PNE Lab 1 & 2 Assignment

Sensitive Nerves

• Stepping on a nail, house alarm, sunburn, pearl harbor, airport security and 9/11, christmas tree.

• Peripheral neuropathic pain, peripheral nerve sensitization, central sensitization, hyperalgesia, allodynia.

• Hyperalgesia, allodynia, pain sensitivity to cold and stress, neuroplasticity (hope for change), stress/anxiety/fear, tissue issues, past treatment issues, decreased function issues, movement/exercise/pacing/graded exposure issues, food/GI issues.

• First imagine taking a warm shower and you’re body is calm and your skin is not irritated. Now imagine you have a sunburn. Your skin feels tender and extra sensitive.

• If you use that same shower temperature, it suddenly feels way too hot. The water did not change, but your skin’s sensitivity changed. To tolerate the shower, you turn the temperature down.

• This is your body’s alarm system protecting the sunburned area. This is similar to how to nervous system works. When there is no injury, the alarm system stays at a normal resting level. When there is an injury, the alarm system becomes more sensitive.

• This makes normal things like touch, pressure, or movement feel more uncomfortable. This sensitivity is normal and is meant to protect the area while it heals.

• The good news is that tissues heal, just like a sunburn. As healing happens, the alarm system can calm back down. Gentle movement can help calm the nervous system. This is why we say “motion is lotion.”

• The goal is to move little and often, without pushing too far. Hurt does not always mean harm. Pain with movement can mean the alarm system is extra sensitive, not that more damage is happening.

Nerve Sensors

• The alarm system’s sensors, the car dashboard.

• Ion channel expression, neuroplasticity, peripheral neuropathic pain, peripheral nerve sensitization, hyperalgesia, allodynia, membrane stabilizing drugs.

• Hyperalgesia, allodynia, pain sensitivity to cold and stress, immune responses, inflammatory responses, neuroplasticity (hope for change), emotions and pain, stress/anxiety/fear, tissue issues, past treatment issues, decreased function issues, movement/exercise/pacing/graded exposure issues, physical fatigue and sore muscle issues, food/GI issues.

• Think about the sensors and warning lights on the car dashboard. These sensors tell us when something needs attention, like low gas, tire pressure, or oil change.

• If your gas light comes on, it is not usually a major emergency. It is a warning that gets your attention so you can respond. You interpret the message, stop for gas, and the light turns off.

• The nervous system works in a similar way. The nerves are constantly scanning the body and environment for changes or possible danger.

• When everything is balanced, these sensors give helpful information. When pain develops, the nervous system can become more sensitive. It may create more sensors for things like stress, movement, pressure, or temperature.

• This means normal things may feel more intense or painful than they usually would. This does not always mean there is new injury or damage. It may mean the nervous system is more sensitive and protective right now.

• These sensors can change over time. As the body heals, the alarm system can calm down again. The goal is to understand the alarm, respond appropriately, and help the nervous system return to a healthier balance.

Nosy Neighbors

• Nosy and irritated neighbors, car alarms, neighborhood break-in, perimeter attacks, party at the apartment building, christmas tree competition.

• Spreading pain, neuroplasticity, peripheral neuropathic pain, peripheral nerve sensitization, central sensitization, hyperalgesia, allodynia, immune responses.

• Hyperalgesia, allodynia, spreading pain, immune responses, inflammatory responses, neuroplasticity (hope for change), stress/anxiety/fear, tissue issues, past treatment issues, swelling issues, decreased function issues.

• Think of the alarm on cars to protect you from danger. Sometimes, we accidentally set off our own car alarm in the parking lot.

• When the alarm goes off, everyone notices and looks over at it. Once you realize what happened, you turn it off, and everything settles down.

• Sometimes the alarm goes off when the owner is not near by and does not notice. If the alarm keeps going off, it can set off car alarms nearby too. Now there are several alarms going off and that gets everyone’s attention.

• This is similar to how our nervous system works. It acts like the body’s alarm system. It’s job is to scan for danger and alert us when something may need attention.

• For example, if you fall and sprain your wrist, the “wrist alarm” may go off to tell you to protect it or get it checked. Usually, as the injury heals, the alarm calms down. But, if the alarm keeps going off for a long time, areas nearby may become more sensitive too.

• This does not always mean there is more damage. It may mean the nervous system has become extra sensitive and is setting off nearby alarms. The goal is to calm the alarm system, not assume every alarm means new injury.

Calming Nerves

• Calming nerves (big picture), pacing and graded exposure (spiders), pacing and graded exposure (keep the fire risk low), pacing (dating pain, making popcorn and toast, and brushing teeth), setting goals (grandma and Toblerone), no flat tires.

• Peripheral neuropathic pain, pain neuroscience education, endogenous mechanisms, pacing, graded exposure, aerobic exercise.

• Hyperalgesia, allodynia, pain sensitivity to cold and stress, immune responses, inflammatory responses, neuroplasticity (hope for change), emotions and pain, stress/anxiety/fear, tissue issues, past treatment issues, decreased function issues, movement/exercise/pacing/graded exposure issues, physical fatigue and sore muscle issues, sleep issues, food/GI issues.

• Think about someone who is afraid of spiders, it can be yourself. One way way to face that fear would be to put them in a box full of spiders. That would probably overwhelm them and make the fear worse.

• A better way is through graded exposure by slowly facing the fear in small, safe steps.

• First, they might read about spiders to understand them as a low-threat start. Then, they might look at a dead spider in a sealed jar. Then look at the spider out in the open which makes it feel more real.

• Then, they might look at live spiders in a closed container. Eventually, they might touch or hold a small, harmless spider. Over time, they work up to fully handling the spider they were so afraid of.

• The goal is to slowly teach the brain that the spider is not as dangerous as it thought. The same idea can apply to pain.

• When movement hurts, the brain may see that as threatening. Instead of avoiding that movement completely, we start with small, safe amounts.

• Slowly, we build tolerance and confidence with the goal of returning to daily activities with less fear and more control.

Pain and the Brain

• Threat value, nociception versus pain, inhibition, facilitation, pain as an output of the brain.

• Hyperalgesia, allodynia, altered brain function responses, neuroplasticity (altered maps), emotions and pain, stress/anxiety/fear.

• If you sprain your ankle, you would expect it to hurt. But imagine you sprain your ankle while crossing a busy street. At the same time, you see a bus coming toward you.

• In that moment, your ankle may not hurt because your brain sees the bus as the bigger threat. Pain could slow you down, so your brain may choose not to produce pain yet.

• Once you’re safe on the sidewalk, your brain may produce the ankle pain to get your attention since the bus is no longer your biggest threat.

• This shows that pain is produced by the brain based on what it sees as threatening.

• Another example is noticing a bruise and not knowing how it happened. The tissue was injured, but your brain did not produce pain at the time.

• You can have tissue damage without pain, and you can have pain without tissue damage.

• Pain is not just about what is happening in the tissues, but how much threat the brain perceives.

Brain’s Pain Map

• Grandma, battle stations, driving the same road every day.

• Pain neuromatrix, threat, neuroplasticity, functional MRIs, neuronal activation, pain uses in other areas, chronic pain enslaves those areas, Hebbien theory (nerves that fire together wire together).

• Hyperalgesia, allodynia, spreading pain, altered brain function responses, neuroplasticity (altered maps), neuroplasticity (hope for change), emotions and pain, stress/anxiety/fear, tissue issues, past treatment issues, swelling issues, decreased function issues, movement/exercise/pacing/graded exposure issues.

• Imagine you drive the same single-lane road to work every day. At first, it takes about 42 minutes because the road is rough and slow.

• This road gets paved due to increased traffic. You now get to work faster because the road is smoother.

• If the road keeps increasing in traffic, it may become wider, making the trip faster and easier.

• This represents how our brain works. The more we practice something, the brain’s “road” for that skill becomes faster and more efficient.

• The same thing happens with movement. Your brain has a “map” for that movement and with repetition, that map becomes easier to use.

• This can also happen with pain. If pain keeps happening with movement, the brain may become better at setting off the “pain alarm.” Over time, pain may begin earlier in the movement or even without movement.

• This does not always mean the tissue is getting worse, but that the nervous system has become more protective/sensitive.

• One way to help is pacing where you move in a safe range, stop before pain gets too high, and repeat often.

• With practice, the brain can build a new, less painful movement pathway.

Body, Inc.’s CEO

• The chief executive officer (CEO) of body Inc., processor problem with the computer.

• Inhibition, facilitation, pain neuromatrix, spreading pain, central sensitization.

• Hyperalgesia, allodynia, spreading pain, altered brain function responses, neuroplasticity (altered maps), neuroplasticity (hope for change), stress/anxiety/fear, tissue issues, past treatment issues, swelling issues, sleep issues.

Story

Lions and Stress

• Lion attacks, police lights.

• Stress biology, fight or flight, sympathetic, adrenaline, cortisol, immune responses, multiple output mechanisms.

• S/Sx

Story

Tissue Issues

• Tissues heal, pain issue versus tissue issue, normal findings, paradigm shift, threat value, knowledge.

• S/Sx

Story

Neurogenic Inflammation

• Peripheral neuropathic pain, retrograde firing, thoughts as nerve impulses, immune response, inflammation, persistent swelling.

• S/Sx

Story

The Brain’s Body Maps

• Smudging 101, charcoal drawings, coffee spills.

• Neuroplasticity, homunculus, sensory cortex, phantom limb pain, complex regional pain syndrome, use it or lose it, spreading pain, neglect, laterality, smudging, graded motor imagery.

• S/Sx

Story

Emotions and Pain

• Emotional overload, fear, catastrophization, nociception, threat, homunculus.

• S/Sx

Story