פיזיולוגיה של הכאב מבוא

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הרצאת מבוא לקורס פיזיולוגיה של הכאב והטיפול ב-Trigger points. - רקע נוירואנטומי ונוירופיזיולוגי - אפיון כאב - Trigger points, פתופיזיולוגיה - פרמקולוגיה של הכאב

Saúde e medicina

NOCICEPTORS–
NC
SKIN NOCICEPTORS
JOINT NOCICEPTORS
VISCERAL NOCICEPTORS

Mechanoreceptor
Thermo receptor
Chemo receptor
Polymodal receptor
SKIN NOCICEPTORS

(Silent NC)
Golgi Tendon organ
Muscle spindle
Chemo receptorNeuropeptides, Substance P, CGRP*
Polymodal receptor
JOINT NOCICEPTORS
*CGRP: Calcitonin gene-related peptide
PROPRIOCEPTION

SOMATOSENSORY CORTEX
Penfield Homunculus (1951)

Ascending pathwaysDescending pathways
Detection
Deduction
Transduction
Modulation
Perception
Pain Modulation
)
Morphine receptors
(Brain and digestive tract)
Dynorphin, Endorphine,
Endomorphine, Nociceptine

Pain location Prev
HEADACHE 40%
ABDOMINAL 23%
BACK 39%
NECK 31%
SHOULDER 29%
HAND/WRIST 23%
HIP/KNEE 28%
ANKLE/FOOT 17%
Windt et al. 2008
-

.1
-
-
Merskey 1979; Merskey and Bogduk 1994; van Tulder et al. 1997

MYOFASCIAL TRIGGER POINT
Janet G. Travell – 1942
Clinical definition

MYOFASCIAL TRIGGER POINT
Janet G. Travell – 1942
Taut band–
Etiological definition

MYOFASCIAL TRIGGER POINT
Central Tp’Satellite Myofascial Tp’
(secondary Tp’)

MYOFASCIAL TRIGGER POINT
Dry Needling
-Central Tp’
Shah et al.– Dry needling for MTrp’ - 2008
.1–
.2–
-Fast twitch

Cell damage * Vasodilatation  Edema
** Hyperalgesia  Muscle contraction  Ischemia
* Cell damage  Arachidonic acid + Cycloxygenase (COX) = Prostaglandin
INFLAMMATION
**Prostaglandin = PAIN

* Cell damage  Arachidonic acid + Cycloxygenase (COX) = Prostaglandin
**Prostaglandin = PAIN
COX 1
–
COX 2

PARACETAMOL (Acetaminophen
Analgetics
Acamol, Dexamol, Paramol, Aldolor

IBUPROFEN
Nsaid’s / non selective COX
COX inhibitor
-COX
Neurofen, Adex, Advil, Artofen, Diclofenac

ETORICOXIB
Nsaid’s / non selective COX
COX 2 inhibitor
-COX 2
Etodolac, Etopan

ETODOLAC
Nsaid’s / selective COX
COX 2 inhibitor
-COX 2
Arcoxia, VIOXX (Rofecoxib)

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2. - - -Trigger point - -

4. NOCICEPTORS– NC SKIN NOCICEPTORS JOINT NOCICEPTORS VISCERAL NOCICEPTORS

5. Mechanoreceptor Thermo receptor Chemo receptor Polymodal receptor SKIN NOCICEPTORS

6. SKIN NOCICEPTORS

7. (Silent NC) Golgi Tendon organ Muscle spindle Chemo receptorNeuropeptides, Substance P, CGRP* Polymodal receptor JOINT NOCICEPTORS *CGRP: Calcitonin gene-related peptide PROPRIOCEPTION

8. JOINT NOCICEPTORS

9. VISCERAL NOCICEPTORS

10. VISCERAL NOCICEPTORS

11. THE PATHWAYS

12. SOMATOSENSORY CORTEX Penfield Homunculus (1951)

13. Ascending pathwaysDescending pathways Detection Deduction Transduction Modulation Perception Pain Modulation ) Morphine receptors (Brain and digestive tract) Dynorphin, Endorphine, Endomorphine, Nociceptine

14.

15. - - - - -

16. - - - - - - -

17.

18. Pain location Prev HEADACHE 40% ABDOMINAL 23% BACK 39% NECK 31% SHOULDER 29% HAND/WRIST 23% HIP/KNEE 28% ANKLE/FOOT 17% Windt et al. 2008 -

19. .1 .2 .3 .4

20. .1 - - Merskey 1979; Merskey and Bogduk 1994; van Tulder et al. 1997

21.

22.

23.

24. MYOFASCIAL TRIGGER POINT Janet G. Travell – 1942 Clinical definition

25. MYOFASCIAL TRIGGER POINT Janet G. Travell – 1942 Taut band– Etiological definition

26.

27. MYOFASCIAL TRIGGER POINT Central Tp’Satellite Myofascial Tp’ (secondary Tp’)

28. MYOFASCIAL TRIGGER POINT Dry Needling -Central Tp’ Shah et al.– Dry needling for MTrp’ - 2008 .1– .2– -Fast twitch

29.

30. Cell damage * Vasodilatation  Edema ** Hyperalgesia  Muscle contraction  Ischemia * Cell damage  Arachidonic acid + Cycloxygenase (COX) = Prostaglandin INFLAMMATION **Prostaglandin = PAIN

31. * Cell damage  Arachidonic acid + Cycloxygenase (COX) = Prostaglandin **Prostaglandin = PAIN COX 1 – COX 2

32. PARACETAMOL (Acetaminophen Analgetics Acamol, Dexamol, Paramol, Aldolor

33. IBUPROFEN Nsaid’s / non selective COX COX inhibitor -COX Neurofen, Adex, Advil, Artofen, Diclofenac

34. ETORICOXIB Nsaid’s / non selective COX COX 2 inhibitor -COX 2 Etodolac, Etopan

35. ETODOLAC Nsaid’s / selective COX COX 2 inhibitor -COX 2 Arcoxia, VIOXX (Rofecoxib)

36. - -– -- -

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