Dr Hermann Locher Orthopedic Surgeon Traumatologist Germany Tettnang

Dr. Hermann Locher Orthopedic Surgeon, Traumatologist Germany, Tettnang Lake of Constance MWE, DGMM, ESOMM Anatomical and neurophysiological basics of pain perception and pain transformation A „hands on“ drawing workshop…. .

Lake of Constance

Tettnang Castle

Neurophysiologic function - 1 sensory posterior horn (SPH) spinal cord motor anterior horn (MAH)

Neurophysiologic function – 2 skin joint nerve SPH muscle intestine blood-v. lymphatic-v. MAH

Neurophysiologic function – 3 central nervous system: Neocortex limbic system thalamus hypophysis brain stem

Neurophysiological function – 4 -wide dynamic range neuron- wide dynamic range neuron (WDR) spinothalamic tract

Skin Convergence Muscle Intestines Joints

Neurophysiological function – 4 -wide dynamic range neuron- wide dynamic range neuron (wdr) spinothalamic tract

Neurophysiologic function – 5 -nociceptionsmall (slow) C-fibres big (faster) A-delta-fibres L-glutamate Substance P

Neurophysiologic function – 6 -nociceptionsmall (slow) C-fibres big (fast) A-delta-fibres L-glutamate substance P

Neurophysiologic function – 7 activation alpha-motoneuron by skin cognitive affective topic endocrine vegetative protective reflex Alpha-motoneuron axon collaterals of wdr inhibitory interneuron RENSHAW

Neurophysiologic function – 8 nociception of segmental disorder capsule nociception of joint

Neurophysiologic function – 9 hypo mobile articular dysfunction s articular dysfunction, block short rotators

Neurophysiologic function – 10 activation of motor system Motor system activation descending limbic fibres muscular dysbalance gamma motoneuron spindle

Neurophysiologic function – 11 activation of sympathetical system CRPS 1 CRPS 2 axon coll. wcb gcb

Substance P Neurogene Inflammation Membrane PLA 2 Arachidonic Acid COX 2 Prostaglandine E 2 Hista Brady Sero

Neurogene Inflammation = Peripheral Sensitisation PEG 2 Central Sensitisation Glia Cells

Neurophysiologic function – 12 neurogenic inflammation

Neurophysiologic function – 13 GABA-erg inhibitory system proprioceptors A-beta afference GABA-erg inhibitory interneuron

Neurophysiologic function – 14 opioid-erg inhibitory system periaqueductal grey big raphe nucleus A-delta fibre opioiderg inhibit. interneuron

Neurophysiologic function – 15 serotonin-erg inhibitory system descending inhibitory serotonin-erg pathways

Mechanisms of Chronification Socio. Psychologic factors Sensive Neuron Specific Ion-Channels Formation of Ephapses Conditioning Neuroplasticity COX 2 P Opioidergic Inhibitoriic Interneuron PGE 222 PGE Synapses to A-Beta Fibers Glutamate Substance P Primary Hyperalgesia NMDA-Receptor „Wind-Up“ Apoptoses Sodium Channels Vergrösserung der Nozizeptiven rezeptiven Felder Secundary Hyperalgesia Transscription Sympathetic Sprouting Acid Sensive Ion-Channels Neurokinine Transmitters Receptors Membrane Channels

Therapy Pharmacological Therapy Manual Medicine Acupuncture Physical Therapy Physiotherapy, Gymnastics • Injections • Deafferentation (pharm. /surgical) • Psychotherapy • • •

Neurophysiologic function – 16 system of WDR-activation and inhibition Pharmacological Therapy Manual Medicine Acupuncture Physical Therapy Physiotherapy, Gymnastics Injections Deafferentation (pharm. /surgical) Psychotherapy

Sedation of pain is divine

Thank you for your attention !

Neurophysiologic function - 1 sensory posterior horn (SPH) spinal cord motor anterior horn (MAH)

Neurophysiologic function – 2 skin joint nerve muscle SPH intestine blood-v. lymphatic-v. MAH

Neurophysiologic function – 3 central nervous system: - neocortex - limbic system - thalamus - hypophysis - brain stem

Neurophysiological function – 4 -wide dynamic range neuron- wide dynamic range neuron (WDR) spinothalamic tract

Skin Convergence Muscle Intestines Joints

Neurophysiological function – 4 -wide dynamic range neuron- wide dynamic range neuron (wdr) spinothalamic tract

Neurophysiologic function – 5 -nociceptionsmall (slow) C-fibres big (faster) A-delta-fibres L-glutamate Substance P

Neurophysiologic function – 6 -nociceptionsmall (slow) C-fibres big (fast) A-delta-fibres L-glutamate substance P

Neurophysiologic function – 7 activation alpha-motoneuron by skin cognitive affective topic endocrine vegetative protective reflex Alpha-motoneuron axon collaterals of wdr inhibitory interneuron RENSHAW

Neurophysiologic function – 8 nociception of segmental disorder capsule nociception of joint

Neurophysiologic function – 9 hypo mobile articular dysfunction s articular dysfunction, block short rotators

Neurophysiologic function – 10 activation of motor system Motor system activation descending limbic fibres muscular dysbalance gamma motoneuron spindle

Neurophysiologic function – 11 activation of sympathetical system CRPS 1 CRPS 2 axon coll. wcb gcb

Neurophysiologic function – 12 neurogenic inflammation

Neurophysiologic function – 13 GABA-erg inhibitory system proprioceptors A-beta afference GABA-erg inhibitory interneuron

Neurophysiologic function – 14 opioid-erg inhibitory system periaqueductal grey big raphe nucleus A-delta fibre opioiderg inhibit. interneuron

Neurophysiologic function – 15 serotonin-erg inhibitory system descending inhibitory serotonin-erg pathways

Chronifizierungsmechanismen Sozio. Psyche Sensive Neuron Specific Ion-Channels Ephapsenbildung Conditionierung Neuroplastizität COX 2 P Opioiderges Inhibitorisches Interneuron PGE 222 PGE Synapsen zu A-Beta Fasern Glutamat Substanz P Primäre Hyperalgesie NMDA-Rezeptor „Wind-Up“ Apoptose Na-Kanäle Transscription Sympathisches Sprouting Vergrösserung der Nozizeptiven rezeptiven Felder Secundäre Hyperalgesie Acid Sensive Ion-Channels Neurokinine Transmitter Rezeptoren Membrankanäle

Therapy Pharmacological Therapy Manual Medicine Acupuncture Physical Therapy Physiotherapy, Gymnastics • Injections • Deafferentation (pharm. /surgical) • Psychotherapy • • •

Neurophysiologic function – 16 system of WDR-activation and inhibition Pharmacological Therapy Manual Medicine Acupuncture Physical Therapy Physiotherapy, Gymnastics Injections Deafferentation (pharm. /surgical) Psychotherapy

Sedation of pain is divine

Thank you for your attention !