[libribook.com] Traumatic Scar Tissue Management 1st Edition
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[libribook.com] Traumatic Scar Tissue Management 1st Edition

hongchingyee
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Clinical ConsiderationAccording to Jacobs (2014):Skin is well supplied with exteroceptive receptors and fibers thattransmit information to the brain using fast dorsal column pathwaysand non-nociceptive slow spinothalamic pathways, to centers in boththe internal regulation system and the primary sensory cortex of thebrain. As long as manual therapy is mostly non-nociceptive, treatmentwill be physically safe for most pain presentations. Ruffini endingsare particularly capable of transducing lateral stretch to skin. It is slowadapting, which means it will actively fire the entire time a skinstretch is held, allowing the nervous system time and providingstimulation that will alter the motor output and pain output at spinalcord and more rostral levels.

Clinical ConsiderationAcute and chronic or persistent pain present as different clinical entities.Acute pain, provoked by a specific disease or injury, serves a usefulbiologic purpose and is self-limited, lasting less than 6 months. Thetherapy of acute pain is aimed at treating the underlying cause andinterrupting the nociceptive signals. The therapy of chronic pain must relyon a multidisciplinary approach and should involve more than onetherapeutic modality (Grichnik & Ferrante 1991).Fasciagenic pain: because fascia has been largely overlooked as a potential paingenerator and because scarring impacts fascia, specific consideration is givenhere. Fascia contains type C nociceptors and some of the free nerve endings infascia are substance P-containing receptors, commonly assumed to benociceptive and rendering fascia a potential pain generator (Tesarz 2009). And,as previously noted, neurofascial coverings are innervated by nervi nervorum.Hyperalgesia: heightened pain sensation from a stimulus that normallyprovokes pain, a consequence of hyperexcitation involving peripheral or centralsensitization or both.• Primary hyperalgesia: occurs at the site of injury, associated with increasedsensitivity of peripheral receptors (e.g. local nocis activated by substancesreleased as a result of injured tissue).• Secondary hyperalgesia: occurs in tissue outside the site of injury, associatedwith central sensitization (e.g. changes in spinal cord glial and satellite cellsand voltage spiking pattern changes).• Opioid-induced hyperalgesia: sensitization associated with long-term use ofexogenous opioids (e.g. heroin, oxycodone).Neuropathic pain: pain that arises as a consequence of injury or diseaseaffecting the somatosensory NS (Treede et al. 2008, Correa-Illanes et al. 2010).Neuropathic pain may occur as a manifestation of various conditions that causenerve damage, such as viral infections (postherpetic neuralgia), metabolic

Clinical Consideration

According to Jacobs (2014):

Skin is well supplied with exteroceptive receptors and fibers that

transmit information to the brain using fast dorsal column pathways

and non-nociceptive slow spinothalamic pathways, to centers in both

the internal regulation system and the primary sensory cortex of the

brain. As long as manual therapy is mostly non-nociceptive, treatment

will be physically safe for most pain presentations. Ruffini endings

are particularly capable of transducing lateral stretch to skin. It is slow

adapting, which means it will actively fire the entire time a skin

stretch is held, allowing the nervous system time and providing

stimulation that will alter the motor output and pain output at spinal

cord and more rostral levels.

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