1) Biological organisms have sophisticated protective responses to threats, including pain. Pain is a conscious experience that motivates protective action in the entire organism, and is particularly well-developed in humans. 2) Opioid use can lead to hyperalgesia and neuropathic changes in the nervous system that sensitize pain pathways. Gradual tapering is recommended for treatment. There is no evidence opioids work better than placebo for chronic pain. 3) While opioid prescribing continues to increase, effective long-term drug therapies for pain are unlikely to emerge. Non-drug approaches may play a larger role in pain management and help reduce harms.

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Håndtering av mekanosensitivitet i klinikk?
- hvordan skape et klima hvor nevroner ikke gir faen hele tiden - Farmakologi
Generell
Aktivitet
Spesifikk
Aktivitet
Lage
mening
SMERTE
Biological organisms are proficient at protecting themselves from
threat. Seminal work more than a century ago clearly demonstrated
that even unicellular organisms can propel themselves away from
physical threat. The sophistication with which organisms can protect
themselves from threat increases in line with the sophistication of
the organism. Mammals are a fine case in point, with a protective
armory that includes monosynaptic motor responses, co-ordinated
polysynaptic motor responses, sympathetic, endocrine, local and
systemic immune responses. The most sophisticated response
however, one that is particularly well developed (and certainly well
studied) in humans, is a conscious experience that motivates the
entire organism to take drastic protective action. PAIN.
L. Moseley www.bodyinmind.org
2003 2011
2018
2017
Opioid indusert hyperalgesi
• Nosiseptive sensitivisering
gjennom eksponering til opioider
• Nevroplastiske endringer i PNF og
CNS som sensitiviserer og endrer
de nosiseptiske baner
• Være påpasselig når plager og
medisinbruk ikke lenger står i stil
• Behandling er å komme av
opioidene gradvis
Opioider i nevropatiske smerter
• Det finnes ingen bevis for at
opioider virker bedre enn
placebo i kroniske smerter
• Det er dog sterke bevis for en
mengde konsekvenser og
problemstillinger
• Være påpasselig når plager og
medisinbruk ikke lenger står i stil
• Behandling er å komme av
opiatene gradvis
However, opioid prescribing continues to increase despite clinical evidence that this is unlikely to be a helpful strategy. The
problem does not seem to be awareness of the evidence, but rather hopelessness about what to do instead.4
Effective drug therapies for long-term pain are unlikely to emerge and a shared recognition by healthcare professionals and
people with pain that medicines play only a small role in pain management will help to reduce harms.

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Nevrontin
Tramadol
Cannabis
Lidocaine
TCAs = Amitryptiline / Sarotex
SNRIs = Duloxetine / Cymbalta
Farmakologi
Generell
Aktivitet
Spesifikk
Aktivitet
Lage
mening
SMERTE
Generell Aktivitet ?
Forebygging
Behandling
Sammenheng
1. Andrzejewski W, Kassolik K, Brzozowski M, Cymer K. The
influence of age and physical activity on the pressure sensitivity
of soft tissues of the musculoskeletal system. J Bodyw Mov
Ther. 2010;14:382–390. [PubMed]
2. Bobinski F, Ferreira TA, Cordova MM, Dombrowski PA, da
CC, Santo CC, Poli A, Pires RG, Martins-Silva C, Sluka KA,
Santos AR. Role of brainstem serotonin in analgesia produced
by low-intensity exercise on neuropathic pain after sciatic nerve
injury in mice. PAIN. 2015;156:2595–2606.
3. Ellingson LD, Colbert LH, Cook DB. Physical activity is
related to pain sensitivity in healthy women. Med Sci Sports
Exerc. 2012;44:1401–1406.
4. Ellingson LD, Shields MR, Stegner AJ, Cook DB. Physical
activity, sustained sedentary behavior, and pain modulation in
women with fibromyalgia. J Pain. 2012;13:195–206. [PMC free
article] [PubMed]
6. Grace PM, Fabisiak TJ, Green-Fulgham SM, Anderson ND,
Strand KA, Kwilasz AJ, Galer EL, Walker FR, Greenwood BN,
Maier SF, Fleshner M, Watkins LR. Prior voluntary wheel
running attenuates neuropathic pain. PAIN. 2016;157:2012–
2023.
9. Hoeger Bement MK, Sluka KA. Exercise-induced
hypoalgesia: An Evidence-based review. In: Sluka KA,
editor. Pain Mechanisms and Management for the Physical
Therapist. Philadelphia: Wolters Kluwer; 2016. pp. 177–202.
13. Naugle KM, Riley JL., III Self-reported physical activity
predicts pain inhibitory and facilitatory function. Med Sci
Sports Exerc. 2014;46:622–629.
15. Stagg NJ, Mata HP, Ibrahim MM, Henriksen EJ, Porreca F,
Vanderah TW, Philip MT., Jr Regular exercise reverses sensory
hypersensitivity in a rat neuropathic pain model: role of
endogenous opioids. Anesthesiol. 2011;114:940–948.
Farmakologi
Generell
Aktivitet
Spesifikk
Aktivitet
Lage
mening
SMERTE

3. 25.11.2018
3
From my perspective, describing pain as an output robs the experience of pain’s harsh, all-
encompassing, life-changing reality. We are not machines producing outputs. We are
people, biological organisms who are magnificently complex.
This is why I think it an important distinction to differentiate between explaining our
current understanding of pain science, which is still limited (as is our understanding of
consciousness, until that problem is solved how we experience being human, let alone being
a human in pain, is still a big unknown), and explaining what pain is, in all it’s
complexity and contexts and meanings.
People living with pain know what pain is. Better than anybody. Even if they can’t find
the words to articulate their experience or don’t know the science of it, they live pain. No one
knows pain more that the person who has lived with it for a long period of time. It’s an
unsolicited, unexpected education.
What they may not know is the science of pain or the biology underlying pain processes.
But pain science is not pain itself. Pain is not a thing that can be solely objectively
studied because pain never occurs bereft of context. This is problematic for a lot of folks,
though, despite it being widely agreed upon that pain is personal and always subjective.
http://www.mycuppajo.com
#moderne forståelse av smerte er alfa / omega
Top Down Bottom Up
Men like så er forståelsen av #kontekst
Top Down Bottom Up
Eventuelt så er #mennesket enda viktigere å forstå
Top Down Bottom Up
N = 1https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-271

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Farmakologi
Generell
Aktivitet
Spesifikk
Aktivitet
Lage
mening
SMERTE
Spesifikk aktivitet = Neurodynamisk Aktivitet
Ingen evidens på metaanalyse, RCT ? Behandlingsprinsipper – what to do?
Gabbapentin
Neural sliders
Hands off
NEVROPATISKSM
ERTE?

5. 25.11.2018
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NEVRODYNAMISK
Manuelle tiltak Aktive tiltak
TILTAK