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
- 4. NOCICEPTORS– NC SKIN NOCICEPTORS JOINT NOCICEPTORS VISCERAL NOCICEPTORS
- 5. Mechanoreceptor Thermo receptor Chemo receptor Polymodal receptor SKIN NOCICEPTORS
- 7. (Silent NC) Golgi Tendon organ Muscle spindle Chemo receptorNeuropeptides, Substance P, CGRP* Polymodal receptor JOINT NOCICEPTORS *CGRP: Calcitonin gene-related peptide PROPRIOCEPTION
- 11. THE PATHWAYS
- 12. SOMATOSENSORY CORTEX Penfield Homunculus (1951)
- 13. Ascending pathwaysDescending pathways Detection Deduction Transduction Modulation Perception Pain Modulation ) Morphine receptors (Brain and digestive tract) Dynorphin, Endorphine, Endomorphine, Nociceptine
- 15. - - - - -
- 16. - - - - - - -
- 18. 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 -
- 19. .1 .2 .3 .4
- 20. .1 - - Merskey 1979; Merskey and Bogduk 1994; van Tulder et al. 1997
- 24. MYOFASCIAL TRIGGER POINT Janet G. Travell – 1942 Clinical definition
- 25. MYOFASCIAL TRIGGER POINT Janet G. Travell – 1942 Taut band– Etiological definition
- 27. MYOFASCIAL TRIGGER POINT Central Tp’Satellite Myofascial Tp’ (secondary Tp’)
- 28. MYOFASCIAL TRIGGER POINT Dry Needling -Central Tp’ Shah et al.– Dry needling for MTrp’ - 2008 .1– .2– -Fast twitch
- 30. Cell damage * Vasodilatation Edema ** Hyperalgesia Muscle contraction Ischemia * Cell damage Arachidonic acid + Cycloxygenase (COX) = Prostaglandin INFLAMMATION **Prostaglandin = PAIN
- 31. * Cell damage Arachidonic acid + Cycloxygenase (COX) = Prostaglandin **Prostaglandin = PAIN COX 1 – COX 2
- 32. PARACETAMOL (Acetaminophen Analgetics Acamol, Dexamol, Paramol, Aldolor
- 33. IBUPROFEN Nsaid’s / non selective COX COX inhibitor -COX Neurofen, Adex, Advil, Artofen, Diclofenac
- 34. ETORICOXIB Nsaid’s / non selective COX COX 2 inhibitor -COX 2 Etodolac, Etopan
- 35. ETODOLAC Nsaid’s / selective COX COX 2 inhibitor -COX 2 Arcoxia, VIOXX (Rofecoxib)
- 36. - -– -- -