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פיזיולוגיה של הכאב   מבוא
 

פיזיולוגיה של הכאב מבוא

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הרצאת מבוא לקורס פיזיולוגיה של הכאב והטיפול ב-Trigger points. ...

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

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    פיזיולוגיה של הכאב   מבוא פיזיולוגיה של הכאב מבוא Presentation Transcript

    • - - -Trigger point - -
    • NOCICEPTORS– NC SKIN NOCICEPTORS JOINT NOCICEPTORS VISCERAL NOCICEPTORS
    • Mechanoreceptor Thermo receptor Chemo receptor Polymodal receptor SKIN NOCICEPTORS
    • SKIN NOCICEPTORS
    • (Silent NC) Golgi Tendon organ Muscle spindle Chemo receptorNeuropeptides, Substance P, CGRP* Polymodal receptor JOINT NOCICEPTORS *CGRP: Calcitonin gene-related peptide PROPRIOCEPTION
    • JOINT NOCICEPTORS
    • VISCERAL NOCICEPTORS
    • VISCERAL NOCICEPTORS
    • THE PATHWAYS
    • 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 .2 .3 .4
    • .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)
    • - -– -- -