Articles

Recent neuroimaging studies suggest that the brain adapts with pain, as well as imparts risk for developing chronic pain. Within this context, we revisit the concepts for nociception, acute and chronic pain, and nega-tive moods relative to behavior selection. We redefine nociception as the mechanism protecting the organism from injury, while acute pain as failure of avoidant behavior, and a mesolimbic threshold process that gates the transformation of nociceptive activity to conscious pain. Adaptations in this threshold process are envi-sioned to be critical for development of chronic pain. We deconstruct chronic pain into four distinct phases, each with specific mechanisms, and outline current state of knowledge regarding these mechanisms: the limbic brain imparting risk, and the mesolimbic learning processes reorganizing the neocortex into a chronic pain state. Moreover, pain and negative moods are envisioned as a continuum of aversive behavioral learning, which enhance survival by protecting against threats.

This overview covers advances in mechanisms of chronic pain and their consequent clinical opportunities. Our research field is fractured into two separate camps: “peripheralists” and “centralists”. While the strong position of the first group is the contention that mechanisms of chronic pain can be understood within the limits of afferent inputs and spinal cord circuitry, the second group insists that the rest of the brain plays a critical role. Here we attempt to conjoin these positions, across clinical pain conditions and animal studies, and demonstrate that the effort can lead to novel translational concepts.

Objectives: Research has provided us with an increased understanding of nociception-motor interaction. Nociception-motor interaction is most often processed without conscious thoughts. Hence, in many cases neither patients nor clinicians are aware of the interaction. It is aimed at reviewing the scientific literature on nociception-motor interaction, with emphasis on clinical implications. Methods: Narrative review. Results: Chronic nociceptive stimuli result in cortical relay of the motor output in humans, and a reduced activity of the painful muscle. Nociception-induced motor inhibition might prevent effective motor retraining. In addition, the sympathetic nervous system responds to chronic nociception with enhanced sympathetic activation. Not only motor and sympathetic output pathways are affected by nociceptive input, afferent pathways (proprioception, somatosen-sory processing) are influenced by tonic muscle nociception as well. Discussion: The clinical consequence of the shift in thinking is to stop trying to restore normal motor control in case of chronic nociception. Activation of central nociceptive inhibitory mechanisms , by decreasing nociceptive input, might address nociception-motor interactions.

The practical healthcare during recent decades has been marked by the growing popularity of evidence-based medicine when determining methods or means of treatment and/or medical examination. At the same time, however, expenses on non-drug methods of treatment applied in neurology, orthopedics and rehabilitation medicine continue to increase. In recent years, there has been a tendency towards the growing use of osteopathy and applied kinesiology, which have slightly supplanted exercise therapy, manual therapy and physiotherapeutic methods of treatment. Among the methods practiced more and more often over the last years, there is a proprietary method stemmed from applied kinesiology and osteopathy, but based on the classical principles of neurophysiology — the method of proprioceptive deep tendon reflex (P-DTR), elaborated by Jose Palomar. The following article provides the theoretical evidence underlying the method and verified by the results of the neurophysiological research.

Link to the article in the Russian Medical Journal

As noted in the previous chapter, a sense of body position is necessary for adaptive motor control. In order to move a limb toward a particular location, it is imperative to know the initial starting position of the limb, as well as any force applied to the limb. Muscle spindles and Golgi tendon organs provide this type of information. In addition, these receptors are components of certain spinal reflexes that are important for both clinical diagnosis as well as for a basic understanding of the principles of motor control.

A case of severe low back pain, which was completely treated by release of the middle cluneal nerve, was presented. Clunealgia is underdiagnosed cause of low back pain and leg pain. The middle cluneal nerve may be entrapped where this nerve pass under or through the long posterior sacroiliac ligament.

A clinical overview of the autonomic nervous system, the supply to the gut and mind–body pathways.
LOUIS GIFFORD AND MICK THACKER

Clifford J Woolf, Program in Neurobiology and FM Kirby Neurobiology Center, Children’s Hospital Boston, and Harvard Medical School, Boston, Ma.

The paper discusses some characteristics of the science of human movement; it analyzes the movement rules, paying a special attention to the study of the neurological muscle health. In this work, we studied the features of playing sports by patients with physiological disadaptation.

The interconnection between stimuli from the external and internal environment along with different physiological reflexes has been widely described by many physiologists of the past. Great Russian physiologist, Dr. Pavlov, described many examples where different stimuli caused musculocutaneous or visceral reflexes.

The hip joint serves as a central pivot point for the body as a whole. This large ball-and-socket joint allows simultaneous, triplanar movements of the femur relative to the pelvis, as well as the trunk and pelvis relative to the femur. Lifting the foot off the ground, reaching towards the floor, or rapidly rotating the trunk and pelvis while supporting the body over one limb typically demands strong and specific activation of the hips’ surrounding musculature.

A 60-year-old woman complains of falls, imbalance, and numbness and tingling in her hands and legs. There is also some incoordination of hand use and she has difficulty manipulating small items such as buttons.

The purpose of this article is to present a kinesiological analysis of motion of the shoulder complex. The literature of the shoulder complex kinesiology is reviewed and is presented as a cohesive whole. Basic information regarding structural components of the shoulder complex is presented in table form for easy accessibility. Terminology is defined. The coordinated movement of the three bones of the shoulder complex is described and their interdependence is emphasized. The clinical importance of this interdependence is stressed. Finally, basic biomechanical and kinesiological information is used to analyze motion of the shoulder complex as a whole. Combined muscle actions are described throughout the range of motion for four representative movements.

More and more practitioners are beginning to use X and II lines in their practice to assess the stretch reflex using Manual Muscle Testing.

The article discusses modern approaches from the outlook of evidence-based medicine to the non-drug methods of treatment included in the modern schemes of rehabilitation after various diseases with the focus on one of the rehabilitation methods based on the use of Proprioceptive-Deep Tendon Reflex – a method that has been developed by Dr. Jose Palomar.
Link to the article in Russian magazine "PAIN"