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Pain specialist since 2003
Anesthesiologist since 1986
Pain specialist to H.E.
Governor of Gujarat
Having private clinic and
attached to Apollo Hospitals,
Ahmadabad
Faculty in national and
international conferences
Authored a chapter in
textbook on pain

2. Dr Rajeev Harshe
MD (Anesthesiology)
Pain Consultant
Apollo Hospitals, Ahmadabad
(Hon. Pain consultant to H.E.Govorner of Gujarat)
Email: dr.harshe@gmail.com
Blog: drharshe.blogspot.in
Apollo Hospital
11 am to 5 pm
Consulting Room
―Relief‖ pain clinic
35/1,sector 2 A
Gandhinagar
9 to 11 am and 5 to 8 pm

3.  Stiff
muscle
 Palpable taut band in muscle
 Hyperalgesic muscle
 Pain which can be unbearable
 Pain not responding to analgesics
 Pain lasting for long times
 Emotional distress,Physical Distress

4.  Abnormal
muscle use
 Give away at ―critical load‖
 Spindle injured
 Initiation of cascade

5.  Deconditioning
caused by lack of exercise
 Inadequate muscle use
 Impaired posture
 General factors: Nutritional deficiencies,
electrolyte disorders, metabolic or endocrine
dysfunction, sleep disturbances, or other
concurrent illnesses.

6.  Trauma
and ischaemia of muscle leads to
Central sensitisation
 Supersensitivity in muscle leads to
Muscle shortening
 Muscle becomes sensitised to palpation; a
term sometimes referred to as allodynia or
myalgic hyperalgesia

7.  Injured
sarcomere – improper healing—
contracted state---trigger points
 Sympathetic innervation of intrafusal fibres
play role
 Uncontrolled contraction—ischemia—release
of autocoids--

8.  Energy
crisis theory
 Muscle spindle theory
 Motor end plate hypothesis

9.  Release
of calcium from injured sarcomeres—
sarcomere shortening—increased metabolism
and compromised local circulation
 Disparity…increased energy demand and
reduced energy supply due to impaired
circulation—ENERGY CRISIS--- release of
autocoids--pain

10.  Dysfunctional
muscle spindle—highly
localized electrical activity---this is
maintained by sympathetically mediated
factors like emotional stress

11. Neuro muscular junction region
cause of trigger activity
Supported by
1. Clinical effectiveness of botox
2. Electrical activity noted in triggers by EMG
community
3. Length of propagation of spike potential
along length of taut band

12. Dr Rajeev Harshe
MD (Anesthesiology)
Pain Consultant
Apollo Hospitals, Ahmadabad
(Hon. Pain consultant to H.E.Govorner of Gujarat)
Mobile: 9825252100