Neurophysiology: There are two ways that nociceptive information reaches the central nervous system. One is the neospinothalamic tract for quick pain and two is the paleospinothalamic tract for slow pain that increases.
Neurophysiology Of Pain Part II
Intensity, Location & Quality of Pain…
… involve Spinothalamic and Trigeminal Pathways
The trigeminal pathway brings information from the face area.
The spinothalamic pathway brings information from the rest of the body.
Both these pathways project to the sensory cortex, which also receives information on innocuous stimuli such as touch, pressure and warmth via a separate pathway.
2 Pain Transmission Pathways For Location Intensity Quality
There is difference between the objective and subjective aspects of injury and pain.
Despite similar injury, people can differ in how much pain they feel.
Depending on the context, pain may not be felt despite injury, e.g. battlefield injury, during intense sports.
This suggests that there is a physiological mechanism that controls the transmission of nociceptive signals to the brain or modifies the interpretation of pain.
The pain control system can also explain the placebo effect.
Pain Modulation Pathway
Nerve signals are sent form the somatic sensory cortex and hypothalamus to the periaqueductal gray matter (PAG).
PAG sends signals to the parabrachial nucleus, medullary reticular formation, locus coeruleus, and Raphe neulei.
These in turn can control the in the transmission of nociceptive signals from the spinal cord to the brain.
This involves different involves different neurotransmitters.
Endogenous Opioids
Internally produced molecules with opioid-like action which regulate transmission of nociceptive signals.
Three classes of these molecules have been identified. All are peptide molecules
Enkephalins
Endorphins
Dynorphins
Despite these being powerful, endogenous modifiers of nociceptive signals, it has been difficult to produce and administer them in a way than can used in clinical practice.
Location Of Nerve Cells With Endogenous Opioid Receptors
In the spinal cord, endogenous opioids can prevent transmission between 1st order nerve cells (bringing signals from the periphery) and 2nd order spinal nerve cells that transmit the signals to the brain.
Also can prevent the increased synaptic efficiency, which plays a role in hyperalgesia.
Knowing the molecules involved in the �inflammatory soup� and how they are synthesized provides possible targets for pain reduction.
e.g. prostaglandins are produced by the COX enzyme. The activity of this enzyme is blocked by non-steroidal anti- inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac.
Allodynia
A condition when normally non- painful stimuli cause pain, e.g., touch, light pressure, cold.
Involves changes in the synaptic sensitivity of the nociceptive neurons in the spinal cord (central sensitization).
Drugs such as ketamine, block NMDA receptors and so reduce transmisison of the nociceptive stimuli.
Gate Control Theory of Pain
Mother says to child, �Come I will rub the area which is painful and this will make it feel better.�
After stubbing a toe, we instinctively rub the area; this reduces the sensation of pain.
Ronald Melzack and Patrick Wall in 1962 provided an possible explanation for this effect.
Ascending Tracts | Pain Modulation: Gate Control Theory
Gate Theory
Rubbing the area that hurts stimulates receptors of innocuous stimuli like touch, pressure and vibration.
These mechano-receptors send signals along the A? nerve fibers that:
(1) stimulate spinal nerves (inhibitory inter-neurons) that in turn inhibit signaling in the 2nd order neurons (projection neuron) and (2) directly inhibit the 2nd order neuron to reduce or stop pain signal from being sent to the brain
Transcutaneous Nerve Stimulation (TENS) is based on the Gate Control Theory. Nerves of the innocuous sensory system are stimulated and they in turn, inhibit transmission of nociceptive stimuli in the spinal cord.
Abnormalities Of Pain System
Phantom Pain
Patients with amputation often have burning or tingling pain in the body part removed.
One possible cause is that nerve fibers at the stump are stimulated and the brain interprets the signals as originating in the amputated portion.
The other is the rearrangement within the cortical areas so that area say for the hand now responds to signals from other parts of the body but still interprets them as coming for the amputated hand.
Peripheral Sensitization
Peripheral sensitization represents a reduction in the threshold and/or an increase in magnitude of responsiveness at the peripheral ends of sensory nerve fibers.
This occurs in response to chemical mediators released by nociceptors and non-neuronal cells (e.g. mast cells, basophils, platelets, macrophages, neutrophils, endothelial cells, keratinocytes and fibroblasts) at the site of tissue injury or inflammation.
Basically, it is an increased sensitivity to an afferent nerve stimuli.
Central Sensitization
Peripheral & Central Sensitisation
A condition of the nervous sytem that is associated with the development and maintenance of chronic pain.
Known as �wind-up� or persistent high reactivity.
�Plastiticity in pain pathways� or the persistence of pain even after an injury has healed.
Is this negative or positive plasticity?
Central Sensitization & C Fibers
Two Main Characteristics Of Central Sensitization:
� Allodynia � occurs when a person experiences pain with things that are normally not painful, ie, soft touch causes pain.
� Hyperalgesia � occurs when a stimulus that is typically painful is perceived as more painful that it should be, ie, a simple bump.
Both are due to hyperreactivity of the nervous system.
Neurophysiology of pain: Pain�defined is the unpleasant sensation that accompanies injury or near injury to tissues, though it can also occur in the absence of such damage if the nociception system is not functioning. Nociception means the system that carries pain signals of injury from the tissues. This is the physiological incident that comes with pain.
Neurophysiology Of Pain
Objectives
Basics of the nervous system
Synaptic function
Nerve impulses
Transduction of peripheral painful stimuli
Central pathways
Central Sensitization
PeripheralSensitization
Control or modulation of pain signals
Pathophysiology of pain signaling pathway
Definition Of Pain
“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.
It is important to know the basic structure of the nervous system.
This will help in:
� Understanding the mechanism by which nociceptive signals are produced.
� Know the different regions of the nervous system involved in processing these signals.
� Learn how the different medications and treatment for pain management work.
Nervous System
Central nervous system (CNS)
Brain and Spinal Cord
Peripheral Nervous System (PNS)
Nerve fibers go to all parts of the body.
Send signals to the different tissues and send signals back to the CNS.
Nerve Cells
The nervous system is made up of nerve cells which send long processes (axons) to make contact with other cells.
Nerve Cell-To-Nerve Cell Communication
Nerve cells communicate with other cells by releasing a chemical from the nerve endings � Neurotransmitters
Basic Steps In Synaptic Transmission
Synaptic Transmission
Steps in the passage of signal from one nerve cell to other.
Drugs are used to block the transmission of signals from one nerve cell to other.
These drugs can effect:
Ca2+ ion channel to prevent Ca2+ inflow which is essential for neurotransmitter (NT) release, e.g., the action of gabapentin.
Release of NT.
Prevent NT from binding to its receptor so stop further transmission of the signal.
Electrical Impulse
Signals move along a nerve process (axon) as a wave of membrane depolarization called the Action Potential.
The inside of all nerve cells has a negative electrical potential of around � 60 mV.
When stimulated this negative electrical potential becomes positive and then negative again in milliseconds.
The action potential moves along the nerve process (axon) to the nerve ending where it cause release of NT.
Action Potential
When there is no stimulation the membrane potential is at its Resting Potential.
When stimulated, channels in the nerve membrane open allowing the flow of sodium ions (Na+) or calcium ions (Ca2+) into the nerve or cell. This makes the inside less negative and in fact positive -the peak of the action potential (+40 mV).
These channels than close and by the opening of K+ channels the membrane potential returns to its resting level.
Stopping Action Potentials To Stop Nociceptive Stimuli
Nociceptive stimuli are those that will create a sensation of pain after they are processed in the CNS.
Nociceptive signals can be prevented from reaching the CNS by blocking the action of the channels that control the movement of ions across the nerve membrane.
A number of anesthetic agents stop Na+ channel from working and hence stop the generation of actions potentials and transmission of signals to the CNS.
Sensory Systems
The sensory system that can be divided into two divisions:
A Sensory System that transmits innocuous stimuli such as touch, pressure, warmth.
A System that transmits stimuli that indicate that tissues have been damaged = nociceptive .
These two systems have different receptors and pathways in the PNS & CNS
Nociceptors are free nerve endings that respond to stimuli that can cause tissue damage or when tissue damage has taken place.
Present in membrane of free nerve endings are receptors (protein molecules) whose activity changes in the presence of painful stimuli.
(Note the use of the same term receptor is used for cell or organs or molecules that involved in transduction of a stimuli.)
Transduction
Transduction is the process of converting the stimuli into a nerve impulse.
For this to occur the flow of ions across the nerve membrane has to change to allow entry of either Na+ or Ca2+ ions to cause depolarization of the membrane potential.
This involves a receptor molecule that either directly or indirectly opens the ion channels.
Chemical Agents…
… which can cause the membrane potential at the free nerve ending (nociceptor) to produce an action potential.
Many stimuli � mechanical, chemical and thermal � give rise to painful sensation making transduction a complex process.
Recently receptor molecules have been identified�� Transient Receptor Potential (TRP) channels � that respond to a number of strong stimuli.
TRP receptors are also involved in transmitting the burning sensation of chili pepper.
In time, drugs that act on these receptors will be developed to control pain.
Different TRP Channels
Capsasin, the active ingredient in chili pepper, is used in patches for relief of pain.
Menthol and peppermint gels are used to relieve muscle pain.
Motor Output & Sensory Input To Spinal Cord
Sensory nerves have their cell body outside the spinal cord in the dorsal root ganglia ( = 1st order neurons).
One process goes to the periphery, the other goes to the spinal cord where it makes synaptic contact with nerve cells in the spinal cord ( = 2nd order neurons).
The 2nd order neuron sends processes to other nerve cells in the spinal cord and to the brain.
2nd Order Nerve Cells Send Nerve Fibers In The Spinal Cord White Matter
Transmission Of Nociceptive Signals From The Periphery To The Brain
Silverthorn
A Delta (?) & C Nerve Fibers
Nerve fibers are classified according to the:
� (1) diameter of the nerve fiber and
� (2) whether myelinated or not.
A? and C nerve fiber endings respond to strong stimuli.
A? are myelinated and C are not.
Action potentials are transmitted 10 times faster in the A?
(20 m/sec) fibers than in C fibers (2 m/sec).
A? & C fibers
A? fibers respond mainly to mechanical and mechno-thermal stimuli.
C fibers are polymodal, i.e. the nerve ending responds to several modalities � thermal, mechanical and chemical
This polymodal ability is due to the presence of different receptor molecules in a single nerve ending.
Fast & Slow Pain
Most people when they are hit by an object or scrape their skin, feel a sharp first pain (epicritic) followed by a second dull, aching, longer lasting pain (protopathic).
The first fast pain is transmitted by the myelinated A? fibers and the second pain by the unmyelinated C fibers.
Central Pain Pathways
Nociceptive signals are sent to the spinal cord and then to different parts of the brain where sensation of pain is processed.
There are a pathways/regions for assessing the:
Location, intensity, and quality of the noxious stimuli
Unpleasantness and autonomic activation (fight-or-flight response, depression, anxiety).
Dr. Sletten Discussing Central Sensitization Syndrome (CSS)
Pain perception varies across different people based on their mood, psychological condition and previous experience, even when pain is brought on by similar physical stimulation and ends in a similar level of damage. In 1965, Ronald Melzack and Patrick Wall summarized a scientific theory about the psychological influence on pain perception; known as the gate control theory.
If it wasn’t for this theory, pain perception would still be connected to the intensity of the pain stimulation and the degree of damage caused to the affected tissue. But Melzack and Wall made it clear that pain perception is far more complicated than we believe.
Based on the gate control theory, pain signals aren’t free to travel to the brain as soon as they’re generated in the region of the damaged or injured tissues. These first need to encounter specific neural gates found at the level of the spinal cord level, where these gates ascertain whether the pain signals should reach the brain or not. To put it differently, pain is perceived when the gate gives way to the pain signals and it is not as intense or it is not sensed at all when the gate closes for the signs to pass through.
This theory provides the explanation for why people find relief by massaging or rubbing a damage, injured or painful site. Although the gate control theory cannot demonstrate the whole picture of the fundamental system which underlies pain, it’s visualized the mechanism of pain perception and it has created a pathway to various pain management treatment approaches.
Nerve Fibers in Transmission of Sensory Signals
Every organ, or portion of the human body, has its own nerve supply which are in charge of carrying electric impulses generated in reaction to several senses, such as touch, temperature, pressure and pain. These nerves, which make up the peripheral nervous system, transmit these sensory signals, to the central nervous system, or the brain and the spinal cord. These impulses are then translated and perceived as senses. The peripheral nerves send signals to the dorsal horn of the spinal cord and from there, the sensory signals are transmitted into the brain through the spinothalamic tract. Pain is a sensation which alarms a person that a tissue or certain portion of the human body has been damaged or injured.
Due to their axonal diameter and their conduction speed, nerve fibers can be categorized into three different types, nerve fibers A, B and C. The C fibers are considered to be the smallest among the three different types. Moreover, there are four subtypes within the A fibers: A-alpha, A-beta, A-gamma and A-delta. From the A fiber subtypes, the A-alpha fibers are the largest and the A-delta fibers are the smallest.
The A fibers which are larger compared to the A-delta fibers, carry sensations, such as touch, pressure, etc., into the spinal cord. The A-delta fibers as well as the C fibers carry pain signals into the spinal cord. A-delta fibers are faster and carry sharp pain signals while the C fibers are slower and carry diffuse pain signals.
When thinking about that the conduction velocity of nerve fibers, the A-alpha fibers, which are the biggest A nerve fibers, have greater conduction speed compared to A-delta fibers and C fibers, which are considered to be the smallest nerve pathways. When a tissue is damaged or injured, the A-delta fibers are activated first, followed by the activation of the C fibers. These nerve fibers have a tendency to carry the pain signals to the spinal cord and then to the brain. However, the pain signals are transmitted through a much more complex process than what is simply explained above.
The gate control theory implies that the sensory signals or impulses which are transmitted by the nerve fibers encounter neural gates at the level of the spinal cord and these will need to get cleared through those gates to reach the brain. Various factors determine how the pain signals ought to be treated in the neurological gates, including:
The intensity of the pain signals
The degree of another sensory signal, such as touch, temperature and pressure, if produced at the site of damage or injury
The message from the brain itself to deliver the pain signals or not
As previously mentioned, the nerve fibers, both large and small, carrying the sensory signals, end in the dorsal horn of the spinal cord from where the impulses are transmitted into the brain. According to the original postulate of Melzack and Wall, the nerve fibers project to the substantia gelatinosa, or SG, of the dorsal horn and the initial central transmission (T) cells of the spinal cord. The SG consists of inhibitory interneurons that behave as the gate and ascertain which sensory signals should get to the T cells then go further throughout the spinothalamic tract to finally reach the brain.
When the pain signals carried by the small nerve fibers, or the A-delta fibers and the C fibers, are somewhat less intense compared to another non-pain sensory signal like touch, temperature and pressure, the inhibitory neurons stop the transmission of the pain signals through the T cells. The non-pain signals override the pain signals and therefore the pain is not perceived by the brain. When the pain signals are somewhat more intense compared to the non-pain signals, the inhibitory neurons are inactivated and the gate is opened. The T cells transmit the pain signals into the spinothalamic tract which carries those impulses to the brain. As a result, the neurological gate is influenced by the relative amount of activity from the large and the small nerve fibers.
How Emotions and Thoughts Affect Pain
The gate control theory also suggests that the pain signal transmission could be affected by thoughts and emotions. It’s well known that people do not feel that a chronic pain or, more appropriately, the pain does not disturb them if they concentrate on other activities which interest them. Whereas, people who are depressed or anxious may often feel intense pain and can also find it challenging to cope with. This is due to the fact that the brain sends messages through descending nerve fibers which stop, reduce or enhance the transmission of pain signals through the gate, depending on the emotions and thoughts someone may be going through.
Gate Control Theory in Pain Management
The gate control theory has caused a radical revolution within the field of pain management. The theory suggested that pain management can be accomplished by influencing the larger nerve fibers that carry non-pain stimulation. The concept has also paved way for more research on cognitive and behavioral strategies to achieve pain relief.
Among the most tremendous advances in pain management research is the arrival of Transcutaneous Electrical Nerve Stimulation (TENS). The gate control theory forms the cornerstone of TENS. In this procedure, the selective stimulation of the large diameter nerve fibers taking non-pain sensory stimulation from a particular region nullifies or reduces the impact of pain signals from the region. TENS is a non-invasive and affordable pain control strategy that has been widely used for the treatment of chronic and intractable pain by various healthcare professionals, which may otherwise have been non-responsive to analgesics and surgical interventions. TENS is tremendously advantageous over pain drugs from the aspect that it does not have the problem of medication interactions and toxicity.
For instance, many doctors of chiropractic, or chiropractors, utilize TENS and other electrotherapeutic procedures in their practice. These are generally utilized along with spinal adjustments and manual manipulations to increase circulation as well as to aid in the support of chiropractic care. Several other invasive and noninvasive electrical stimulation techniques are discovered to be helpful in several chronic pain conditions such as arthritic pain, diabetic neuropathy, fibromyalgia, etc.. The theory has also been extensively studied in treating chronic back pain and cancer pain. However, favorable results are not attained in some conditions and the long term efficacy of these techniques based on the theory still remains under consideration.
Dr. Alex Jimenez’s Insight
Chiropractic care is widely utilized to benefit patients with chronic pain. Symptoms of persistent pain and discomfort have become a big health issue in the United States where many years of research have found that drugs and/or medications are not necessarily a solution to the problem. The gate control theory, which was first proposed over half a century ago, has offered healthcare professionals new insights on the perception of pain, providing a variety of pain management treatment methods, such as the use of transcutaneous electrical nerve stimulation, or TENS, as well as other electrotherapeutic procedures. Chiropractors can help with pain management through spinal adjustments and manual manipulations, and through the use of TENS.
Nevertheless, the gate control theory has radically revolutionized the area of pain research and it has achieved to get numerous studies which aim at presenting a pain-free lifestyle into the patients who suffer from chronic pain. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Malik Decquir is an athlete who has learned how to accomplish anything he sets his mind to through chiropractic rehabilitation. The trainer’s at Push have taught Malik never to give up, always being there to help him achieve his fitness goals and offering nutritional as well as fitness advice when he needs it. Malik Decquir has found tremendous mental and physical support with the trainers at Push.
Chiropractic Rehabilitation
Sports medicine, also referred to as sport and exercise medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to exercise and sports. Although most sports clubs have used team doctors for several years, it is only because the late 20th century that sports medicine has emerged as a distinct field of healthcare in order to help treat sports injuries.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
Integrated: Brian Filidor is an aspiring wrestler who’s had a life-changing experience through chiropractic and agility training with Dr. Alex Jimenez. Over a variety of lifestyle modifications, Brian Filidor has achieved a higher conditioning, including improved performance in his strength, reaction time and overall health. Brian Filidor appreciates the help of all the trainers towards helping him become a better athlete.
Integrated Chiro & Rehab
Physical fitness is a state of health and well-being and, more specifically, the capacity to perform aspects of sports, jobs and daily activities. Physical fitness is usually accomplished through proper nourishment, moderate-vigorous physical exercise, and adequate rest. Fitness is defined as the quality or state of being healthy.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
Back Pain Specialist: Mike Melgoza is a very active person who is always engaging in physical activity, as a result, he occasionally suffers from debilitating back pain symptoms. Mike Melgoza was struggling to sleep properly due to his symptoms of back pain before receiving chiropractic care with Dr. Alex Jimenez. Mike Melgoza has already started experiencing tremendous relief from his back pain and he highly recommends Dr. Alex Jimenez as the non-surgical choice for back pain.
Back Pain Specialist
Back pain is one of the most common reasons people visit the doctor or miss work and it is also a leading cause of disability globally. The majority of people have back pain at least once throughout their lifetimes. Luckily, you can take steps to prevent or relieve back pain. If prevention fails, easy treatment and appropriate body mechanics frequently will heal your back in a few weeks and keep it operational for the long haul. Surgery is rarely required to treat back pain.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
Patellofemoral Syndrome: As the weather warms and spring is in full swing, more and more runners are heading outside, hitting the pavement to train for upcoming races or to just step up their game after a long winter. While there are some die hard runners who don�t let even the most brutal winter stop them, most tend to retreat indoors, waiting for warmer days and a more pleasant environment. Unfortunately, increased activity can also lead to an increased risk of injury, particularly patellofemoral pain syndrome (PFPS), also known as runner�s knee.
What Is Patellofemoral Pain Syndrome?
Runner�s knee is often used to describe PFPS, but runner�s knee is actually a broader term describing several different knee injuries or ailments. PFPS is a painful condition that is caused when the tissue that is between the femur (thigh bone) and the patella (kneecap) becomes inflamed or irritated.
Most people will notice pain in the front portion or anterior part of the knee, but pain can be experienced in other parts of the knee and even back pain may occur. Running increases the discomfort, as does sitting for long periods and going up or down stairs.
The causes of PFPS can also vary widely. Overuse is often the first thing that people think, but a problem with the way the knee is aligned is actually the most common reason.
If the patella is not properly aligned, when it moves through the groove that is at the end of the femur, it causes irritation to the surrounding tissues. This usually happens because the muscles and joints are out of balance.
For instance, if the quad muscle on one side is weaker than the other side it throws the entire system out of balance, causing the knee to become misaligned. This leads to knee pain and discomfort.
Treatment For Patellofemoral Syndrome – Runner�s Knee
When treating PFPS, rest is usually first on the list, followed by icing the area to reduce inflammation. Once the pain is under control, the next step is to determine what is causing the problem. It is important to rule out more serious conditions or injuries first in order to determine the best course of treatment.
If it is indeed PFPS, strengthening the muscles in and around the knee is generally the first step in treatment. It is important that the muscle strength is balanced so that the knee can be properly aligned. Getting a good pair of running shoes is also recommended so that future injury can be prevented.
Chiropractic For Runner�s Knee
Runner�s knee, or PFPS, responds very well to chiropractic treatment. The chiropractor is able to do a complete exam and find the cause of the problem, then tailor the treatment accordingly. This is typically done on a case by case basis with treatment that is based on the individual�s unique needs. The chiropractor may do various chiropractic alignments and manipulations on the spine, hip, ankle, and knee in order to bring the body back into proper balance.
The chiropractor may also recommend other complimentary treatments including special supplements, dietary adjustments, and an exercise plan. The chiropractor may also recommend certain stretching exercises to aid in healing. Kinesio taping is another common treatment that may be used in conjunction with chiropractic care. It is particularly beneficial when there is a muscular strength imbalance. The tape can help support the weaker muscle group.
Chiropractic care is a very effective treatment for patellofemoral syndrome and the associated knee pain. It works to correct the problem by bringing the body back into proper alignment, allowing it to function as it should.
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Brain Areas Involved In Processing Of Nociceptive Signals
The Anterior Cingulate & Insula Cortex Are Activated In Human Subjects
Adapted from Craig et al. 1994, 1996. From Principles of Neural Science, Kandell et al.
Inflammatory Soup – Hyperalgesia
Julius-D & Basbaum-AI, Nature 2001;413:203
Gate Control Theory of Pain
http://wikidoc.org/images/f/fe/Gate_control_A_firing.png
Abnormalities Of Pain System
Peripheral Sensitization
Somatosensory Cortex Organization
Cortical Reorganization
Neuroscience. 2nd edition. Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Fig 25.14
Nerve Cell-To-Nerve Cell Communication
Nerve cells communicate with other cells by releasing a chemical from the nerve endings � Neurotransmitters
TRP Channels
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