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

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פיזיולוגיה של הכאב מבוא

  1. 1. - - -Trigger point - -
  2. 2. NOCICEPTORS– NC SKIN NOCICEPTORS JOINT NOCICEPTORS VISCERAL NOCICEPTORS
  3. 3. Mechanoreceptor Thermo receptor Chemo receptor Polymodal receptor SKIN NOCICEPTORS
  4. 4. SKIN NOCICEPTORS
  5. 5. (Silent NC) Golgi Tendon organ Muscle spindle Chemo receptorNeuropeptides, Substance P, CGRP* Polymodal receptor JOINT NOCICEPTORS *CGRP: Calcitonin gene-related peptide PROPRIOCEPTION
  6. 6. JOINT NOCICEPTORS
  7. 7. VISCERAL NOCICEPTORS
  8. 8. VISCERAL NOCICEPTORS
  9. 9. THE PATHWAYS
  10. 10. SOMATOSENSORY CORTEX Penfield Homunculus (1951)
  11. 11. Ascending pathwaysDescending pathways Detection Deduction Transduction Modulation Perception Pain Modulation ) Morphine receptors (Brain and digestive tract) Dynorphin, Endorphine, Endomorphine, Nociceptine
  12. 12. - - - - -
  13. 13. - - - - - - -
  14. 14. 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 -
  15. 15. .1 .2 .3 .4
  16. 16. .1 - - Merskey 1979; Merskey and Bogduk 1994; van Tulder et al. 1997
  17. 17. MYOFASCIAL TRIGGER POINT Janet G. Travell – 1942 Clinical definition
  18. 18. MYOFASCIAL TRIGGER POINT Janet G. Travell – 1942 Taut band– Etiological definition
  19. 19. MYOFASCIAL TRIGGER POINT Central Tp’Satellite Myofascial Tp’ (secondary Tp’)
  20. 20. MYOFASCIAL TRIGGER POINT Dry Needling -Central Tp’ Shah et al.– Dry needling for MTrp’ - 2008 .1– .2– -Fast twitch
  21. 21. Cell damage * Vasodilatation  Edema ** Hyperalgesia  Muscle contraction  Ischemia * Cell damage  Arachidonic acid + Cycloxygenase (COX) = Prostaglandin INFLAMMATION **Prostaglandin = PAIN
  22. 22. * Cell damage  Arachidonic acid + Cycloxygenase (COX) = Prostaglandin **Prostaglandin = PAIN COX 1 – COX 2
  23. 23. PARACETAMOL (Acetaminophen Analgetics Acamol, Dexamol, Paramol, Aldolor
  24. 24. IBUPROFEN Nsaid’s / non selective COX COX inhibitor -COX Neurofen, Adex, Advil, Artofen, Diclofenac
  25. 25. ETORICOXIB Nsaid’s / non selective COX COX 2 inhibitor -COX 2 Etodolac, Etopan
  26. 26. ETODOLAC Nsaid’s / selective COX COX 2 inhibitor -COX 2 Arcoxia, VIOXX (Rofecoxib)
  27. 27. - -– -- -

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