Announcement

Collapse
No announcement yet.

Five Questions

Collapse
This is a sticky topic.
X
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • #16
    AIGS: Abnormal Impulse Generating Sites, ectopic firing sites. I think there is still confusion at our interpretive level about how they form or why, but they indicate that a nerve is in trouble and is firing wildly, and they are part of a "sensitization" sequence of events, where nocioception is turned up, spontaneous firing occurs, and pain is more readily felt. If you google AIGS with google scholar, you'll get a bunch of studies that talk about them.

    (Found the artwork with the google image tool. )
    Diane
    www.dermoneuromodulation.com
    SensibleSolutionsPhysiotherapy
    HumanAntiGravitySuit blog
    Neurotonics PT Teamblog
    Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
    Canadian Physiotherapy Association Pain Science Division Facebook page
    @PainPhysiosCan
    WCPT PhysiotherapyPainNetwork on Facebook
    @WCPTPTPN
    Neuroscience and Pain Science for Manual PTs Facebook page

    @dfjpt
    SomaSimple on Facebook
    @somasimple

    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

    “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

    "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

    "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

    Comment


    • #17
      From David's notes:

      AIGS or ectopia

      Pain and other symptoms from peripheral nerves must come from a change in sensitivity, number or organisation of receptors in the axolemma, or it can arise from innervated connective tissue of nerve. Concepte of ectopia fit neatly with the neurodynamic concepts.
      The neural pathway is designed for conduction only - generation of impulses occurs probably at the ends, or at the DRG. When sprouting occurs, or the myelin is damaged in some way, AIGS occur. When they do, the DRG becomes extremely anxious...

      Interestingly, the maximal firing can take up to 21 days to occur, but it is also possible for nerve injury to be symptomless for up to 14 days. Steroids can repair the damage; also remodelling (spontaneous) which occurs every 1-2 days.

      I presume that 'injury' may include mechanical deformation...

      So once we have identified an abnormal neurodynamic and proceded with whatever treatment is chosen, is our aim to calm down the DRG? By enhancing remodelling and/or decreasing ischaemic states? One would hope so.

      Nari
      Last edited by nari; 17-05-2006, 11:13 PM.

      Comment


      • #18
        First Question: What is the origin of the pain?

        How would you determine that?
        I suppose I would determine that by whether the person is able to alter their pain with movement or positioning. If not, manual therapy is unlikely to be of much benefit.
        "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

        Comment


        • #19
          I presume that 'injury' may include mechanical deformation...
          I think so too. The system is alerted to any decrease in oxygen levels by the chemoreceptors, part of the nervi nervorum/nocioception sensor array right on the nerves themselves, the sensory nervous system of the nerves. The DRGs get interested.. The nerve starts to "hurt..", sets up the AIGS. It isn't necessarily damaged yet (pain is just neurogenic not neuropathic), and the AIGS can be reversed with increased circulatory flow, which will;
          a) bring the preferred levels of oxygenation to the nerve, so the chemoreceptors go quiet, and;
          b) wash out all the neural metabolites.

          It's probably not 100% precisely accurate, but to patients I say that the AIGS on a nerve are like diaper rash on a baby; it needs fed, and cleaned, and changed, and that increased circulation/more motion(lotion) will do it all, will help provide the necessary factors to quiet down the system/help it dismantle the AIGS/heal the rash within a few days.
          Diane
          www.dermoneuromodulation.com
          SensibleSolutionsPhysiotherapy
          HumanAntiGravitySuit blog
          Neurotonics PT Teamblog
          Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
          Canadian Physiotherapy Association Pain Science Division Facebook page
          @PainPhysiosCan
          WCPT PhysiotherapyPainNetwork on Facebook
          @WCPTPTPN
          Neuroscience and Pain Science for Manual PTs Facebook page

          @dfjpt
          SomaSimple on Facebook
          @somasimple

          "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

          “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

          “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

          "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

          "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

          Comment


          • #20
            I think that is an important distinction; ie pain as a result of an AIGS developing is not necessarily neuropathic - but neurogenic.

            jon

            If ALL movement/positioning increases pain and nothing reduces it - does that imply manual therapy is not useful, or is it just the alteration of the pain experience that indicates MT would help?
            I'm thinking of the persistent pain people who have 24/7 pain and, fear avoidance aside, nothing improves the pain? Just curious.

            Nari

            Comment


            • #21
              Nari,

              Alteration, not elimination.

              Jon's post fits accurately and simply into this discussion, I think.

              Last time I talked to David Butler in person I told him that, to me, AIGs were represented by neural membranes that were more like lace and less like canvas. He didn't like this but didn't tell me why. Of course, I couldn't get him to listen to anything about ideomotion either. Guess he was too busy.

              This first question has generated plenty of discussion and has almost been answered - to my satisfaction anyway.

              The second question soon.
              Barrett L. Dorko

              Comment


              • #22
                Barrett

                I didn't suggest or imply elimination but I think I have answered my own question anyway.

                Comment


                • #23
                  Barrett,

                  The answer from Nic is, 'Yes, spontaneous discharge does occur in the absence of transduction. This may happen both within the DRG and the nerve axon.

                  Luke
                  Luke Rickards
                  Osteopath

                  Comment


                  • #24
                    So, four origins can be defended. The last two are probably the most difficult to alter rapidly with therapy though it's concievable that a carefully concieved program might succeed eventually.

                    The origin most likely to respond to the corrective movement Simple Contact reveals is mechanical deformation, of course (not that the others cannot be concurrent), so it's the one I want to know is present. A single question will reveal this.
                    Barrett L. Dorko

                    Comment


                    • #25
                      Chris,

                      Central deafferentation pain refers to pain related to central nervous system damage from stroke (often post-thalamic) or spinal cord injury. It is different to central sensitisation in that pain may be genearted in the absence of any peripheral input.

                      Luke
                      Luke Rickards
                      Osteopath

                      Comment


                      • #26
                        Nari (or whomever) what is DRG?

                        Dana

                        Comment


                        • #27
                          DRG- dorsal root ganglion
                          Luke Rickards
                          Osteopath

                          Comment


                          • #28
                            I think it's time for the second question: Are there any disease processes or pathological problems that are relevant to and might be responsible for your pain?

                            Obviously, this is no small issue. As I say to my classes, "I'm a PT and my ability to diagnose is severely limited. I depend upon my referral souces to answer this question and make no apologies for this limitation on my part."

                            Thoughts?
                            Barrett L. Dorko

                            Comment


                            • #29
                              Barrett,

                              I'm not sure, but I think what you are getting at is the relative uselessness/meaninglessness of PT diagnoses. The more I practice and learn, the more I would agree; if that is in fact your point.

                              You may also be hinting at the idea of "if nothing is wrong (in terms of true pathology), then do nothing". Simple as it sounds, I like it and have been trying to integrate it into my practice. Strangely, I find it quite satisfying to have a patient recover while I do essentially nothing.

                              Maybe I am way off on my assessment, but I'm trying to think like I think you would think. Someone let me know if I'm getting warm.

                              Wes

                              Comment


                              • #30
                                I have to admit that I rather enjoy having the process of labeling a disease and pathology done by someone intensively trained to do that. I think I could recognize if such a thing exists but I am not particularly interested in labeling it. Unless something requires careful restriction of movement, a special pill or surgery, most of those labels are not going to be particularly helpful in guiding what I do next. I suppose that last point is a bit redundant as I think Wes already addressed it.
                                "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                                Comment

                                Previously entered content was automatically saved. Restore or Discard.
                                Auto-Saved
                                x
                                Insert: Thumbnail Small Medium Large Fullsize Remove  
                                x
                                x

                                Please enter the six letters or digits that appear in the image below.

                                Registration Image Refresh Image
                                Working...
                                X