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An Urban Experience
In particular, the glial network of the spine and CNS
has been gathering significant respect as a long-term modifier of pain. The glial cells become activated by activity within the synapse, and rapidly spread this excitement (non-synaptically) from cell to cell, across midline, and facilitating the intensity of the signal. These changes may persists far longer than the wind-up that occurs in the nerves, and can contribute to conditions such as neuropathic pain, opioid tolerance and addiction, and reduced healing within the nervous system.
NMDA antagonists Opioid antagonists Glial antagonists Acupuncture, exercise
Muscle and fascia live alongside the neurological framework and become implicated in changes that occur. With excessive neuronal activity associated muscles spasm and enter an ‘energy crisis’. An
initial sustained release of calcium due to muscle splinting and activation results in sustained sarcomere contracture. Increased metabolic rate of these muscle groups is compounded by local ischemia due to the contracted state of the muscle inhibiting local blood
flow. Energy in the form of ATP is required to move intracellular calcium back into the sarcoplasmic reticulum at the end of the contraction, which is no longer possible in the sarcomeres anoxic state, thus the high intracellular calcium remains, sustaining the contraction.
In addition to be painful of their own right, chronic muscle contraction (trigger points) contribute to changes in movement and put additional strain on joints and/
or spinal segments served by the contracted muscle bellies. Over time this ‘myofascial restriction’ help to create co-morbid conditions that accumulate into a multi-faceted pain experience. Furthermore, in our non- speaking patients, a knowledge of these patterns can create a standard ‘pain map’ that helps us to identify
the likely sources of pain, or at least implicate typically- associated groups (shoulder/neck and iliopsoas/caudal lumbar).
Acupuncture with trigger-point deactivation Local anesthetics
PRP- regenerative medicine
Exercise/ motion/ Stretching
Laser/ shock-wave

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