This document discusses central sensitization (CS), including its recognition and implications for physiotherapy. It defines CS and reviews evidence that CS can be assessed using questionnaires, quantitative sensory testing, and factors like temporal summation. Management of CS may include education, cognitive approaches, TENS, exercise and medications targeting central pain processing. The document provides tips for physiotherapists in managing patients with CS, such as using appropriate pressures and treatment windows, addressing pain behaviors and beliefs, and taking a multidisciplinary approach.
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
Tender points are areas of the body that experience different types of pain when pressure is applied to them.
A Trigger Point (TrP) is a hyperirritable spot, a palpable nodule in the taut bands of the skeletal muscles' fascia.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Concept given by Shacklock (modern concept) and Butler (old concept), a method of assessment as well as treatment of peripheral neurological system by physiotherapists.
Part-I: The current slideshow: theoretical aspect of neurodynamics.
Part-II: Assessment of peripheral nervous system on the basis of neurodynamic concepts: Date: 01/04/2020
Part-III: treatment part: Date: 03/04/2020
Part-IV: Self neurodynamics: 05/04/2020
Tender points are areas of the body that experience different types of pain when pressure is applied to them.
A Trigger Point (TrP) is a hyperirritable spot, a palpable nodule in the taut bands of the skeletal muscles' fascia.
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
In this presentation I have tried to explain in brief about pain management, different types of pain, its diagnostic criteria, its physiology, and its treatment approaches both pharmacological and non pharmacological
Pain is one of the most challenging problem in medicine and biology:
A challenge to the suffer --> learn live with pain.
A challenge to the physician --> seeks every possible means to help the patient
A challenge to the scientist --> who tries to understand the mechanism of terrible suffering.
It is also a challenge to society --> find financial to relieve or prevent the pain and suffering.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
3. Basics of Central sensitization(CS)
Neuro immunology
Recognition of CS
Implications for
physiotherapy/therapist(assessment/management/g
uidelines)
What Evidences say?
4. PAIN
“An unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage” ISAP (1979)
Pain is a noxious unwanted
perception
“Pain is subjective,
individual and modified by
degrees of attention,
emotional state and the
conditioning of past
experiences.” (Livingstone
1943)
5. PHYSIOLOGY OF PAIN
Receptors
A fibers – Localized and
quick type of pain C fibers
– Slow acting type of
pain(Peripheral Nervous
System)
Spinal Cord (Substantia
Gelatinosa)
Spinothalamic Tracts
(Lateral / Anterior)
Thalamus
Cerebral Cortex
(Somatosensory Cortex)
Influenced
by Limbic
system &
Reticular
formation
9. Pain sensitization
Primary hyperalgesia or peripheral pain sensitization
pain
Secondary hyperalgesia or central sensitization
Unimodal/polymodal
nociceptors
10.
11.
12. Central sensitization
Top down mechanisms Bottom up mechanisms
Augmentation of
responsiveness(Meyer et al
1995)
Altered sensory processing
(Staud et al.,2007)
Malfunctioning of descending
inhibitory system(Meeus et al.,
2008)
Potentiation of neuronal
synapses (zuho 2007)
Temporal summation of
secondpain or windup(Nijis
2007)
Pro inflammatory
cytokines(samad et al)
Prostoglandin
E2/cox-2
releasestressors
17. Glial cells-neuro immunology
Dr. Watkins, at the Headache Cooperative of the Pacific’s
2009 Winter Colloquium
Glial cell activation has been
demonstrated in every clinically
relevant animal model study to date,
including that of peripheral nerve
injury, bone cancer, multiple sclerosis
(MS), spinal cord injury, herniated
disks, low back pain, and migraine,
noted Dr. Watkins, Professor of
Psychology and Neuroscience at the
University of Colorado at Boulder.
“Targeting the glial cells and their
proinflammatory products doesn’t
make a patient analgesic, and it doesn’t
suppress all pain sensitivity. It simply
returns the pain to normal. It removes
the abnormal pain,
27. Clinical decision making
Diagnostic criteria
eg:
2010 PRELIMINARY DIAGNOSTIC CRITERIA (EXCERPT)
CRITERIA Diagnostic criteria for fibromyalgia if the following 3
conditions are met:
1.Widespread pain index (WPI) ≥7 and symptom severity (SS) scale score
≥5 or WPI 3 - 6 and SS scale score ≥9.
2.Symptoms have been present at a similar level for at least 3 months.
3.The patient does not have a disorder that would otherwise explain the
pain.
Biomarkers
Clinical testing of hyper algesia/allodynia
35. SCREENING TOOLS FOR
NEUROPATHIC PAIN.
Leeds Assessment of Neuropathic Symptoms and
Signs (LANSS)
Neuropathic Pain Questionnaire (NPQ)
Douleur Neuropathique en 4 questions (DN4)
pain DETECT
ID-Pain
36. Mechanisms-based classifications
of musculoskeletal pain
'Disproportionate, non-mechanical, unpredictable pattern
of pain provocation in response to multiple/non-specific
aggravating/easing factors', 'Pain disproportionate to the
nature and extent of injury or pathology‘
'Strong association with maladaptive psychosocial factors
(e.g. negative emotions, poor self-efficacy, maladaptive
beliefs and pain behaviours)‘
'Diffuse/non-anatomic areas of pain/tenderness on
palpation'. This cluster was found to have high levels of
classification accuracy (sensitivity 91.8%, 95% confidence
interval (CI): 84.5-96.4; specificity 97.7%, 95% CI: 95.6-99.0).
Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs
of centralsensitisation in patients with low back (± leg) pain.Smart KM1, Blake C Staines A, Thacker
M Doody C Man Ther.2012 Aug;17(4):336-44. doi: 10.1016/j.math.2012.03.013. Epub 2012 Apr 23
38. Guidelines
1. Assessment of pressure pain thresholds at sites
remote from the symptomatic site;
2. Assessment of sensitivity to touch during manual
palpation at sites remote from the symptomatic site;
and
3. Assessment of pressure pain thresholds during and
following exercise
Nijs J, Van Houdenhove B, Oostendorp R a B. Recognition of central
sensitization in patients with musculoskeletal pain: Application of
pain neurophysiology in manual therapy practice. Manual therapy
[Internet]. Elsevier Ltd; 2010 Apr [cited 2014 Feb 24];15(2):135–41.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/20036180
42. Behavioral/Cognitive Approaches
• Guided Imagery
• Systematic
desensitization
• Reframing
• Meditation
• Stress management
techniques – not as
effective as other
techniques
• Thinking about the pain
and expectations –
Bandura et al. (1987)–
an increase in
endorphines with
cognitive technique
43. How do placebos influence pain?
Patient’s expectation about the effects
of the treatment
Airily (2008) study of differential
effectives of placebo based on perceived
cost ($.10 v. $2.50)
http://www.npr.org/templates/story/story
.php?storyId=87938032
Classical conditioning
Patient’s may change behaviors
Physiological changes which inhibit
the experience of pain
44. 10khz medium
frequency current
has marked
discrimination
between motor and
pain threshold
Clinically we use
2and 4khz
equipments for
therapy
48. Chronic back pain cases
DAY(me
an/sd)
20HZSEN 2OHZM
OT
2OHZPAI
N
50
HZSEN
50HZMO
T
50HZPAI
N
100HZSE
N
100HZM
OT
100HZPA
IN
NPRS
one 4.4 6.25 10.8 4.75 6.6 11.2 4.75 6.6 11.5
5.05
thre
e
4.55 6.5 11.5 4.8 6.6 11.3 5.2 7.3 12.1 4.0
five 5.05 6.8 11.8 5.10 7 12 5.3 7.2 12.4 3.6
49. Response to 100 hz low
frequency current on
different groups
50. OA
Interventions such as cognitive-
behavioral therapy and neuroscience
education potentially target cognitive-
emotional sensitization (and descending
facilitation), and centrally acting drugs and
exercise therapy can improve endogenous
analgesia (descending inhibition) in patients
with osteoarthritis.
Phys Ther. 2013 Jun;93(6):842-51. doi: 10.2522/ptj.20120253. Epub 2013 Feb 7.
Pain treatment for patients with osteoarthritis and central sensitization.
Lluch Girbés E1, NijsJ, Torres-Cueco R, López Cubas C
51. Activity dependent treatments
in neuropathic pain
Treadmill running Electrical stimulation
,TR induced strong agonistic
effects in relieving pain. TR
reduced the levels of pro-
nociceptive factors such as
BDNF, NGF and GDNF in
DRG.
Combination of ES and
TR induced intermediate
levels suggesting an
optimal balancing of
treatment effects.
ES enhanced motor and sensory
reinnervation
ES speeded up expression of
BDNF and GDNF in DRG ., and
of BDNF and NT3 in the ventral
horn.
Exp Neurol.2013 Feb;240:157-67. doi:
10.1016/j.expneurol.2012.11.023. Epub 2012
Nov 30.Differential effects of activity
dependent treatments on axonal
regeneration and neuropathic pain
after peripheral nerve injury.Cobianchi
S1, Casals-DiazL, Jaramillo J, Navarro X
52. TENS
Positive study Negative study
Frequency-dependent
antihyperalgesic and
analgesic effects in humans.
No long-lasting analgesic
and antihyperalgesic effects
of a single TES treatment
(TES(60Hz) > TES(100Hz))
• Anesth Analg.2010 Nov;111(5):1301-7. doi:
10.1213/ANE.0b013e3181e3697e. Epub 2010 Jun 8.The analgesic
and antihyperalgesic effects of transcranial
electrostimulation with combined direct and
alternating current in healthy volunteers.Nekhendzy
V, Lemmens HJ, Tingle M, Nekhendzy M, Angst MS.
Tens influence on centrally
sensitized OAk patients may
be augmented to the input of
electrical stimuli.
Adverse therapy effect of
tens.
To increase treatment
effectiveness - identify a
subgroup of symptomatic
OAk patients, i.e., non-
sensitized patients.
Trials.2012 Feb 21;13:21. doi: 10.1186/1745-6215-13-
21.Effect of tens on pain in relation to central
sensitization in patients with osteoarthritis of
the knee: study protocol of a randomized
controlled trial.Beckwée D1, De Hertogh
W, Lievens P, BautmansI, Vaes P.
53. Acetaminophen, serotonin-reuptake inhibitor drugs,
selective and balanced serototin and norepinephrine-
reuptake inhibitor drugs, the serotonin precursor
tryptophan, opioids, N-methyl-D-aspartate (NMDA)-
receptor antagonists, calcium-channel alpha(2)delta (a2δ)
ligands, ketamine ,pragabalin,
duloxetine,transcranial magnetic stimulation.
+
transcutaneous electric nerve stimulation
(TENS), manual therapy and stress
management each target central pain processing
mechanisms in animals that – theoretically – desensitize
the CNS in humans
55. Tips
Treat acute pains at right times
The pain tolerance –can be improved/cs is
reversible
Get the pain control first then go for exercise
therapy
Use pressures sensibly
Use appropriate therapy windows when we use
electro physical agents.
Understand pain behaviours.
56. Pain can be triggered from normal
tissues(secondary hyperalgesia),not necessarily
psychogenic.
Pain has a learned component and produces
physical changes in CNS and musculoskeletal
system.
Education and learning(motor and cognitive)
plays important role
(AustJPhysiotherv45i2Shacklock)
A multidisciplinary approach to care of chronic
pain conditions is an absolute necessity
ensure that whichever treatment protocol is
utilized the treatments must not induce any
pain for the patient
57. APPROACH to CS
block or reduction of the nociceptive input from the injured areas
specific pharmacological intervention on the cord mechanisms
pharmacologic or psychologic interventions at supraspinal level
descending modulatory system
a multimodal physical therapy program
a clinician should use caution with generically prescribing exercise to
patients experiencing chronic pain.
psychosocial characteristics, such as inappropriate beliefs about pain, pain
catastrophizing, and/or depression may contribute to the mechanisms of
central sensitization.
58. Why deep tissues are
more frequently
affected in chronic pain
state?
Mirror-image pain
(pain or hyperalgesia in
unaffected side or area)
stress-induced
hyperalgesia
59. To provide a comprehensive treatment for
‘unexplained’ chronic pain disorders
characterized by central sensitization, it is
advocated to combine the best evidence
available with treatment modalities known to
target central sensitization
60. References
Woolf CJ. Central sensitization : Implications for the diagnosis and treatment of
pain. Pain [Internet]. International Association for the Study of Pain;
2011;152(3):S2–15. Available from: http://dx.doi.org/10.1016/j.pain.2010.09.030
Winkelstein B a. Mechanisms of central sensitization, neuroimmunology &
injury biomechanics in persistent pain: implications for musculoskeletal
disorders. Journal of electromyography and kinesiology : official journal of the
International Society of Electrophysiological Kinesiology [Internet]. 2004 Feb
[cited 2014 Feb 24];14(1):87–93. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/14759754
Nijs J, Van Houdenhove B, Oostendorp R a B. Recognition of central
sensitization in patients with musculoskeletal pain: Application of pain
neurophysiology in manual therapy practice. Manual therapy [Internet]. Elsevier
Ltd; 2010 Apr [cited 2014 Feb 24];15(2):135–41. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/20036180
Nijs J, Wilgen CPV, Oosterwijck JV, Ittersum MV, Meeus M. How to explain
central sensitization to patients with “ unexplained ” chronic musculoskeletal
pain : Practice guidelines. Manual Therapy [Internet]. Elsevier Ltd;
2011;16(5):413–8. Available from: http://dx.doi.org/10.1016/j.math.2011.04.005
Smart KM, Blake C, Staines A, Doody C. Self-reported pain severity , quality of
life , disability , anxiety and depression in patients classified with “ nociceptive ”,
“ peripheral neuropathic ” and “ central sensitisation ” pain . The discriminant
validity of mechanisms-based classifications of low back ( Æleg ) pain. Manual
Therapy [Internet]. Elsevier Ltd; 2012;17(2):119–25. Available from:
http://dx.doi.org/10.1016/j.math.2011.10.002
Smart KM, Blake C, Staines A, Thacker M, Doody C. Mechanisms-based
classifications of musculoskeletal pain : Part 3 of 3 : Symptoms and signs of
nociceptive pain in patients with low back ( Æleg ) pain. Manual Therapy
[Internet]. Elsevier Ltd; 2012;17(4):352–7. Available from:
http://dx.doi.org/10.1016/j.math.2012.03.002
Smart KM, Blake C, Staines A, Thacker M, Doody C. Mechanisms-based
classifications of musculoskeletal pain : Part 2 of 3 : Symptoms and signs of
peripheral neuropathic pain in patients with low back ( Æleg ) pain. Manual
Therapy [Internet]. Elsevier Ltd; 2012;17(4):345–51. Available from:
http://dx.doi.org/10.1016/j.math.2012.03.003
18. Smart KM, Blake C, Staines A, Thacker M, Doody C. Mechanisms-
based classifications of musculoskeletal pain : Part 1 of 3 : Symptoms and signs
of central sensitisation in patients with low back ( Æleg ) pain. Manual Therapy
[Internet]. Elsevier Ltd; 2012;17(4):336–44. Available from:
http://dx.doi.org/10.1016/j.math.2012.03.013
Kumar SP. Physical Therapy and Central Sensitization : Are We
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