Friday, March 21, 2014

Systematic review reports the best web sites for Bladder Pain Syndrome

A good resource for patient

Tirlapur SA, Leiu C, Khan KS.  Int Urogynecol 2013;24:1257-1262.

Friday, March 7, 2014

Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice.

Nijs J, Van Houdenhove B, Oostendrop RAB. Manual Therapy 2010 15:135-141.
Pelvic PT distance journal club 3/5/14
Beth Shelly PT, DPT, WCS, BCB PMD

Mechanism based clinical guidelines using medical diagnosis and history, clinical examination

·         Primary hyperalgesia - acute pain - several days - sensitization of the nociceptors to protect from further damage - local phenomenon
·         Secondary hyperalgesia - chronic pain -  increased responsiveness of dorsal horn neurons in the spinal segments of the primary nociceptors - central sensitization

Central sensitization (CS) - defined by Meyer 1995 - "an augmentation of responsiveness of central neurons to input from unimodal and polymodal receptors."
·         Altered sensory processing in the brain
·         Impaired descending inhibition of pain
·         Overactive ascending pain facilitatory pathways
·         Temporal summation of secondary pain = wind up
·         Long term enhancement of synapses in some areas of the brain
·         Net result
o   Augmented nociceptive signal
o   Increase responsiveness to a variety of peripheral stimuli
o   Decrease tolerance of senses

"How to explain central sensitization to patients with 'unexplained' chronic musculoskeletal pain: Practice guidelines."

Nijs J, et al. (2011)  Manual Therapy  16(5):413-418.
Pelvic PT Distance Journal Club 3/5/14
Beth Shelly PT, DPT, WCS, BCB PMD

Prior to starting rehab
·         Correct maladaptive pain beliefs
·         Reconceptualize pain
·         Affect deep learning
·         Resulting in the perception that pain is less dangerous

RCT - short term pain education alone is more effective for pain relief and improving pain self-efficacy than pain education and group exercise for patients with chronic LBP (Ryan 2010)

Just handing the patient a booklet is not effective in changing beliefs, need to have individually tailored sessions, one on one in person or phone in patients with fibromyalgia. (Van Oosterwijck 2013)