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  • Diane
    replied
    Her is another by the same researcher, June 2008:
    Sensory transduction in peripheral nerve axons elicits ectopic action potentials.
    Link.

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  • Diane
    replied
    I could easily point to a couple of books but isn't there a study out there about the rapid and significant effects of tension and blood flow in the nerve? Something I can rattle off as if I always knew it?
    I'm still looking for such a paper myself.
    Maybe Shacklock's book will list one or several..
    Meanwhile, I did a search for nervi nervorum lately, and found papers by Lundborg (from the 80's, not online) which look promising. I think his name cropped up quite a lot in both Shacklock and Butler's books.

    One that I was able to get was Rat Peripheral Nerve Components Release Calcitonin Gene-related Peptide and Prostaglandin E2 in Reponse to Noxious Stimuli: Evidence that Nervi Nervorum are Nociceptors.
    Not a very catchy title, I'm afraid..

    Link.
    Last edited by Diane; 05-09-2008, 06:12 PM.

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  • NateM
    replied
    Still, in this day and age; "I treat dysfunction, NOT pain."
    Gosh, not only is this pervasive, but it's emphasized to the Nth degree. I think most manual texts I've got (biomechanical as they are) and many course descriptions ALWAYS give this statement in some form or another.

    You mean, I'm supposed to help their pain issues, too??!! Ugh!

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  • Barrett Dorko
    replied
    Jon,

    Wonderful quote, and right on point here. Often I have to decide these days whether or not to bring a patient to the department or treat them in their room. In the late AM I find the environment among others (including staff) potentially threatening though it may happen that the possible encouragement from other patients will be lost if I don't bring them in. I also have to consider the day of the week and which staff may or may not be nearby.

    This is all part of the clinician's art, I think, and, like all art, its effect may be unknown to the one controlling its expression.

    I like Cory's "bottom up and top down" terminology and wonder if a therapist might craft a story to illustrate this complex relationship between mechanisms. As always, we need a story. Any ideas are appreciated.

    I was recently asked, "How do we know that neural tension exists and if it does when does it become clinically significant?" I could easily point to a couple of books but isn't there a study out there about the rapid and significant effects of tension and blood flow in the nerve? Something I can rattle off as if I always knew it?

    Leave a comment:


  • Jon Newman
    replied
    What percentage of the problem can we reliably consider the result of a central mechanism and what tells us that?--Barrett Dorko
    Barrett, your clarification

    Once I make it clear that the output of pain (the "problem") is the consequence of two mechanisms working in concert, most therapists will want tests that delineate one from the other. They will want some idea of how much each contributes so that they might devise a strategy to oppose it.--Barrett Dorko
    helped and reminded me of the following quote

    Whether a placebo-controlled trial can assess the contribution of various treatment components rests on the assumption that each treatment component has an additive effect. Only on this additive model can the observed effect be thought to be constructed from a series of components, each adding a discrete proportion of the observed efficacy. Treatment components may, however, have a more complex relationship. For instance, psychological and physical effects may interact with one another. An optimistic outlook may enhance the efficacy of a physical effect, and a physical effect may buoy a patient's optimism that a treatment is in fact working. This multiplicative relationship between treatment components would tend to undercut the ability of a trial to focus on particular components in isolation.
    From this paper

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  • Diane
    replied
    Bas, great post. Way to free associate.
    BB, great link to stroop test. Loved this bit:
    In fact this effect is so reliable that it has been used to catch spies. If a Russian agent is pretending to be American they can be tested to see if they exhibit the Stroop Effect for Russian words. If you cannot read a language, there will be no delay; if you can then you cannot avoid the delay.
    I think (regarding the peripheral/central issue) that it's important to remember that everything from dorsal horn in is central processing.

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  • BB
    replied
    Do you think that central and peripheral are mistaken in that they are attempting to use a description of a place when a description of a viewpoint would be more useful? Wouldn't bottom up and top down be a better description as it described the place from which you are viewing? Some scenes you can see better from above and others from below, but the top and bottom exist in both situations.

    More on top down/bottom up processing.

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  • Bas Asselbergs
    replied
    Ah. Thanks for that, Barrett.

    Funny that patients "get" this so much easier than many PTs. Lack of pre-drilled holes, filled with pre-chewed facts, I guess.

    Leading them away from too much deductive reasoning may require quite a feat: completely changing a focal point of their brain/mind attention. Present deductive thinking is SO mired in detail (details=knowledge in which PTs take great pride), and a simultaneous fear for complexity or chaos, that it is ripe for a magician to dazzle them.

    Re-setting the minds into a different mode of "looking, thinking, and seeing" will require a more profound (earthquake?) shake.

    When I talk to patients or insurance-agents about pain, I have to always begin with the basics. I suggest "pain is a personal neurological experience" that is seamlessly tied in with input from and output to the body. That it can vary form one day to the next, that stress can affect it enormously, that it can cause fear and fear can cause more pain behaviours which can cause more sensitivity to pain ..... Thankfully I have articles like Shacklock's to refer to.

    The hardest group to convince of the fuzzy neuromatrix approach to pain - any pain - acute or "chronic" - are my colleagues, who have a knee jerk reaction to pain. Still, in this day and age; "I treat dysfunction, NOT pain."
    These are the ones who will HAVE to have tests for the central and peripheral "components" - to unravel the little parts and assign values to each part. This type of thinking is how we were and are taught. Despite improvements - it still prevails.

    Ooops. A free association moment.

    Leave a comment:


  • Mary C
    replied
    I've started treating the few recent fractures I see as if the pain is of central origin. I the use light skin stretches for lymph drainage to calm the pain before I do anything else. Works like a charm so far. So much nicer for the patients than passive or active stretches of stiff joints. (It's so calming, I find myself nodding off at times.)

    Leave a comment:


  • nari
    replied
    Isn't this the old mind-body separation belief?
    Break a leg: pain, trauma, loss of function. Peripheral problem, treat peripherally. Even if it is recognised that pain originates in the brain, the analgesics take care of that. Mobilise as per protocol, and exercise.
    Fairly straightfoward peripheral issue, unlike CRPS...
    Until Oliver Sacks woke up one morning, (A Leg to Stand On) lost all contact with his ex-broken leg and wrote about it.

    What do we do? I think we have been trying for some years to clarify the peripheral/central thingy in the clinical scene. It's only when outcomes are not what PTs expect that central issues are considered. And moreover, the answer is still 'psychosocial', although I wonder how this gets categorised...

    Warning: Anecdote...
    My daughter in another state recently attended a highly-regarded PT for ongoing cervical-shoulder-ribcage pain. It has been intermittent since 1993 when she crashed on rollerblades. She was told that the tissues haven't healed and need 'healing' by taping for support, and specific exercise. She may well get better, but the words 'sensitivity' and 'defence' will not enter the dialogue, I'm sure. (As to why I haven't 'treated' her - one doesn't educate members of one's family- it's doomed for cynicism).


    Nari
    Last edited by nari; 04-09-2008, 04:19 AM.

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  • Barrett Dorko
    replied
    Bas,

    Perhaps I should restate that. Once I make it clear that the output of pain (the "problem") is the consequence of two mechanisms working in concert, most therapists will want tests that delineate one from the other. They will want some idea of how much each contributes so that they might devise a strategy to oppose it.

    In other words, they'll think as therapists commonly do, in my experience.

    What to do?

    Leave a comment:


  • Diane
    replied
    I am borrowing heavily here from Diane’s post here, including the brilliant writing by Shacklock attached there.
    Actually Barrett, you linked to the paper, not to anything I might have written (brilliant or not brilliant..).

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  • Chancellor Mobley
    replied
    Tell me, what does chronically and recurrently acute pain mean?
    Intermittent persistence.

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  • Bas Asselbergs
    replied
    But tissue damage does not cause pain when the nociceptive signal to the brain is interrupted. I.e. with epidural. Pain is always central.
    I am trying to get my head around "the problem" that Barrett mentions in the his bolded sentence.

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  • Barrett Dorko
    replied
    Chance,

    The first part of your answer is a wonderful example of how confusing and personally idiosyncratic these terms have become - nearly to the point of uselessness. Tell me, what does chronically and recurrently acute pain mean?

    Leave a comment:

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