IPHREHAB: APPROACH FOR NEUROGENIC DISORDER TREATMENT

IPHREHAB

APPROACH FOR NEUROGENIC DISORDER TREATMENT

Approach for neurogenic disorder treatment 

With the above in mind, I felt the need to produce an approach that is in some ways uniquely useful to the clinician. 

The approach is therefore characterized by the following:

1. links between mechanics and physiology of the nervous system

2. integration of neurodynamics with musculoskeletal functions

3. a new movement diagram that enables the clinician integrate musculoskeletal and neural mechanisms

4. a new system for determining the kind and extensiveness of examination and treatment based on

neurodynamics and neuropathodynamics

5. the concept of neurodynamic sequencing and various options in assessment and treatment

6. new diagnostic categories of specific dysfunctions based on neuropathodynamics

7. treatment progressions derived from the above.

Nevertheless, it is common for therapists to diagnose more frequently the problems they have recently learned about, which raises the possibility of false diagnosis due to raw enthusiasm. At all times, the reader will realize that clinical neurodynamics is only one aspect of management of the person in pain and all other relevant information should be included in clinical decision making. For instance, the existence of a neural problem does not necessarily mean that a treatment with a neurodynamic technique is warranted. This could be because other treatments may attack the causative mechanisms more effectively or neurodynamic application may be contraindicated. Clearly, the biopsychosocial approach to neural problems will place this

book in its rightful place as just a modality of treatment that will be effective in some patients and not in

others.

Clinical neurodynamics is for clinicians dealingwith musculoskeletal disorders with peripheral neurogenic pain mechanisms, including those of the nerve root and peripheral nerve. There is no assumption that all problems are as such, or that the treatments presented in this book act only on peripheral mechanisms. The clinician will naturally and responsibly establish that it is appropriate to treat patients with clinical neurodynamics before doing so.

IPHREHAB : PAIN MODULATION AND MECHANISM

IPHREHAB
PAIN MODULATION

• Variability of pain caused by similar injuries.
• Psychological variability.
• Even suggestions of pain relief helpful.
• Existing brain circuits modulate pain transmission pathways.

• One of these circuits has links with hypothalamus, midbrain, medulla oblongata.
• This pathway selectively controls spinal pain transmission neurons through descending pathways.
• Attention, suggestion and opiods work and modulate pain through this pathway.
• Endogenous opiod peptides such as enkephalins and endorphins work through this pathway. 

• Prolonged pain and fear are the most  reliable activating factors for endogenous opiod pathway.
• Released during surgical procedures and even by placebo.

Pain modulating circuits can suppress and enhance pain.

• Both pain-inhibiting  and pain-facilitating neurons in the medulla project to and control spinal pain transmission. Hence pain can be generated without any peripheral nocuous stimuli.
• Increased activity of these circuits is seen during migraine.
• Pain can also be induced by suggestions-psychological factors contribute to pain.

NEUROPATHIC PAIN:

1. Lesions in central and peripheral pathways results in loss or impairment of pain sensation.
2. Paradoxically the damage may also produce pain- diabetic neuropathy, herpes zoster.
3. Also damage to spinothalamic tract or thalamus can also produce pain.
4. Severe and notoriously intractable to standart treatment.
5. Unusually burning, tingling or electric shock like quality.
6. Examination-Sensory deficit in the area of pain.
7. Hyperpathia/allodynia.
8. Topical preprations (5% lidocaine) helpful.

Mechanisms

• Sensitized primary afferent neurons.
• Damaged primary afferent neurons.
• Sensitized nociceptors.-generate impulses in absence of stimulus.
• Increased concentration of sodium channels.
• Sensitivity to norepinephrine.

Sympathetically Maintained Pain

• Causalgia in peripheral nerve injury.
• Pain often begins after a delay of hours to days or even weeks.
• Pain accompanied by swelling of extremity, periarticular osteoporosis and arthritic changes in distal joints.
• Pain relief by sympathetic blockages.

Similar events- reflex sympathetic dystrophy- without nerve damage including fractures, soft tissue injuries, MI, stroke.

Treatment :

• History, Evaluate, examine.
• Remove cause.
• Analgesics NSAIDS, Opiods