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