PAIN PATHWAY - “Routeway of unpleasant sensation “ Pain plays an important in the survival of all animals. It acts as a signal, alerting us to potential tissue damage, and leads to a wide range of actions to prevent or limit further damage. Physiologically, pain occurs when sensory nerve endings called nociceptors (also referred to as pain receptors) come into contact with a painful or noxious stimulus. The resulting nerve impulse travels from the sensory nerve ending to the spinal cord, where the impulse is rapidly shunted to the brain via nerve tracts in the spinal cord and brainstem. The brain processes the pain sensation and quickly responds with a motor response in an attempt to cease the action causing the pain. Nociceptive Pathways The classic nociceptive pathway involves three types of neurons: Primary sensory neurons in the peripheral nervous system, which conduct painful sensations from the periphery to the dorsal root of the spinal cord Secondary sensory neurons in the spinal cord or brainstem, which transmit the painful sensation to the thalamus Tertiary sensory neurons, which transmit the painful sensation from the thalamus to the somatosensory areas of the cerebral cortex. There are two major classes of nerve fibers associated with the transmission of pain: Unmyelinated C fibers Myelinated A-delta fibers Destinations of the Spinothalamic and Spinoreticular Tracts in the Brain A illustration of the destinations of the spinothalamic and spinoreticular tracts in the brain The thalamus is the destination of spinothalamic tract—the sensory pathway responsible for processing pain, temperature, and crude touch. The brainstem reticular formation, which forms a diffuse, central core within the brainstem is the destination of the spinoreticular tract. Source: 3DScience.com. Used by permission. The C fibers are small and conduct impulses slowly. They respond to thermal, mechanical, and chemical stimuli and produce the sensation of dull, diffuse, aching, burning, and delayed pain. A-delta fibers, which are myelinated and thus conduct impulses rapidly, respond to mechanical (pressure) stimulus and produce the sensation of sharp, localized, fast pain. One of the most important central pain pathways is the spinothalamic tract, which originates in the spinal cord and extends to the thalamus. This spinal tract transmits sensory information related to pain, temperature, and crude touch. Another prominent pathway is the spinoreticular tract, which is involved in nociceptive processing. The spinoreticular tract is similar to the spinothalamic tract in that it is excited by similar sensory fibers. Rather than ascending to the thalamus however, spinoreticular neurons terminate within the brainstem.
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Pain And Pain Pathway : Pain is a somatic and emotional sensation that is unpleasant in nature and associated with actual or potential tissue damage. Physiologically, the function of pain is critical for survival and has a major evolutionary advantage. This is because behaviours that cause pain are often dangerous and harmful, therefore they are generally not reinforced and are unlikely to be repeated. The classification of pain is complicated and there are many different types of pain, each arising through unique mechanisms. Types of pain include: sharp pain, prickling pain, thermal pain, aching pain. In addition, the origin of pain can be somatic, visceral, thalamic, neuropathic, psychosomatic, referred, or illusionary. Pain can also be acute or chronic in nature. The General Pain Pathway Within the pain pathway there are 3 orders of neurones that carry action potentials signalling pain: First-order neurones – These are pseudounipolar neurones which have cells bodies within the dorsal root ganglion. They have one axon which splits into two branches, a peripheral branch (which extends towards the peripheries) and a central branch (which extends centrally into the spinal cord/brainstem). Second-order neurones – The cell bodies of these neurones are found in the Rexed laminae of the spinal cord, or in the nuclei of the cranial nerves within the brain stem. These neurones then decussate in the anterior white commissure of the spinal cord and ascend cranially in the spinothalamic tract to the ventral posterolateral (VPL) nucleus of the thalamus. Third-order neurones – The cell bodies of third-order neurones lie within the VPL of the thalamus. They project via the posterior limb of the internal capsule to terminate in the ipsilateral postcentral gyrus (primary somatosensory cortex). The postcentral gyrus is somatotopically organised. Therefore, pain signals initiated in the hand will terminate in the area of the cortex dedicated to sensations of the hand. Activation of First Order Neurons Nociceptors Some first-order neurones have specialist receptors called nociceptors which are activated through various noxious stimuli. Nociceptors exist at the free nerve endings of the primary afferent neurone. Since nociceptors are free nerve endings this means they are unencapsulated cutaneous receptors. This is opposed to encapsulated cutaneous receptors (e.g. Merkel’s discs) which detect other sensory modalities such as vibration and stretching of the skin. G.KAVIVARSHINI 1st YEAR "A" SNS COLLEGE OF PHYSIOTHERAPY #snsinstitutions #snsdesignthinkers #snscollegeofphysiotherapy
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Acupuncturist, PhD Bio. Open minded, take delight sharing nature's "hidden" wonder he saw, enjoy reading scientific news and pondering over if the wonder of human body can be unveiled by quantum physics, stem cells ...
Are Trigger Points Useful for Shoulder/Arm Pain Relief? Put The Bible to The Test (12) Travell JG' et al's books on TrPs & Pain is the bible in mysofasical world, which claims MtrPs cause and are central to the myofascial pain. So there came “trigger point therapy”. But under scientific testing, such a therapy has advanced to nowhere in the past half century. Are MtrPs necessary? Jay Shah, a senior physiatrist in the NIH Clinical Center, among many critical thinkers, questioned the tenet (Shah J et al, 2015). TrPs for Shoulder/Arm Pain The bible claims more than dozens of TrPs located in shoulder area can cause shoulder and upper arm pain. If indeed “TrPs cause and are central to the myofascial pain”, then we can anticipate that the intervention not targeting any of the TrPs at shoulder area will not work, or work very poorly for arm pain. Under Scrutiny of Scientific Trials A 2018 systematic review (11 trials with 496 participants) published in Physiotherapy examined the effects of shoulder TrP-guided dry needling (TDN) for shoulder or upper arm pain and dysfunction. The review found: There was very low evidence that trigger point dry needling of the shoulder region is effective for reducing pain and improving function in the short term. The authors concluded: There is very low evidence to support the use of TDN in the shoulder region for treating patients with upper extremity pain or dysfunction. No Consensus Reached on Any Single Thing The review also identified “considerable heterogeneity” between trials with regards to how the TDN was performed by clinicians, how comparison group was designed, and how the outcomes were measured. 80 years having passed since the TrP theory established, we have no consensus reached among clinicians yet over any single factor which may affect the outcomes. Every clinician can claim their intervention design is the best. But none of any single intervention design has been proved by scientific tests to be better than others, or the outcome to be significantly superior to a placebo. Science Goes Nowhere on Blind Beliefs “Science is the belief in the ignorance of experts…” (Richard Feynman, Quantum Physicist). Science does not move forward if we blindly accept everything of what we see, hear or read (including this post). Instead, we need to keep thinking, testing and retesting. In this information-flooding era which sinks everyone, we all should be more skeptic than ever before. Do your test and retest on what this post is telling you. Shah JP et al, PM R. 2015 Jul;7(7):746-761. Hall ML et al, Effects of dry needling trigger point therapy in the shoulder region on patients with upper extremity pain and dysfunction: a systematic review with meta-analysis, Physiotherapy, Vol 104, Is 2, 2018, P167-177. #shoulderpain #armpain #triggerpoints #myofascialpain #biblebooks #criticalthinking #blindbeliefs (Images from Tavell J et al, 1999)
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POSSIBLE CAUSES OF RADIATING PAIN DOWN THE LEG ————————————————————————————————— “What is simple, is simply seen. And what is simple is rarely understood.” - unknown ————————————————————————————————— As usual, trigger points are rarely considered as a possible cause of radiating pain down the leg. Check it out. https://lnkd.in/gR_yAbqg. Not one mention. I personally have no problem determining nerve pain from myofascial pain. BECAUSE I PALPATE FOR TRIGGER POINTS. It’s simple. If I find no trigger points, or the patient doesn’t feel dramatically better after eliminating the trigger points. I know it’s nerve pain. It’s very simple. I don’t need to bother with imaging, or sophisticated orthopedic testing in order to determine either way. It takes just a few minutes. So someone misdiagnosed with nerve pain goes through rehab therapy designed for nerve pain. It ain’t gonna work. In this patients case. IT WAS ONLY TWO TRIGGER POINTS. So he suffered needlessly for months because no one bothered to palpate for trigger points. ONLY 2 TRIGGER POINTS !!!! No way this patient needed to be referred to a Pain Management Clinic. But that’s what happened. ————————————————————————————————— Those clinicians who have become skilled at diagnosing and managing myofascial trigge points frequently see patients who were referred to them by other practitioners as a last resort. These patients commonly arrive with a long list of diagnostic procedures, none of which satisfactorily explained the cause of, or relieved, the patient's pain. Myofascial Pain and Dysfunction, by David Simons, Janet Travell and Lois Simons, P36 ————————————————————————————————- Reason for Appointment 1. Right hip pain, with radiation down the leg History of Present Illness Manual Therapy: Physical pain or discomfort (0-10): 4/10. Emotional pain or discomfort (o-10): n/a. Assessments 1. Myofascial pain - M79.1 Procedures Manual Therapy: Painful palpatory areas: n/a. Modalities applied: trigger point release. Trigger points found and deactivated: RIGHT, sacrum(Si), quadratus lumborum. Post therapy response: All the trigger points deactivated quickly and easily. Pain is completely gone. Patient might need a follow up treatment in a few days, otherwise it's over. Post physical pain or discomfort: 0/10. Post emotional pain or discomfort: n/a. Length of session: 15 minutes. Performed by: Gordon Wallis, LMT. Procedure Codes 97140 MANUAL THERAPY Electronically signed by GORDON WALLIS, Lmt
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President/CEO @ Midwest Spine & Brain Institute | Founder HyperCharge Performance, Longevity and Recovery Clinics | Top Leadership Voice | Wellness at the Speed of Light Podcast Host | Keynote/Motivational Speaker
Why do I use the analogy of Lyme Disease when I discuss Sacroiliac Joint problems? Sacroiliac joint (Joint between spine and pelvis) dysfunction and pain can present in so many ways and is often misdiagnosed! I often use the analogy of Lyme Disease, which is also often missed, because it can present in so many different ways. Aside from the typical acute presentation of Lyme disease, those that develop chronic issues can present with Musculoskeletal pain,Fatigue, Cognitive issues, Sleep disturbances, Neurological problems, Headaches, Mood swings and anxiety, Sensitivity to light and sound, Digestive issues, Joint swelling and others. This often leads to delayed diagnosis because it can mimic so many other conditions! 👉🏽Similarly, when the SI joint malfunctions, it can cause significant pain in the lower back, buttocks, leg pain, numbness, groin pain, testicular pain, feeling of instability etc.. Diagnosing SI joint dysfunction can be tricky because the symptoms mimic other conditions and often patients end up having their lumbar spine treated with poor results! And distrurbingly there are reports of people having orchietomy (testicle removal) because of the severity of pain and obviously had no symptom relief. 🩺So, how do we diagnose SI joint problems? Patient history and physical exam: pain location, activities that aggravate it is key as well as performing specific maneuvers to assess SI joint movement and tenderness. Imaging tests: X-rays, CT scans, and MRIs are helpful to rule out other causes of pain and assess the joint itself. Diagnostic injections: Injecting a numbing medication into the SI joint can confirm if it's the pain source. ⚕️Treatment Strategies for SI joint dysfunction: Physical therapy: Exercises to strengthen the core and pelvic muscles can stabilize the joint and improve pain. Manipulation: Has been shown to be effective Medication: Anti-inflammatory drugs can help reduce pain and inflammation. Heat/ice therapy: Alternating heat and ice packs can provide temporary pain relief. Sacroiliac joint injections: Corticosteroid injections can offer longer-lasting pain relief. Radio frequency ablation: Cauterizing the lateral branches can be effective In some cases, minimally invasive surgical procedures may be recommended to stabilize the joint or address specific abnormalities. 👉🏽 In summary making the diagnosis of SI Joint Dysfunction can be challenging but there are effective treatment options once the correct diagnosis is made! In future videos we’ll discuss using radiofrequency neurolysis to improve symptoms and also “Transfer Syndrome” which refers to SI joint issues that arise after lumbar fusion! #SacroilliacJoint #Backpain #Sciatica #Diagnosis #Treatment #DrSinicropi #SpineSurgeron
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Empowering people to free their families from physical and financial pain | Wellness and Prosperity Leader | Promoting health living | Transforming Lives
In simple terms, Gordon Wallis highlights the importance of considering trigger points as a possible cause of radiating leg pain. He emphasizes that through palpation for trigger points, he can easily differentiate between nerve pain and myofascial pain. By identifying and treating just two trigger points, he successfully relieved the patient's pain, proving that specialised diagnostic procedures were unnecessary. This approach, based on the book "Myofascial Pain and Dysfunction," can lead to effective pain management and prevent unnecessary referrals to Pain Management Clinics.
POSSIBLE CAUSES OF RADIATING PAIN DOWN THE LEG ————————————————————————————————— “What is simple, is simply seen. And what is simple is rarely understood.” - unknown ————————————————————————————————— As usual, trigger points are rarely considered as a possible cause of radiating pain down the leg. Check it out. https://lnkd.in/gR_yAbqg. Not one mention. I personally have no problem determining nerve pain from myofascial pain. BECAUSE I PALPATE FOR TRIGGER POINTS. It’s simple. If I find no trigger points, or the patient doesn’t feel dramatically better after eliminating the trigger points. I know it’s nerve pain. It’s very simple. I don’t need to bother with imaging, or sophisticated orthopedic testing in order to determine either way. It takes just a few minutes. So someone misdiagnosed with nerve pain goes through rehab therapy designed for nerve pain. It ain’t gonna work. In this patients case. IT WAS ONLY TWO TRIGGER POINTS. So he suffered needlessly for months because no one bothered to palpate for trigger points. ONLY 2 TRIGGER POINTS !!!! No way this patient needed to be referred to a Pain Management Clinic. But that’s what happened. ————————————————————————————————— Those clinicians who have become skilled at diagnosing and managing myofascial trigge points frequently see patients who were referred to them by other practitioners as a last resort. These patients commonly arrive with a long list of diagnostic procedures, none of which satisfactorily explained the cause of, or relieved, the patient's pain. Myofascial Pain and Dysfunction, by David Simons, Janet Travell and Lois Simons, P36 ————————————————————————————————- Reason for Appointment 1. Right hip pain, with radiation down the leg History of Present Illness Manual Therapy: Physical pain or discomfort (0-10): 4/10. Emotional pain or discomfort (o-10): n/a. Assessments 1. Myofascial pain - M79.1 Procedures Manual Therapy: Painful palpatory areas: n/a. Modalities applied: trigger point release. Trigger points found and deactivated: RIGHT, sacrum(Si), quadratus lumborum. Post therapy response: All the trigger points deactivated quickly and easily. Pain is completely gone. Patient might need a follow up treatment in a few days, otherwise it's over. Post physical pain or discomfort: 0/10. Post emotional pain or discomfort: n/a. Length of session: 15 minutes. Performed by: Gordon Wallis, LMT. Procedure Codes 97140 MANUAL THERAPY Electronically signed by GORDON WALLIS, Lmt
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