Physiological Effects Of Manual Therapy

Question 1

What happens in the neuroaxis when pain occurs?

Answer 1

• pain stimulus in peripheral tissues => activation of peripheral nervous system
• transmission to DH (dorsal horn) + spinal cord
• DH => activation of CNS at spinal cord => input => ascending up to brain stem then thalamus for routing
• nociception sent to thalamus => limbic system (remember+empotion) + neo-cortex (where)
• descending modulation from PAG + RVM (DNIC = descending noxious inhibitory control) => DH

Question 2

What is the goal of pharmacological pain TTT?

Answer 2

• increase inhibition by providing analgesia and decoupling nociception + pain
• prevent development of peripheral and central sensitisation
• restore normal responsiveness of nociceptive signalling

Question 3

Where do pain meds act on the nervous system?

Answer 3

• Amygdala = thoughts + beliefs + expectations + sleep + stress relief +mindfulness + reassurance + exx + microdosing + harmonics + hypnotherapy + breathing
• PAG (midbrain) = Opioids + NSAIDS
• RVM (medulla) = Opioids + Cannabinoids
• DRG = TCAs (Tricyclic anti-depressants) + Seratonin Noradrenaline Reuptake Inhibitors (SNRIs) + Selective Seratonin Reuptake Inhibitor + Alpha2 agonists + Opioids + stretching joint capsule + MET + pain gating + ST + HVT
• Peripheral = capsicum + topical analgesia + shockwave + ice + heat

Question 4

Name common analgesic meds

Answer 4

• TCAs = amitriptyline
• SNRI/SSRIs = Sertraline + citalopram + fluroxine (prozac)
• Opioids = codeine + morphine + fentanyl + tramadol
• NSAIDS = ibuprofen + naproxen + Diclofenac
• neuropathic pain meds = gabapentin + amitriptyline + duloxetine + pregabaline