4. DISCUSSION
The main finding of this study is that JM performed with a distinctive dose led to an immediate transient reduction in SBP, implying a sympatho-inhibitory effect. Thus, this disparate result contrasts with the prevailing theory that JM produces sympatho-excitatory effect (Kingston et al., 2014). Chiefly, we postulate that the dissimilar dosing employed in our study may largely explicate the divergent results. It is noteworthy that in practically all spinal JM studies (Kingston et al., 2014), the most widespread dosage employed was 60 seconds of JM followed by a 60-second rest. The current study, with resultant sympatho-inhibitory cardiovascular effects akin to a previously reported study (Yung et al., 2014), employed an oscillatory technique with a unique dosage of 5 bouts of 10 seconds, with 10 seconds rest in between each bout. This represents a substantial reduction in the duration of each bout and the rest time between bouts. Furthermore, the total duration and the total rest time are greatly reduced compared to the other conventional dosages. This implies that the dosage of spinal mobilization may be a critical factor for manual therapists to consider as it pertains to the resultant BP response.
A recent systematic review of Kingston et al. (2014) concluded that spinal JM largely leads to sympatho-excitation as the dominant paradigm of neurophysiological mechanisms underlying pain relief. Kingston el al. (2014) cited only 1 study that utilized the PA
Research has shown that there are several organizations and active advocates who are working on pain management problems to face this public health issue. The following establishments involve: The American Academy of Pain Medicine, Institute of Medicine, and American Pain Society and many for-profit and nonprofit organizations are also working at different level towards pain management. Most specifically, the IOM has been devoted to studying pain and its consequences on individuals, the healthcare system, as well as on government (IOM, 2011).
I have attached a recent research report published in the Cardiopulmonary Physical Therapy Journal. With our busy schedules at work and home we often have limited time to review journal articles. I proffer this information hoping to stimulate awareness, thought, and discussion among us. I hope to follow up with monthly articles throughout the year.
More recently discovered and less well understood, the 5-HT7 receptor in the spinal cord and thalamus appear to modulate nociception (Bannister, Lockwood, Goncalves, Patel, & Dickenson, 2017; Dogrul, Ossipov, & Porreca, 2009). Intrathecal injections of 5-HT were shown to have
Melzack and Wall published the Gate Control Theory (GCT). GCT proposed that the brain monitors activity generated by a gated circuit which is located in the dorsal horn of the spinal cord which can be regulated by activity carried by nociceptive as well as non-nociceptive afferents. It is thought that descending pathways from the brain ‘close the gate’ by inhibiting the projector neurons and diminishing pain perception (Braz et. al.,
The specific aim of this cross-sectional study is to improve pain outcome in patients with chronic idiopathic neck pain (CINP), providing foundational information for ultimately improving function and cutting costs. To do this, the study will examine how many visits of mobilization (hypothesis) affect the MCID on pain reduction for patients to begin exercising for functional gains. In addition,
“The picture of pain that emerges is that of a complex phenomenon involving factors to do with the nerves, learning, memory and emotions. It is no wonder that treating pain is still such a big challenge..” (Carstoniu, par. 6). One of the largest debates in the medical world revolves around a single word, pain. Everything about pain seems very simple when someone thinks about it as a sensation or a feeling. However, pain has many more sides than that. Pain is a disease, a feeling, and a symptoms. Pain is real and imaginary all at once. The meaning and effects of pain change according to who is experiencing it and the emotional bonds between those involved. Pain is a symptoms to those with a spinal cord injury, a disease to those with
The modern era in neuromodulation for the treatment of pain has started after the seminal work of Melzack and Wall, who described the so-called gate control theory (Melzack and Wall 1965). The first application of neuromodulation in a chronic pain patient was performed by Shealy in 1967 (Shealy, Mortimer et al. 1967). SCS has become a valuable method to treat chronic neuropathic pain. Traditionally, SCS consisted of an electrode placed on the dorsal columns of the spinal cord.
Pain in the central nervous system is a complex process that has been studied by many researchers. Pain is controlled by certain pathways in the CNS. One of these paths is descending serotonergic system (Millan, 2002). This route originated from the nucleus raphe Magnus (NRM). The main function of the NRM is mostly pain mediation; in fact it sends projections to the dorsal horn of the spinal cord to directly inhibit pain (Haines et al., 2013).
In this article by William Cheshire, he informs the audience of how the brain reacts during pain and how pain is then assessed. Researchers were able to identify a consistent neurologic signature that was specific to heat-induced pain. Areas of the brain that lit up included the thalamus, the posterior and anterior insulate, the secondary somatosensory cortex, the anterior cingulate cortex, and the periaqueductal grey. The researchers called this anatomical profile a “neurologic signature of physical pain.” Although this study was successful, the study examined only one type of pain. Most clinical pain syndromes are far more complex, perceptually and physiologically, especially in cases of chronic pain, which involves sensitization of pain
It is estimated that 20% of the European population suffer from chronic pain.1 The understanding of pain in research has considerably developed from the simplistic pain-gate theory.2,3 It is now understood that stimulation of peripheral nociceptors at high threshold triggers central pathways that travel via the lateral spinothalamic tract to the medulla and brainstem.4 Nociceptive information also arrives via spinoreticular and spinomesencephalic tracts; controlling autonomic, arousal and homeostatic responses.56 Sensory firing is just one influence to central pain processing. Cortical areas associated with emotional valence, memory, autonomic and motor control are all seen to activate during a pain experience supporting
There are two types of pain that can be distinguished by its durations, such as pain that is short lasting and it lasts from days to few weeks, which are known as acute pain (AP) and persisting pain that lasts over three months or more, which are known as chronic pain (CP) (Kramer-Kile, Osuji, Larsen, & Lubken, 2014; Lewis et al., 2014). The CP concept was chosen because the number of people experiencing Chronic Pain (CP) is increasing causing a decrease in people’s quality of life (QOL) and co-mortalities (Paul, Day, & Williams, 2016; Kramer-Kile, et al., 2014). Human body cannot be separate for its one entity. Thus, patients (Pts) with CP may arise from experience of both the Physical Pain(PP) and Psychosocial or Social Pain (PP/SP)
In the present study, both components of the ANS were assessed including the sympathetic and the parasympathetic nervous systems. The sympathetic nervous system was assessed by using the BP changes in response to postural changes and SSR. The parasympathetic nervous system was assessed by HR changes in response to postural changes [18].
Chronic pain and inflammation increases serotonin receptor density in the DRG and spinal cord (Bardin, 2011). Spinal 5-HT3 receptors in particular are implicated in central sensitization (Kayser et al., 2007; Zeitz et al., 2002). 5-HT3 antagonists relieve pain intensity in patients with FMS (Vergne-Salle et al., 2011; Wolf, 2000). While they do appear to play a role in decreasing acute pain in tail-flick and thermal plate tests in rats (Glaum, Proudfit, & Anderson, 1988) they also increase wind-up and sensitization, two phenomena that characterize FMS pain, and are most often associated with pronociceptive signaling (D'Mello & Dickenson, 2008; Suzuki et al., 2004). 5-HT3 receptors are believed to have an important role in supraspinal facilitation and hyperalgesia (Dogrul et al., 2009). These receptors enhance the release of nociception promoting substances such as substance P, calcitonin gene-related peptide, and neurokinin A (Bannister et al., 2009). Symptoms that
Second, this study also provides supporting evidence for endogenous modulation of pain based on fc changes compared cLBP in different pain condition with HC and within cLBP. Substantial evidence is accumulating to show that the striatum plays an important role in the endogenous modulation of pain.
Pain is something that connects all of us. From birth to death we can identify with each other the idea and arguably the perception of it. We all know we experience it, but what is more important is how we all perceive it. It is known that there are people out there with a ‘high’ pain tolerance and there are also ones out there with a ‘low’ pain tolerance, but what is different between them? We also know that pain is an objective response to certain stimuli, there are neurons that sense and feel pain and there are nerve impulses that send these “painful” messages to the brain. What we don’t know is where the pain