ECTOPIC SIGNALING
CONSISTS OF NEURONS FIRING WITHOUT USUAL TRIGGER
CAUSES ABNORMAL RESPONSIVENESS TO HEAT, CHEMICAL OR MECHANICAL STIMULI
PHYSIOLOGICAL RESPONSE = AFTER DISCHARGE, EXTRA SPIKE FORMATION, CROSSTALK, NON-SYNAPTIC NEURON TO NEURON CROSS EXCITATION
ECTOPIC HYPEREXCITABILITY OCCURS IN…
NEUROMA END BULBS
REGENERATING OR COLLATERAL SPROUTS => RECRUITMENT OF A-BETA FIBERS DURING PAIN
PATCHES OF DEMYELINATED AXONS
CELL SOMA IN THE DRG AND NEIGHBORING UNINJURED NEURONS
END RESULT OF ECTOPIC SIGNALING
REMODELING OF VOLTAGE-SENSITIZATION CHANNELS, TRANSDUCER MOLECULES, AND RECEPTORS IN THE CELL MEMBRANE
I.E. INCREASED EXPRESSION OF NAV CHANNELS AND DECREASED EXPRESSION OF CAV CHANNELS
TYPES OF NEUROPATHIES
MONONUEROPATHIES MULTIPLE MONONEUROPATHIES POLYNEUROPATHIES PHANTOM LIMB PERIPHERAL NEUROPATHIES
MONONEUROPATHIES
DAMAGE TO 1 MAIN NERVE (CARPAL TUNNEL)
MULTIPLE MONONEUROPATHIES
MANY MONONEUROPATHIES BUT WITHIN A LOCALIZED AREA (GULLIAN BARE DISEASE, HIV)
POLYNEUROPATHIES
MONONEUROPATHIES IN MULTIPLE REGIONS OF THE BODY (DIABETIC NEUROPATHY)
PHANTOM LIMB
CENTRAL SENSITIZATION CAUSES STUMP PAIN (NEUROMA AT EXTRACTION SITE) OR PHANTOM PAIN (PAIN WHERE STUMP USED TO BE)
BOTH HAVE DIFFERENT ETIOLOGIES
PERIPHERAL NEUROPATHY
COMPLEX REGIONAL PAIN SYNDROME, SPINAL CORD INJURY PAIN, TRIGEMINAL AND GLOSSOPHARYNGEAL NEURALGIA
DEEP SOMATIC PAIN EXAMPLES
MUSCLE PAIN, POST-OPERATIVE PAIN, JOINT PAIN, LBP, OSTEOARTHRITIS, RHEUMATOID ARTHRITIS, FIBROMYALGIA
My(2) Poop Just Looks Overly Fucking Red
OSTEOARTHRITIS
DUE TO OVERUSE
TOTAL JOINT FAILURE AFFECTING CARTILAGE, BONE, MENISCI, SYNOVIUM, LIGAMENTS, AND NEUROMUSCULAR TISSUE
PAIN ON WEIGHT BEARING ACTIVITIES, WITH PROGRESSION TO MORE PERSISTENT PAIN
TREATMENT = WEIGHT LOSS EXERCISE, PHYSIOTHERAPY, BRACING, ACM, NSAIDS
FOUND IN MOST DISTAL PORTIONS OF LIMBS, KNEES, AND HIPS (MOST COMMON)
RHEUMATOID ARTHRITIS
MULTISYSTEM INFLAMMATORY DISORDER CHARACTERIZED BY DESTRUCTIVE SYNOVITIS WITH EFFUSIONS, CARTILAGE DAMAGE, BONE EROSION, AND TENOSYNOVITIS
STIFFNESS AND POSITIVE FOR RHEUMATOID FACTOR
TREATMENT = ANTI-RHEUMETIC DRUGS (METHOTREXATE), CYTOKINE-TARGETING DRUGS (ANTI-TUMOR NECROSIS FACTOR ALPHA)
FOUND IN HANDS, FEET, ANKLES, AND KNEES
JOINT PAIN - NORMAL JOINT
NORMAL JOINT - INTENSE PRESSURE/MOVEMENTS EXCEEDING NORMAL WORKING RANGE CAUSE PAIN
JOINT PAIN - PATHOLOGICAL JOINT
PATHOLOGICAL JOINT - NOCICEPTIVE SYSTEM IS HYPERSENSITIVE => PAIN UPON PALPITATION AND DURING NORMAL WORKING RANGE AND PAIN AT REST
CAUSES A DECREASE IN MECHANICAL THRESHOLD AND SILENT JOINT NOCICEPTORS
NOCICEPTION IS CAUSED BY RESPONSE RESPONSES BY INFLAMMATORY MEDIATORS - PRG AND CYTOKININS
FROM THE BRAIN - DESCENDING INHIBITORY/EXCITATORY SYSTEMS INFLUENCE NOCICEPTIVE PROCESSING WHICH CAUSES A LOSS OF INHIBITION AND MORE PAIN IN JOINT DISEASE
CONNECTION BETWEEN JOINT AND NERVOUS SYSTEM IS BIDIRECTIONAL
SYMPATHETIC NERVOUS SYSTEM IS ACTIVATED WHEN EFFERENT NEURONAL MECHANISMS ARE STIMULATED WHICH TRIGGERS THE RELEASE OF NEUROPEPTIDES FROM NOCICEPTIVE AFFERENTS
MUSCLE PAIN
MOST COMMON COMPLAINT
MUSCLE NOCICEPTORS = FREE NERVE ENDINGS CONNECTED TO THE CNS THROUGH A-DELTA OR C-AFFERENT FIBERS
NORMAL = NO ONGOING ACTIVITY W/ HIGH MECHANICAL THRESHOLD
TRIGGERED BY BK, 5-HT, ATP, PROTONS, AND NGF
WHEN DAMAGED - ACQUIRE LOWER MECHANICAL THRESHOLD AND ONGOING NEURONAL ACTIVITY (INDUCES SENSITIZATION OF CENTRAL NOCICEPTIVE NEURONS
SENSITIZATION => INCREASED RESPONSIVENESS, INCREASED INPUT CONVERGENCE, UNMASKING OF FORMERLY INEFFECTIVE NEURONS (CAUSES REFERRED MUSCLE PAIN)
REQUIRES GLIAL CELLS FOR SENSITIZATIONS
CLASSIFICATION OF SOFT TISSUE PAIN
LOCAL - BURSITIS, TENOSYNOVITIS, ENTHESOPATHIES
REGIONAL - MYOFASCIAL PAIN SYNDROME, MYOFASCIAL PAIN DYSFUNCTION SYNDROME, REFERRED PAIN SYNDROME, COMPLEX REGIONAL PAIN SYNDROME
GENERALIZED - FIBROMYALGIA SYNDROME, CHRONIC FATIGUE SYNDROME, HYPERMOBILITY SYNDROME
FIBROMYALGIA SYNDROME
CHRONIC SOFT-TISSUE PAIN STATE
FOUND MOSTLY IN WOMEN
AS AGE INCREASES, PREVALENCE INCREASES
GENERALIZED LOW PAIN THRESHOLD, TENDERNESS TO PALPITATION
DYSFUNCTIONAL SLEEP, FATIGUE, MORNING STIFFNESS, COGNITIVE DYSFUNCTION, DEPRESSION, ANXIETY, IBS, HEADACHE
MYOFASCIAL PAIN
REGIONAL BODY PAIN AND STIFFNESS WITH LIMITED RANGE OF MOTION TO AFFECTED MUSCLES
TWITCH RESPONSE AT TRIGGER POINTS CAUSES REFERRED PAIN
PAIN RESOLVED BY ANESTHETIZING TRIGGER POINTS
VISCERAL PAIN
ORGAN INSULT THAT INVOLVES BILATERAL SPINAL, THORACIC, AND MOST ABDOMINAL ORGAN’S VAGAL AFFERENT ORGANS
DIFFUSE AND POORLY LOCALIZED
RESPOND TO CHEMICAL AND MECHANICAL STIMULI - INFECTIONS OR ULCERS
STIMULI REQUIRED FOR VISCERAL PAIN = DISTENTION OF HOLLOW ORGANS, TRACTION ON THE MESENTARY, ISCHEMIA, AND CHEMICALS ASSOCIATED WITH INFLAMMATORY PROCESSES
ASSOCIATED WITH EMOTIONAL AND AUTONOMIC RESPONSES AS WELL AS EXCESS SOMATIC ACTIVITY
PHANTOM LIMB PAIN
PHENOMENA EXPERIENCED BY ALMOST ALL AMPUTEES
70% OF THEM EXPERIENCE PHANTOM LIMB PAIN = PAIN THAT IS INTERMITTENT AND DECLINE IN SEVERITY WITH TIME
TELESCOPIC PAIN = PAIN IN HAND WHEN ARM IS AMPUTATED, PAIN CAN TELESCOPE TO UPPER LIMB
REORGANIZATION OF SOMATOSENSORY CORTEX HAS TO OCCUR
CANCER PAIN
TUMOR GROWTH CAN DAMAGE NERVE FIBERS (INCREASES IN RISK WITH THE PROGRESSION OF THE DISEASE)
2 WAYS PAIN IS INITIATED:
1.) SURGERY, RADIATION THERAPY, CHEMOTHERAPY => DYSFUNCTION OF SENSORY OR SYMPATHETIC NERVE FIBERS
2.) CANCER CELLS AND STROMAL CELLS RELEASE PROTONS, BK, PRG, ENDOTHELINS, AND PROTEASES THAT CAN STIMULATE PAINFUL INFLAMMATORY RESPONSES
