The Neurophysiology of Pain and Pain Modulation: Modern Pain Neuroscience for Musculoskeletal Physiotherapists 1

NEUROPHYSIOLOGY

UNDERSTANDING HOW THE BRAIN CONTROLS BODY MOVEMENTS.

TISSUE

HOLD THE CAPACITY TO ALERT NERVOUS SYSTEM OF POTENTIAL DANGER, HENCE TO PRODUCE ACTION.

NOCICEPTORS

CONNECTED TO AN ION CHANNEL

A FIBERS

FAST PAIN TRANSMITTED FROM TISSUE TO CNS.

C FIBERS

SLOW PAIN TRANSMITTED FROM TISSUE TO CNS.

ION CHANNEL

OPENS ONCE THE NOCICEPTOR IS ACTIVATED BY A STIMULUS.

SENSORY INFORMATION

ENTERS THE CENTRAL NERVOUS SYSTEM IN SPINAL CORD

PAIN MATRIX

WILL DECIDE WHETER OR NOT THE SIGNAL SHOULD BE INTERPRETED AS THREATENING TO THE BODY HOMEOSTASIS OR NOT.

WIND UP

PROGRESSIVE INCREASE OF ELECTRICAL DISCHARGES FROM THE SECOND-ORDER NEURON IN THE SPINAL CORD IN RESPONSE TO REPETITIVE C-FIBRE STIMULATION.

MUSCULOSKELETAL SYSTEM

CAN GENERATE NOCICEPTION.

NERVOUS SYSTEM

CAN BE A SOURCE OF NOCICEPTION

NEUROPATHIC PAIN

PAIN ARISING AS A DIRECT CONSEQUENCE OF A LESION OR DISEASE AFFECTING THE SOMATOSENSORY SYSTEM.

LESION

AVAILABLE EVIDENCE FROM DIAGNOSTIC INVESTIGATIONS TO REVEAL ABNORMALITY OF THE NERVOUS SYSTEM.

DISEASE

UNDERLYING CAUSE OF THE LESION

SOMATOSENSORY

INFORMATION ABOUT THE BODY PER SE INCLUDING VISCERAL ORGANS, RATHER THAN INFORMATION ABOUT EXTERNAL WORLD.

• BURNING

• SHOOTING

• PRICKING

PATIENT WITH NEUROPATHIC PAIN EXPERIENCE

SENSORY TESTING

PRIME IMPORTANCE FOR DIAGNOSIS OF NEUROPATHIC PAIN

CATASTROPHIZING

AVOIDANCE BEHAVIOR

HANDS ON TECHNIQUES

ONCE EVERY 3 SECONDS CAN ABLE TO TRIGGER PAIN AMPLIFICATION.

3 MONTHS

TISSUE INJURY HEALING