerve is cooled by cold inside the throat. Referred pain can be explained by the findings that pain receptors in the viscera also excite spinal cord neurons that are excited by cutaneous tissue. Since the brain normally associates firing of these spinal cord neurons with stimulation of somatic tissues in skin or muscle, pain signals arising from the viscera are interpreted by the brain as originating from the skin. The theory that visceral and somatic pain receptors converge and form synapses on the same spinal cord pain-transmitting neurons is called "Ruch's Hypothesis".
  • Phantom limb pain, a type of referred pain, is the sensation of pain from a limb that has been lost or from which a person no longer receives physical signals. It is an experience almost universally reported by amputees and quadriplegics.
  • Neuropathic pain, can occur as a result of injury or disease to the nerve tissue itself. This can disrupt the ability of the sensory nerves to transmit correct information to the thalamus, and hence the brain interprets painful stimuli even though there is no obvious or known physiologic cause for the pain. Neuropathic pain is, as stated above, the disease of pain. It is not the sole definition for chronic pain, but does meet its criteria.

For other uses, see Skin (disambiguation). ... This article is about skin in the biological sense. ... For other uses, see Burn. ... Definition A cut is an injury that results in a break or opening in the skin. ... In anatomy, the term ligament is used to denote three different types of structures:[1] Fibrous tissue that connects bones to other bones. ... A tendon (or sinew) is a tough band of fibrous connective tissue that connects muscle to bone and is built to withstand tension. ... f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... For other uses, see Nerve (disambiguation). ... A sprain (from the French espraindre - to wring) is an injury which occurs to ligaments caused by a sudden overstretching (for the muscle injury, see strain). ... Trigger points are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. ... In biology, an organ is a group of tissues which perform some function. ... This article does not cite any references or sources. ... This article needs to be cleaned up to conform to a higher standard of quality. ... The heart and lungs, from an older edition of Grays Anatomy. ... The Spinal cord nested in the vertebral column. ... Illustration of the major elements in a prototypical synapse. ... The gate control theory of pain of Ron Melzack and Patrick Wall arises from evolutionary psychology. ... Amputation is the removal of a body extremity by trauma or surgery. ... Quadriplegia, also known as tetraplegia, is a symptom in which a human experiences paralysis of all four limbs, although not necessarily total paralysis. ... Neuropathy is a disease of the peripheral nervous system. ... The thalamus (from Greek θάλαμος = bedroom, chamber, IPA= /ˈθæləməs/) is a pair and symmetric part of the brain. ...

Some possible causes of pain by region

Visceral pain sensation is often referred by the CNS to a dermatome region which may be far away from the originating organ. These correlate to the position of the organ in the embryo. Examples of this include the heart which originates in the neck, thus producing the classical pain and arm pain experienced during acute cardiac pain.


Head and neck

Temporal arteritis, also called giant cell arteritis (GCA) is an inflammatory disease of blood vessels (most commonly large and medium arteries of the head). ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Otalgia is ear pain or an earache. ... Otitis media is inflammation of the middle ear: the small space between the ear drum and the inner ear. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... A headache (cephalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Tension headaches, which were renamed tension-type headaches by the International Headache Society in 1988, are the most common type of primary headaches. ... Cluster headaches are rare, extremely painful and debilitating headaches that occur in groups or clusters. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... A cerebral aneurysm or brain aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel. ... Sinusitis is an inflammation of the paranasal sinuses, which may or may not be as a result of infection, from bacterial, fungal, viral, allergic or autoimmune issues. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Neck Pain is an increasing phenomenon in the healthcare field. ... Heart attack redirects here. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ...

Thorax

Back pain (also known dorsalgia) is pain felt in the back that may originate from the muscles, nerves, bones, joints or other structures in the spine. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Mastalgia, mastodynia or mammalgia are names for a medical symptom that means - pain in the breast (from the Greek masto-, breast and algos, pain). ... The menstrual cycle is the periodic change in a womans body that occurs every month between puberty and menopause and that relates to reproduction. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... Heart attack redirects here. ... Gastroesophageal Reflux Disease (GERD or GORD using the British Å“sophageal) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus[1]. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. ... Pancreatitis is inflammation of the pancreas. ... Hiatus hernia or hiatal hernia is the protrusion (or hernia) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. ... Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). ... A disease invented by matt jadrnak to get out of school and use as a FAKE excuse. ... Each year, shoulder problems account for about 1. ... Cholecystitis is inflammation of the gall bladder. ... The human musculoskeletal system is the musculoskeletal system that gives us the ability to move. ...

Abdomen

Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... Peptic ulcer is a non-malignant ulcer of the stomach (called gastric ulcer) or duodenum (called duodenal ulcer). ... See also Bacterial gastroenteritis and Diarrhea Gastroenteritis is a general term referring to inflammation or infection of the gastrointestinal tract, primarily the stomach and intestines. ... Hepatitis (plural hepatitides) implies injury to liver characterised by presence of inflammatory cells in the liver tissue. ... Pancreatitis is inflammation of the pancreas. ... Cholecystitis is inflammation of the gall bladder. ... Heart attack redirects here. ... A plate from Grays Anatomy with yellow lines depicting the most common infrarenal location of the AAA. Abdominal aortic aneurysm, also written as AAA and often pronounced triple-A, is a localized dilatation of the abdominal aorta, that exceeds the normal diameter by more than 50%. The normal diameter... In medicine, stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs. ... Appendicitis (or epityphlitis) is a condition characterized by inflammation of the appendix[1]. While mild cases may resolve without treatment, most require removal of the inflamed appendix, either by laparotomy or laparoscopy. ... Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ... Pelvic inflammatory disease (or disorder) (PID) is a generic term for infection of the female uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. ... Diverticulitis is a common digestive disorder particularly found in the large intestine. ... Kidney stones are solid accretions (crystals) of dissolved minerals in urine found inside the kidneys or ureters. ... Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Colorectal cancer, also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. ...

Back

Back pain (also known dorsalgia) is pain felt in the back that may originate from the muscles, nerves, bones, joints or other structures in the spine. ... The human musculoskeletal system is the musculoskeletal system that gives us the ability to move. ... A strain is an injury which occurs to a muscle in which the muscle fibers tear as a result of overstretching. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... A spinal disc herniation, incorrectly called a slipped disc, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out. ... Degeneration of the intervertebral disc, which is often called degenerative disc disease (DDD) of the spine, is a common disorder of the lower spine. ... The coccyx is formed of up to five vertebrae. ... Coccydynia is a medical condition characterized by pain in the coccyx or tailbone area. ...

Limbs

Heart attack redirects here. ... The musculoskeletal system (also known as the locomotor system) is an organ system that gives animals the ability to physically move using the muscles and skeletal system. ... This article is about Deep-vein thrombosis. ... Peripheral vascular disease (PVD) is a disease in the large blood vessels of the arms, legs, and feet. ... Claudication, literally limping, is used as a medical term in various contexts. ... The musculoskeletal system (also known as the locomotor system) is an organ system that gives animals the ability to physically move using the muscles and skeletal system. ... A spinal disc herniation, incorrectly called a slipped disc, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out. ... Sciatica is pain caused by general compression and/or irritation of one of five nerve roots that are branches of the sciatic nerve. ...

Joints

Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease, or in more colloquial terms wear and tear), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints and destruction or... Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ... ... It has been suggested that this article or section be merged with Calcium pyrophosphate deposition disease. ... Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease, or in more colloquial terms wear and tear), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints and destruction or... Septic arthritis is the proliferation of bacteria in joints and resultant inflammation. ... Hemarthrosis (or haemarthrosis, plural h(a)emarthroses) is a bleeding into joint spaces. ... This article needs to be wikified. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... Psoriatic arthritis (or Arthropathic psoriasis) is a type of inflammatory arthritis that affects around 20% of people suffering from the chronic skin condition Psoriasis. ... It has been suggested that this article or section be merged with Reactive arthritis. ...

Physiology of nociception

Pain refers to the subjective, unpleasant sensation that accompanies damage or near-damage to tissues, though it can also occur in the absence of such damage if the systems of nociception are not functioning properly. Nociception refers to the system that carries signals of damage and pain from the tissues; it is the physiological event that accompanies pain.[8] Look up Tissue in Wiktionary, the free dictionary. ...


Nociceptors

All nociceptors are free nerve endings that have their cell bodies outside the spinal column in the dorsal root ganglia and are named based upon their appearance at their sensory ends. Nociceptors can detect mechanical, thermal, and chemical stimuli, and are found in the skin and on internal surfaces such as the periosteum or joint surfaces. Deep internal surfaces are only weakly supplied with pain receptors and will propagate sensations of chronic, aching pain if tissue damage in these areas occurs. A nociceptor is a sensory receptor that responds only after a high level of stimuli or a level enough to hurt the individual. ... NERVE ENDINGS SUCK PENIS!!! ... The spinal cord is a part of the vertebrate nervous system that is enclosed in and protected by the vertebral column (it passes through the spinal canal). ... This is a dorsal root ganglion (DRG) from a chicken embryo (around stage of day 7) after incubation overnight in NGF growth medium stained with anti-neurofilament antibody. ... For other uses, see Skin (disambiguation). ... The periosteum is an envelope of fibrous connective tissue that is wrapped around the bone in all places except at joints (which are protected by cartilage). ... For other uses, see Joint (disambiguation). ...


Nociceptors do not adapt to stimuli. In some conditions, excitation of pain fibers becomes greater as the pain stimulus continues, leading to a condition called hyperalgesia. Hyperalgesia is an extreme sensitivity to pain, which in one form is caused by damage to nociceptors in the bodys soft tissues. ...


Transmission of nociception to the central nervous system

There are two ways for nociceptive information to reach the central nervous system, the neospinothalamic tract for "fast spontaneous pain" and the paleospinothalamic tract for "slow increasing pain".[citation needed] A diagram showing the CNS: 1. ...


Neospinothalamic tract

Fast pain travels via type Aδ fibers to terminate on the dorsal horn of the spinal cord where they synapse with the dendrites of the neospinothalamic tract. The axons of these neurons travel up the spine to the brain and cross the midline through the anterior white commissure, passing upwards in the contralateral anterolateral columns. These fibres terminate on the ventrobasal complex of the thalamus and synapse with the dendrites of the somatosensory cortex. Fast pain is felt within a tenth of a second of application of the pain stimulus and is a sharp, acute, prickling pain felt in response to mechanical and thermal stimulation. It can be localised easily if Aδ fibres are stimulated together with tactile receptors.[citation needed] Aδ fibres are thin, myelinated fibers with a fast conduction velocity, or speed of travel of a nerve signal (2 to 30 m/s) and are associated with acute pain, the sharp pain that triggers reflexes which result in the pulling away from the stimuli (ie: yanking hand away from... The posterior horn (posterior column, posterior cornu, dorsal horn) of the spinal cord is dorsal (more towards the back) to the anterior horn. ... Illustration of the major elements in a prototypical synapse. ... Dendrites (from Greek dendron, “tree”) are the branched projections of a neuron that act to conduct the electrical stimulation received from other neural cells to the cell body, or soma, of the neuron from which the dendrites project. ... An axon or nerve fiber, is a long, slender projection of a nerve cell, or neuron, that conducts electrical impulses away from the neurons cell body or soma. ... Human brain In animals, the brain (enkephale) (Greek for in the skull), is the control center of the central nervous system, responsible for behavior. ... The Anterior Commissure (precommissure) is a bundle of white fibers, connecting the two cerebral hemispheres across the middle line, and placed in front of the columns of the fornix. ... The ventrobasal complex is a relay nucleus of the thalamus of the human brain. ... The lateral postcentral gyrus is a prominent structure in the parietal lobe of the human brain and an important landmark. ...


Paleospinothalamic tract

Slow pain is transmitted via slower type C fibers to laminae II and III of the dorsal horns, together known as the substantia gelatinosa. Impulses are then transmitted to nerve fibers that terminate in lamina V, also in the dorsal horn, synapsing with neurons that join fibers from the fast pathway, crossing to the opposite side via the anterior white commissure, and traveling upwards through the anterolateral pathway. These neurons terminate throughout the brain stem, with one tenth of fibres stopping in the thalamus and the rest stopping in the medulla, pons and periaqueductal grey of the midbrain tectum. Slow pain is stimulated by chemical stimulation, is poorly localized and is described as an aching, throbbing or burning pain.[citation needed] C-fibers are part of the human sensory system, the part of the nervous system responsible for processing sensory information. ... The apex of the posterior column is capped by a V-shaped or crescentic mass of translucent, gelatinous neuroglia, termed the substantia gelatinosa of Rolando (or gelatinous substance of posterior horn of spinal cord), which contains both neuroglia cells, and small nerve cells. ... The brain stem is the lower part of the brain, adjoining and structurally continuous with the spinal cord. ... The thalamus (from Greek θάλαμος = bedroom, chamber, IPA= /ˈθæləməs/) is a pair and symmetric part of the brain. ... Medulla in general means the inner part, and derives from the Latin word for marrow. In medicine it is contrasted to the cortex. ... For other uses, see Pons (disambiguation). ... Periaqueductal Gray (PAG; also called the central gray) is the midbrain grey matter that is located around the cerebral aqueduct within the midbrain. ... The tectum (Latin: roof) is the dorsal part of the midbrain, derived in embryonic development from the alar plate of the neural tube. ...


Effects in CNS

When nociceptors are stimulated they transmit signals through sensory neurons in the spinal cord. These neurons release the excitatory neurotransmitter glutamate at their synapses. Chemical structure of D-aspartic acid, a common amino acid neurotransmitter. ... Glutamate is the anion of glutamic acid. ... Illustration of the major elements in a prototypical synapse. ...


If the signals are sent to the reticular formation and thalamus, the sensation of pain enters consciousness in a dull poorly localized manner. From the thalamus, the signal can travel to the somatosensory cortex in the cerebrum, when the pain is experienced as localized and having more specific qualities. The reticular formation is a part of the brain which is involved in stereotypical actions, such as walking, sleeping, and lying down. ... The thalamus (from Greek θάλαμος = bedroom, chamber, IPA= /ˈθæləməs/) is a pair and symmetric part of the brain. ... Consciousness is a quality of the mind generally regarded to comprise qualities such as subjectivity, self-awareness, sentience, sapience, and the ability to perceive the relationship between oneself and ones environment. ... The lateral postcentral gyrus is a prominent structure in the parietal lobe of the human brain and an important landmark. ... The telencephalon (te-len-seff-a-lon) is the technical name for a large region within the brain which is attributed many functions, which some groups would class as unique features which make humans stand out from other species. ...


Nociception can also cause generalized autonomic responses before or without reaching consciousness to cause pallor, diaphoresis, bradycardia, hypotension, lightheadedness, nausea and fainting.[9] This article or section is in need of attention from an expert on the subject. ... Pallor is a reduced amount of oxyhemoglobin in skin or mucous membrane, a pale color which can be caused by illness, emotional shock or stress, avoiding excessive exposure to sunlight, anaemia or genetics. ... Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions. ... Bradycardia, as applied to adult medicine, is defined as a resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Light-headedness is a common and often unpleasant sensation of dizziness and/or feeling that one may be about to faint, which may be transient, recurrent, or occasionally chronic. ... For other uses, see Nausea (disambiguation). ... It has been suggested that Central Ischaemic Response be merged into this article or section. ...


Analgesia

The body possesses an endogenous analgesia system, which can be supplemented with analgesic drugs to regulate nociception and pain. There is both an analgesia system in the central nervous system and peripheral receptors that decreases the grade in which pain reaches the higher brain areas. The perception of pain can be modified by the body according to gate control theory of pain. An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ... The gate control theory of pain, put forward by Ronald Melzack and Patrick Wall in 1962 [1], and again in 1965 [2], is the idea that physical pain is not a direct result of activation of pain receptor neurons, but rather its perception is modulated by interaction between different neurons. ...


Central

The central analgesia system is mediated by 3 major components : the periaquaductal grey matter, the nucleus raphe magnus and the nociception inhibitory neurons within the dorsal horns of the spinal cord, which act to inhibit nociception-transmitting neurons also located in the spinal dorsal horn. Periaqueductal Gray (PAG; also called the central gray) is the midbrain grey matter that is located around the cerebral aqueduct within the midbrain. ... The nucleus raphe magnus, located directly rostral to the raphe obscurus, is afferently stimulated from axons in the spinal cord and cerebellum. ... The posterior horn (posterior column, posterior cornu, dorsal horn) of the spinal cord is dorsal (more towards the back) to the anterior horn. ...


Peripheral

The peripheral regulation consists of several different types of opioid receptors that are activated in response to the binding of the body's endorphins. These receptors, which exist in a variety of areas in the body, inhibit firing of neurons that would otherwise be stimulated to do so by nociceptors. To meet Wikipedias quality standards, this article may require cleanup. ... For other uses, see Endorphin (disambiguation). ...


Factors

The gate control theory of pain, proposed by Patrick Wall and Ron Melzack, postulates that nociception (pain) is "gated" by non-nociception stimuli such as vibration. Thus, rubbing a bumped knee seems to relieve pain by preventing its transmission to the brain. Pain is also "gated" by signals that descend from the brain to the spinal cord to suppress (and in other cases enhance) incoming nociception (pain) information. The gate control theory of pain, put forward by Ronald Melzack and Patrick Wall in 1962 [1], and again in 1965 [2], is the idea that physical pain is not a direct result of activation of pain receptor neurons, but rather its perception is modulated by interaction between different neurons. ... The gate control theory of pain, put forward by Ronald Melzack and Patrick Wall in 1962 [1], and again in 1965 [2], is the idea that physical pain is not a direct result of activation of pain receptor neurons, but rather its perception is modulated by interaction between different neurons. ...


Genotype and pain

Pain may be experienced differently depending on genotype (i.e, genetic background). A study by Liem et al. suggests that redheads are more susceptible to thermal pain.[10] However, another study suggests that redheads--who have a non-functional melanocortin-1 receptor (MC1R) gene--are less sensitive to pain from electric shock.[11] Although the identification of human genes influencing pain has just begun, more than 230 genes are known to affect pain or analgesic sensitivity in mice (see http://www.jbldesign.com/jmogil/enter.html).


Gene SCN9A has been identified as a major factor in the development of the pain-perception systems within the body. A rare genetic mutation in this area causes non-functional development of certain sodium channels in the nervous system, which prevents the brain from receiving messages of physical damage. People having this disorder are completely ignorant to pain, and can perform without pain any kinds of self mutilation or damage. In the families studied, this has ranged from biting of the person's own tongue leading to damage, through to street acts with knives, to death from injuries due to a failure to have learned limits on injury through experience of pain. The same gene also appears to mediate a form of hyper-sensitivity to pain, with other mutations seeming to be "at the root of paroxysmal extreme pain disorder" according to a 2006 report in Neurone. Various other forms of somatic sensitivity are unaffected.[12] SCN9A is a gene which codes a sodium ion channel. ... Sodium channels are integral membrane proteins that exist in a cells plasma membrane and regulate the flow of sodium (Na+) ions into it. ... Congenital insensitivity to pain (or congenital analgia) is a rare condition where a person cannot feel (and has never felt) physical pain. ...


Pain and alternative medicine

A recent survey by NCCAM (part of the NIH) found pain was the most common reason that people use alternative medicine. Among American adults who used CAM in 2002, 16.8% used CAM to treat back pain; 6.6% for neck pain; 4.9% for arthritis; 4.9% for joint pain; 3.1% for headache; and 2.4% used CAM to treat recurring pain. (Some survey respondents may have used CAM to treat more than one of these pain conditions.) The National Center for Complementary and Alternative Medicine or NCCAM, is a United States government agency. ... NIH can refer to: National Institutes of Health Norwegian School of Sports Sciences: (Norges idrettshøgskole - NIH) Not Invented Here This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... Alternative medicine has been described as any of various systems of healing or treating disease (as chiropractic, homeopathy, or faith healing) not included in the traditional medical curricula taught in the United States and Britain.[1] Alternative medicine practices are often based in belief systems not derived from modern science. ... Terms and concepts in alternative medicine provides a glossary of quick and to the point definitions of important terms and concepts unique to alternative medicine (CAM). ... Back pain (also known dorsalgia) is pain felt in the back that may originate from the muscles, nerves, bones, joints or other structures in the spine. ... Neck Pain is an increasing phenomenon in the healthcare field. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... A headache (cephalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ...


One such alternative, traditional Chinese medicine, views pain as a qi "blockage" equivalent to electrical resistance, or becoming chronic rather as "stagnation of blood" (Chinese: Xue) – theorized as dehydration inhibiting metabolism. Traditional Chinese treatments such as acupuncture are said to be more effective for nontraumatic pain than traumatic pain. Although these claims have not found broad scientific acceptance, research into both the mechanism and clinical efficacy of acupuncture supports that it can have a role in pain reduction for both humans and animals. Although the mechanism is not fully understood, it is likely that acupuncture stimulates the release of large quantities of endogenous opioids.[13] A 2004 NCCAM-funded study showed that acupuncture provides pain relief and improved function in patients with osteoarthritis of the knee, causing some managed care organizations to support acupuncture as adjunctive therapy for this purpose.[14] The NIH's 1997 Consensus Statement on Acupunture notes that research has been mixed, partly due to difficulties with designing clinical studies with the proper controls.[15] Traditional Chinese medicine shop in Tsim Sha Tsui, Hong Kong. ... For other uses, see QI (disambiguation). ... Electrical resistance is a measure of the degree to which an electrical component opposes the passage of current. ... Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ... Acupuncture chart from Hua Shou (fl. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Acupuncture chart from Hua Shou (fl. ... An opioid is any agent that binds to opioid receptors found principally in the central nervous system and gastrointestinal tract. ... NIH can refer to: National Institutes of Health Norwegian School of Sports Sciences: (Norges idrettshøgskole - NIH) Not Invented Here This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ...


Another common alternative treatment for chronic pain is use of nutritional supplements such as:

The efficacy of Glucosamine and Chondroitin, popular supplements for patients with arthritis, were examinied in the GAIT study, a $12 million trial funded by the NIH which showed statistical evidence for the treatment's positive effect only amongst patients with moderate to severe pain, a small subsection of the study.[17] Curcumin is the active ingredient of the Indian curry spice turmeric. ... Polyphenols are a group of chemical substances found in plants, characterized by the presence of more than one phenol group per molecule. ... Binomial name Linnaeus Turmeric (Curcuma longa) is a rhizomatous herbaceous perennial plant of the ginger family, Zingiberaceae which is native to tropical South Asia. ... COX-2 selective inhibitor is a form of Non-steroidal anti-inflammatory drug (NSAID) that directly targets COX-2, an enzyme responsible for inflammation and pain. ... Glucosamine (C6H13NO5) is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. ... Chondroitin is an ingredient found commonly in dietary supplements. ... Pineapple, one member of the Bromeliaceae family Bromelain can refer to one of two protease enzymes extracted from the plant family Bromeliaceae, or it can refer to a combination of those enzymes along with other compounds produced in an extract. ... Omega-3 fatty acids are polyunsaturated fatty acids found in certain fish tissues, and in vegetable sources such as flax seeds, walnuts, and canola oil. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... NIH can refer to: National Institutes of Health Norwegian School of Sports Sciences: (Norges idrettshøgskole - NIH) Not Invented Here This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ...


Philosophy of pain

Main article: Pain (philosophy)

The concept of pain has played an important part in the study of philosophy, particularly in the philosophy of mind. The question of what pain actually consists in is still open since any evaluation is dependent upon what subject one approaches the question from. Identity theorists assert that the mental state of pain is completely identical with some physical state caused by various physiological causes. Functionalists consider pain to be defined completely by its causal role (ie in the role it has in bringing about various effects) and nothing else. Some theologians and other spiritual traditions have much to say about the nature of pain and its various spiritual consequences, especially its role in growth, understanding, compassion, and in providing an aspect of life to be overcome. A much-talked-about issue in philosophy is the role of pain. ... A phrenological mapping of the brain. ... Type physicalism (also known as Type Identity Theory, Type-Type theory or just Identity Theory) is the theory, in the philosophy of mind, which asserts that mental events are type-identical to the physical events in the brain with which they are correlated. ... Functionalism is a theory of the mind in contemporary philosophy, developed largely as an alternative to both the identity theory of mind and behaviorism. ... A causal system is a system that depends only on the current and previous inputs. ... Theology is literally rational discourse concerning God (Greek θεος, theos, God, + λογος, logos, rational discourse). By extension, it also refers to the study of other religious topics. ... Spirituality, in a narrow sense, concerns itself with matters of the spirit. ...


Survival benefit

Despite its unpleasantness, pain is an important part of the existence of humans and other animals; in fact, it is vital to survival. Pain encourages an organism to disengage from the noxious stimulus associated with the pain. Preliminary pain can serve to indicate that an injury is imminent, such as the ache from a soon-to-be-broken bone. Pain may also promote the healing process, since most organisms will protect an injured region in order to avoid further pain. People born with congenital insensitivity to pain usually have short life spans, and suffer numerous ailments such as broken bones, bed sores, and chronic infection. A bone fracture is a medical condition in which a bone becomes cracked, splintered, or bisected as a result of physical trauma. ... Congenital insensitivity to pain (or congenital analgia) is a rare condition where a person cannot feel (and has never felt) physical pain. ... Bedsores, also called pressure sores or decubitus ulcers, are ulcers (sores) caused by prolonged pressure or rubbing on vulnerable areas of the body. ... An infection is the detrimental colonization of a host organism by a foreign species. ...


The study of pain has in recent years diverged into many different fields from pharmacology to psychology and neurobiology. It is also a separate sub-discipline in some terminal illnesses specializations.


Interestingly, the brain itself is devoid of nociceptive tissue, and hence cannot experience pain. Thus, a headache is not due to stimulation of pain fibers in the brain itself. Rather, the membrane surrounding the brain and spinal cord, called the dura mater, is innervated with pain receptors, and stimulation of these dural nociceptors (pain receptors) is thought to be involved to some extent in producing headache pain, been the vasoconstriction of peripheral vessels another common cause. Some evolutionary biologists have speculated that this lack of nociceptive tissue in the brain might be because any injury of sufficient magnitude to cause pain in the brain has a sufficiently high probability of being fatal that development of nociceptive tissue therein would have little to no survival benefit. A headache (cephalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... The dura mater (from the Latin hard mother), or pachymeninx, is the tough and inflexible outermost of the three layers of the meninges surrounding the brain. ... This article is about evolution in biology. ...


Chronic pain, in which the pain becomes pathological rather than beneficial, may be an exception to the idea that pain is helpful to survival, although some specialists believe that psychogenic chronic pain exists as a protective distraction to keep dangerous repressed emotions such as anger or rage unconscious.[4] It is not clear what the survival benefit of some extreme forms of pain (e.g. toothache) might be; and the intensity of some forms of pain (for example as a result of injury to fingernails or toenails) seem to be out of all proportion to any survival benefits.


Pain as pleasure

See also: BDSM

Sadism and masochism, in the original sense, describe psychiatric disorders characterized by feelings of sexual pleasure or gratification when inflicting suffering or having it inflicted upon the self, respectively. ... Collars are a commonly used symbol of BDSM and can be ornamental or functional. ...

Pain and nociception in other species

Pain is defined as a subjective conscious experience. The presence or absence of pain even in another human is only verifiable by their report; "Pain is whatever the experiencing person says it is, and exists whenever he says it does."[18] Currently, it is not scientifically possible to prove whether an animal is in pain or not, however it can be inferred through physical and behavioral reactions.


In veterinary science all uncertainty is overcome by assuming that if something would be painful for a human then it would be painful for an animal.[19] Where possible, analgesics are used preemptively if there is any likelihood of pain being caused to an animal. An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ...


See also

Allodynia, meaning other pain, is an exaggerated response to otherwise non-noxious stimuli and can be either static or mechanical. ... This article or section does not cite its references or sources. ... Neuropathy is usually short for peripheral neuropathy, meaning a disease of the peripheral nervous system. ... A nociceptor is a sensory receptor that sends signals that cause the perception of pain in response to potentially damaging stimulus. ... Pain disorder or body dysmorphic disorder is when a patient experiences chronic and constant pain in one or more areas, and is thought to be caused by psychological stress. ...

References

  1. ^ IASP Pain Terminology
  2. ^ Krebs, Carey, and Weinberger, “Accuracy of the Pain Numeric Rating Scale as a Screening Test in Primary Care,” Journal of General Internal Medicine 22, no. 10 (October 21, 2007): 1453-1458, doi:10.1007/s11606-007-0321-2 (accessed September 28, 2007).
  3. ^ Ann Waugh, Allison Grant (2001). Anatomy and Physiology in Health and Illness. Edinburgh: Churchill Livingstone, pp 174-175. ISBN 0443-06468 7. 
  4. ^ a b Sarno, John E., MD, et al., The Divided Mind: The Epidemic of Mindbody Disorders 2006 (ISBN 0-06-085178-3)
  5. ^ Dahl JB, Moiniche S (2004). "Pre-emptive analgesia". Br Med Bull 71: 13-27. PMID 15596866.
  6. ^ Robert Ornstein PhD, David Sobel MD (1988). The Healing Brain. New York: Simon & Schuster Inc, pp 98-99. ISBN 0-671-66236-8. 
  7. ^ Douglas E DeGood, Donald C Manning MD, Susan J Middaugh (1997). The headache & Neck Pain Workbook. Oakland, California: New Harbinger Publications. ISBN 1-57224-086-5. 
  8. ^ "Assessing Pain and Distress: A Veterinary Behaviorist's Perspective by Kathryn Bayne" in "Definition of Pain and Distress and Reporting Requirements for Laboratory Animals: Proceedings of the Workshop Held June 22, 2000 (2000)
  9. ^ cite seen at Feinstein B, J Langton, R Jameson, F Schiller. Experiments on pain referred from deep somatic tissues. J Bone Joint Surg 1954;36-A(5):981-97 retrieved 2007-01-06
  10. ^ Liem EB, Joiner TV, Tsueda K, Sessler DI. Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads. Anesthesiology. 2005 Mar;102(3):509-14.
  11. ^ Mogil JS et al. [1] Journal of Medical Genetics 2005 Jul;42(7):583-7.
  12. ^ Access : The mutation that takes away pain : Nature News
  13. ^ Robert Sapolsky, Why zebras don't get ulcers, pp 196-197: "Scientists noted that Chinese veterinarians used acupuncture to do surgery on animals, thereby refuting the argument that the painkilling characteristics of acupuncture was one big placebo effect ascribable to cultural conditioning (no cow on earth will go along with unanaesthetized surgery just because it has a heavy investment in the cultural mores of the society in which it dwells. [...] Acupuncture stimulates the release of large quantities of endogenous opioids, for reasons no one really understands. The best demonstration of this is what is called a subtraction experiment: block the activity of endogenous opioids by using a drug that blocks the opiate receptor... acupuncture no longer effectively dulls the perception of pain."
  14. ^ Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. "Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial." Annals of Internal Medicine 2004 Dec 21; 141(12): 901-10.
  15. ^ National Institutes of Health Consensus Panel. "Acupuncture: National Institutes of Health Consensus Development Statement." National Institutes of Health Web site. Accessed at consensus.nih.gov/1997/1997Acupuncture107html.htm on February 24, 2007.
  16. ^ Sharma S, Kulkarni SK, Agrewala JN, Chopra K. "Curcumin attenuates thermal hyperalgesia in a diabetic mouse model of neuropathic pain." Eur J Pharmacol. 2006 May 1; 536(3): 256-61
  17. ^ Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ. "Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis." New England Journal of Medicine. 2006 Feb 23; 354(8): 795-808.
  18. ^ cite sourced from McCaffery M. Nursing management of the patient in pain. Philadelphia, Pa: JB Lippincott 1972.
  19. ^ American College of Veterinary Anesthesiologists' position paper on the treatment of pain in animals retrieved 2007-01-06

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Robert Maurice Sapolsky (b. ... Why Zebras Dont Get Ulcers written in 1994 by Robert M. Sapolsky, a highly acclaimed professor at Stanford University. ...

External links

The nervous system is a highly specialized network whose principal components are nerves called neurons. ... The human eye is the first element of a sensory system: in this case, vision, for the visual system. ... This article is about the senses of living organisms (vision, taste, etc. ... The traditional five senses in human kind are the senses of vision, hearing, taste, and smell, and touch. ... The visual system is the part of the nervous system which allows organisms to see. ... In psychology, visual perception is the ability to interpret visible light information reaching the eyes which is then made available for planning and action. ... The auditory system is the sensory system for the sense of hearing. ... Hearing (or audition) is one of the traditional five senses, and refers to the ability to detect sound. ... A Chemosensor, also known as chemoreceptor, is a cell or group of cells that transduce a chemical signal into an action potential. ... The olfactory system is the sensory system used for olfaction. ... Olfaction (also known as olfactics) refers to the sense of smell. ... The gustatory system is the sensory system that uses taste buds (or lingual papillae) on the upper surface of the tongue to provide information about the taste of food being eaten. ... For the social and aesthetic aspects of taste, see taste (sociology). ... Somatic sensation consists of the various sensory receptors that trigger the experiences labelled as touch or pressure, temperature (warm or cold), pain (including itch and tickle), and the sensations of muscle movement and joint position including posture, movement, and facial expression (collectively also called proprioception). ... A nociceptor is a sensory receptor that sends signals that cause the perception of pain in response to potentially damaging stimulus. ... A thermoreceptor is a sensory receptor that responds to temperature, primarily within the innocuous range. ... It has been suggested that Equilibrioception be merged into this article or section. ... A mechanoreceptor is a sensory receptor that responds to mechanical pressure or distortion. ... This article is about pressure in the physical sciences. ... Oscillation is the variation, typically in time, of some measure about a central value (often a point of equilibrium) or between two or more different states. ... // Proprioception (PRO-pree-o-SEP-shun (IPA pronunciation: ); from Latin proprius, meaning ones own and perception) is the sense of the relative position of neighbouring parts of the body. ... In a sensory system, a sensory receptor is a structure that recognizes a stimulus in the internal or external environment of an organism. ...

 
 

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