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Pain and Inflammation (Pain Pathways (Nociception (Identification of pain,…

- - - - Synapse on neurons within the spinal cord segment where they entered and also on neurons one to two segments above and below.
        
        Passes signal up through spinolthalamic tract
  - - - Descending pathways also affect pain pathways
  - - - Mechanosensitive (Lightly mylinated fast acting neurons that respond to touch and pressure)
      - Mechanothermal (Stimuli responds through temperature - heat)
      - Polymodal (Unmylinated, slowest method of transition, multiple stimuli)
- - - - Things such as massage (touch and pressure), and progressive loading
- - - - Fibroplasia - Secondary to action of fibroblasts in repairing connective tissue
      - Angiogenesis - Repair of vascular supply, provides oxygen for further healing
        
        myfibroblasts initiate remodeling
      - S/A: Decreasing resting sy; symptoms following use; decreasing stiffness post rest; decrease irritability
      - O/A: Decreasing edema normal temp; pain with stretch/contraction or palp; no stiffness through range; endfeel - increasing firmness
      - Aims of treatment: Reduce pain; stimulate fibroplasia stimulate angiogenesis; reduce secondary problems.
    - - Rapid onset, peaks in 1-3 days and last for weeks; complex chemically-mediated amplification cascade
        
        Aims of treatment: Reduce Pain; reduce oedema; reduce aggrivation of cellular/ vascular response
      - Vascular
        
        Initial reflex vasconstriction followed by vasodilation; increased flow in capillary bed; increased vascular permeability
      - Cellular
        
        Chemotactic reaction; platelets are damaged release platelet derived growth factor.
        
        Leads to phagocytosis (eats dead tissue)
      - S/A: Pain at rest with activity; irritable; stiffness post rest
      - O/A: Swelling; Bruising; increased temp; through range resistance; ROM decreased with pain or soft end feel; pain with stretch/contraction/ palpation
    - - Immediately following trauma
      - Depends on nature of tissue (vascularity); depends on nature of injury (crush vs strain).
      - Usually lasts 48 hours
    - - Involves refinement of the collagen and its associated extracellular matrix. Re-orientation of collagen fibers in response to stress; may take months
        
        Orientation of collagen fibers
        
        Re-absorption of Type III Collagen
        
        Replacement with more Type I Collagen
        
        Structure of final scar as similar as possible to parent tissue
      - S/A: Nil resting pain; nil irritability; pain with activity or posture; loss of function rather than stiffness
      - O/A: Nil swelling; firm on palpation; endfeel firm/hard; pain with stretch/contraction or palpation
      - Aims of treatment: Stimulate replacement of Type III with Type I collagen; promote re-orientation of collagen fibers; function
- - - - Via Descending pathway the stimulation of the A-delta fibers provoke impulses to the mid brain that then travel back down the spinal cord to inhibit nociceptor neurones