Palpation of Nerves
Transcript of Palpation of Nerves
![Page 1: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/1.jpg)
The drug cabinet in The drug cabinet in the brainthe brain
David Butler
www.noigroup.com
![Page 2: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/2.jpg)
• present some extraordinary gifts of neuroscience to rehabilitation
• introduce therapeutic neuroscience education as a new evidence based management tool
Aims
![Page 3: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/3.jpg)
The pain sciences The pain sciences revolutionrevolution
Neuroscience/pain sciences Neuroscience/pain sciences `trendy”`trendy”
![Page 4: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/4.jpg)
Gift 1 – the ion channelGift 1 – the ion channel
“the molecular targets of rehab”
![Page 5: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/5.jpg)
The neurone
![Page 6: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/6.jpg)
The ion The ion channelchannel
From Bear et al 2001
![Page 7: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/7.jpg)
“DNA makes messenger RNA. Messenger RNA` makes proteins and proteins make us”
![Page 8: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/8.jpg)
– Open or closedOpen or closed
– Many different Many different kinds of sensorskinds of sensors
– Live for two days, Live for two days, like butterflieslike butterflies
– Reflect your Reflect your perceived needsperceived needs
From Bear et al 2001
Your molecular biology degree ……..
![Page 9: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/9.jpg)
Gift 2 – the Gift 2 – the synapsesynapse
“only 100 years old”
![Page 10: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/10.jpg)
Rejoice in your neurones and Rejoice in your neurones and synapsessynapses
•100 billion neurones100 billion neurones• Up to 100,000 Up to 100,000 connections eachconnections each• More possible More possible
connections than connections than particles in the particles in the
universeuniverse• Baby makes 3 Baby makes 3
million synapses per million synapses per secondsecond
• 200,000 km of 200,000 km of cabling in the braincabling in the brain
From: Neuron 10 (1993) Front Cover
![Page 11: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/11.jpg)
Would this hurt?
![Page 12: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/12.jpg)
An astonishing synapse -the dorsal horn
![Page 13: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/13.jpg)
Gift 3 – The neuromatrix Gift 3 – The neuromatrix paradigmparadigm
• Melzack’s neuromatrixMelzack’s neuromatrix• representationrepresentation
• Maps in the brainMaps in the brain• The virtual bodyThe virtual body
• Schema – “body of knowledge”Schema – “body of knowledge”
“about 12 years old”
![Page 14: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/14.jpg)
Reflect on the phantom
Butler DS, Moseley GL Explain Pain 2003
![Page 15: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/15.jpg)
![Page 16: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/16.jpg)
The outer skin homunculus (map, /representation in the brain)
![Page 17: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/17.jpg)
Key elements of the Key elements of the neuromatrix paradigmneuromatrix paradigm
Four key points
![Page 18: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/18.jpg)
Key elements of the Key elements of the neuromatrix paradigmneuromatrix paradigm
1.1. Many bits of brain get turned Many bits of brain get turned on togetheron together
![Page 19: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/19.jpg)
Courtesy Lozza
The brain activity which occurs when a person suffering chronic pain experiences pain during an attempt at an abdominal contraction
![Page 20: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/20.jpg)
Butler DS, Moseley GL 2003 Explain Pain
A possible pain or movement neurosignature
Note:
•No one “hub”
•Common but will vary
•Turned on together
![Page 21: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/21.jpg)
Key elements of the Key elements of the neuromatrix paradigmneuromatrix paradigm
1.1. Multiple brain areas ignite together creating Multiple brain areas ignite together creating neurosignaturesneurosignatures
2.2. The specific tissue injured The specific tissue injured may not matter for a pain may not matter for a pain
neurosignatureneurosignature
![Page 22: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/22.jpg)
Pain neurosignatures are more related to threat rather than tissue injury
![Page 23: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/23.jpg)
PAIN
Damage
and pain
1. Introduction
+ emotions
PAIN AS INPUT
![Page 24: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/24.jpg)
PAIN
Damage
and pain
1. Introduction
+ emotions
PAIN AS INPUT
![Page 25: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/25.jpg)
PAIN
danger
1. Introduction
THREATS
PAIN AS OUTPUT
![Page 26: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/26.jpg)
Thoughts are Thoughts are nerve impulsesnerve impulses
![Page 27: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/27.jpg)
Key elements of the Key elements of the neuromatrix paradigmneuromatrix paradigm
1.1. Multiple brain areas ignite together creating Multiple brain areas ignite together creating pain representationspain representations
2.2. The specific tissue injured may not matter for a The specific tissue injured may not matter for a pain matrixpain matrix
3. Pain representations are 3. Pain representations are easily modifiedeasily modified
![Page 28: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/28.jpg)
The neurosignature can be easily modified:
turned up
turned down
ignited by numerous stimuli including mirror neurones
![Page 29: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/29.jpg)
![Page 30: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/30.jpg)
Key elements of the Key elements of the neuromatrix paradigmneuromatrix paradigm
1.1. Multiple brain areas ignite together creating Multiple brain areas ignite together creating neurosignaturesneurosignatures
2.2. The specific tissue injured may not matter for a The specific tissue injured may not matter for a pain matrixpain matrix
3. Representations are easily modified3. Representations are easily modified
4. Representation smudging4. Representation smudging
![Page 31: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/31.jpg)
![Page 32: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/32.jpg)
Smudging/brain change are Smudging/brain change are normal – reflects the “need” of normal – reflects the “need” of
the individualthe individual
• Occurs as a normal Occurs as a normal part of life (musicians, part of life (musicians, blind persons, breast blind persons, breast
feeding mice)feeding mice)• ie the “self ie the “self
constructing” brainconstructing” braineg. Elbert T et al (1998) Neuroreport 9: 3571
![Page 33: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/33.jpg)
Smudging and injury states
•Phantom limb stories
•The more chronic and painful a problem is – the more the brain neurosignature is smudged
•“Web fingers”
•On computers – hands grow big and shoulders fade
![Page 34: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/34.jpg)
Some listeners may be interested in the feet as erogenous zones
![Page 35: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/35.jpg)
More neuromatrix/smudging More neuromatrix/smudging giftsgifts
Web four fingers, smudging noted Web four fingers, smudging noted after 30 mins, lasts 2 hours if webbed after 30 mins, lasts 2 hours if webbed
for 5 hoursfor 5 hours How about the toes?How about the toes?
Motor as well as sensoryMotor as well as sensory Immune based – makes sense to Immune based – makes sense to
spread pain or revert to gross spread pain or revert to gross movements when the brain thinks you movements when the brain thinks you
are in troubleare in trouble
Stavrinou et al 2006 Cerebral Cortex
![Page 36: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/36.jpg)
The immune bufferring The immune bufferring behavioursbehaviours
Ability to develop coping skillsAbility to develop coping skills
Perception of stressorPerception of stressorSocial interactionsSocial interactions
Belief systemsBelief systemsExerciseExerciseHumourHumourIntimacyIntimacy
DietDiet Rabin BS 1999 Stress, Immune Function and Health, Wiley-Liss, New York
![Page 37: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/37.jpg)
So what can we take from So what can we take from these giftsthese gifts
1. The obvious – the role of early 1. The obvious – the role of early movement and return to movement and return to
functionfunction
![Page 38: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/38.jpg)
2. Therapeutic neuroscience 2. Therapeutic neuroscience educationeducation
Pain as epidemic
![Page 39: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/39.jpg)
Structure Structure specific style specific style – “school for – “school for
bravery”bravery”
Does not work. Bombardier C et al 1997 Cochrane Collab
Review 22: 837
![Page 40: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/40.jpg)
Psychology booklet basedPsychology booklet based
e.g. McClune T et al 2003 Emergency Medicine Journal 20: 514
![Page 41: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/41.jpg)
Neuroscience/psychology Neuroscience/psychology blended styleblended style
Neuroscience styleNeuroscience style
![Page 42: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/42.jpg)
Neuroscience style education is Neuroscience style education is effectiveeffective
Increase pain theshholds during physical tasks Increase pain theshholds during physical tasks Moseley GL et al 2004 An RCT of intensive neurophysiology education in Moseley GL et al 2004 An RCT of intensive neurophysiology education in
chronic low back pain Clin J Pain 20:324chronic low back pain Clin J Pain 20:324
Reduces unhelpful pain related beliefs and Reduces unhelpful pain related beliefs and attitudes, improves exercise outcomesattitudes, improves exercise outcomes
Moseley GL 2004 Evidence for a direct relationship between cognitive Moseley GL 2004 Evidence for a direct relationship between cognitive and physical change during an education intervention in people with and physical change during an education intervention in people with
chronic low back pain. Eur J Pain 8: 39chronic low back pain. Eur J Pain 8: 39
Helps in acute pain statesHelps in acute pain statesOliviera A et al 2006 A psycho educational video used in the Oliviera A et al 2006 A psycho educational video used in the
emergency department provides effective treatment for emergency department provides effective treatment for whiplash 2006 Spine 31: 1652 whiplash 2006 Spine 31: 1652
![Page 43: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/43.jpg)
Pain states in once “mad” Pain states in once “mad” people now easily explainablepeople now easily explainable
Mirror pains – an immune responseMirror pains – an immune response
Non zonal spread of pain – smudgingNon zonal spread of pain – smudging
Delayed onset post injury – peripheral nerve Delayed onset post injury – peripheral nerve responsesresponses
Associated gut, libido, slow healing, Associated gut, libido, slow healing, memory loss – hypercortisolismmemory loss – hypercortisolism
Night pain – peripheral nerveNight pain – peripheral nerve
Reoccurrence post injury – normal brain Reoccurrence post injury – normal brain based survival responsebased survival response
![Page 44: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/44.jpg)
Neuroscience/psychology Neuroscience/psychology blended styleblended style
Neuroscience styleNeuroscience style
![Page 45: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/45.jpg)
The twin peaks
![Page 46: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/46.jpg)
“The brain story” Petrol Link-up 1994
CONCLUSION
![Page 47: Palpation of Nerves](https://reader035.fdocuments.us/reader035/viewer/2022081504/556daa9ad8b42a875d8b4ccb/html5/thumbnails/47.jpg)
The drug cabinet in The drug cabinet in the brainthe brain
David Butler
www.noigroup.com
Info @noigroup.com