Excellent videos, thanks. I'm a chronic pain doc, and I'm interested in your opinion on who are the best experts on the subject of fibromyalgia. Any review articles or texts on this subject that you would recommend? Thanks, Dave
@urigott13 жыл бұрын
Really great, though I have a question about it: if so (c fibers don't cause pain)- why does blocking c fibers transmission eliminates pain, as in the gait theory? thanks!
@AirMaximus8812 жыл бұрын
Also don't C-fibres control 'slow pain' associated with tissue damage after departure of noxious stimulus?
@NeuroDocUniverse12 жыл бұрын
I appreciate your question and admire your willingness to look for optimal care for your patients. I have presented to medical groups who are treating exclusively with antidepressants and pain meds with marginal results and unsatisfied patients. As the etiologies suggest, the best tx may be in integrated care. Please let me know if you require more information or if I can be of any further help to you. Best regards, NDU
@NeuroDocUniverse12 жыл бұрын
Hi Dave, The growing consensus about the mechanism behind fibromyalgia is that it is a neurological condition stemming from central sensitization. See this article as an example: Persistent or intense nociception can lead to transcriptional and translational changes in the spinal cord and brain resulting in central sensitization and pain. (continued)
@NeuroDocUniverse12 жыл бұрын
This mechanism represents a hallmark of fibromyalgia and many other chronic pain syndromes, including irritable bowel syndrome, temporomandibular disorder, migraine, and low back pain. Importantly, after central sensitization has been established, only minimal nociceptive input is required for the maintenance of the chronic pain state. (continued)
@hybridlifehealth19125 жыл бұрын
can you talk about the A-beta vs A-delta fibers?
@NeuroDocUniverse12 жыл бұрын
The literature cites chronic bombardment of the cord by C fibers (small unmyelinated nociceptors) as the cause of central sensitization. Sources of chronic stimulation of C fibers are dietary Omega 3 and 6 fatty acid imbalance (too much 6, too little 3) which can lead to a build of arachadonic acid in the peripheral tissues. This is a highly inflammatory condition and, in a predisposed individual, can lead to chronic pain. (continued)
@NeuroDocUniverse12 жыл бұрын
Based on the etiologies of the condition it appears that best treatment for fibromyalgia involves dietary evaluation to increase water, balance the fatty acid ratios and decrease the intake of inflammatory foods, optimizing joint movement and increasing activity levels, and counselling to determine if an individual's depressed or anxious state is a contributing cause of the condition or a result of chronic pain. (continued)
@NeuroDocUniverse12 жыл бұрын
Another source of chronic facilitation of C fibers comes from joint degeneration, particularly from immobilization degeneration. The literature states that chronic breakdown of of every structural component of synovial joints occurs with induced restriction of motion. Additionally, negative emotional state contributes to an increased perception of pain. The consensus in the literature surrounding depression and pain is that 80% of sufferers improved with mild exercise such as walking. (cont)
@NeuroDocUniverse12 жыл бұрын
They do, AirMaximus. This is generally due to the sharing od a second-order neuron by A and C fibers. In a sense, nociceptors may or may not result in pain. I was hoping to convey in this tutorial much of what is known but not commonly taught regarding nociceptor function and activity. I hope this clarifies...
@NeuroDocUniverse12 жыл бұрын
Other factors, including pain-related negative affect, have been shown to significantly contribute to clinical fibromyalgia pain. An improved understanding of the mechanisms that characterize central sensitization and clinical pain will provide new approaches for the prevention and treatment of fibromyalgia and other chronic pain syndromes. Nature Reviews Rheumatology 2, 90-98 (February 2006) Mechanisms of Disease: pain in fibromyalgia syndrome Roland Staud & Miguel E Rodriguez (continued)
@TheDesignerfly12 жыл бұрын
Does the nociception that results in PGAD stem from C nociceptors ? (I am referring to cases where symptoms began after single dose of the drug trazodone)
@MrApplewine10 жыл бұрын
I'm feeling cold wet water sensations and burning and stinging sensations all over my body. I'm negative on all neurological tests for autoimmune, EMG, brain MRI and small fiber nerve skin biopsy. What is going on? I also have jaw and temple muscle pain, intermittent decreased sensation below the eyes, tinnitus, neck pain, upper back pain between shoulders, vision shakes up close, lower back pain and hip pain on the right. I also have neurological itching on my right rib and on my ankles. I also have electric shocks near my ears and dizziness in the past.
@NeuroDocUniverse10 жыл бұрын
Without a full history and exam it is not possible to advise you. However, you might consider having some extensive testing for Lyme, Babesiosis, ehrlichiosis, Rocky Mountain spotted fever, and human granulocytic anaplasmosis as these conditions are often over looked. Additionally, consider an ANA test to determine if you have an autoimmune condition.
@NeuroDocUniverse13 жыл бұрын
Great question! C fibers can cause pain for sure (so can the large myelinated A fibers). Increased mechanoreceptor activity causes presynaptic inhibition of much of the dorsal horn targets for both A and C fibers (or so the current theory goes :-)
@NeuroDocUniverse12 жыл бұрын
"This is, in part related to trazodone having both alpha-blocking activity (blockade of adrenalin effect, a strong contracting agent) and serontonergic blocking activity (blockage of sterotonin, a strong inhibitor)." Based on the above information I don't know that c fibers would be involved in PGAD caused by trazadone.
@SSAFADevonvolunteering13 жыл бұрын
Really great lecture, short and sweet and very informative
@vsavchik10 жыл бұрын
Marginal Nucleus is ANS? I breaks my picture of the theme. A-delta (fast pain) fibers go to lamina I and V, i.e. MG and Clarke's Nucleus. Substantia Gelatinosa in lamina II is populated by C-fibers. So if C-fibers are ANS then SG is autonomic, not MG. Also, we definitely feel burning, dull pain. It means C-fibers are not consciousless. See trigeminothalamic tract and anterior spinothalamic tract.
@NeuroDocUniverse10 жыл бұрын
Hi Vladimir :-) I'm not sure I understand your question. The IML (intermediolateral cell column) is ANS (preganglionic sympathetic efferents).
@vsavchik10 жыл бұрын
NeuroDocUniverse IML is LVII (a bit different matter :), while your presentation mentions L1 as a source of ANS pathways... and calls it Substantia Gelatinosa. I still believe that SG is LII. But NB sources are so contradictive that I'm not sure really. I'm trying to collect transparent scheme at code.google.com/p/ahuman/wiki/SpinalCord. Please let me know if you have a time to comment it.
@sfranken222810 жыл бұрын
Vladimir Savchik I looked not only at Spinal Cord but also at code.google.com/p/ahuman/wiki/SpinalCordTracts . The graphics are easy to read with well-ordered information... very helpful. Simply put, your work is lovely & help-filled for learning. Thank you.
@SuperNewf113 жыл бұрын
Pain has ruined my life. Too bad nobody believes I have pain, and they won't treat me. ;-(
@NeuroDocUniverse12 жыл бұрын
Designerfly, Citing sexualmed (dot) org/index.cfm/risk-factors/for-women/trazodone/: "Trazodone is a drug that is associated with the unique ability to cause persistent drug-induced inhibition of genital smooth muscle contraction and persistent drug-induced enhancement of genital smooth muscle relaxation." (continued)
@SSAFADevonvolunteering13 жыл бұрын
Really great lecture, short and sweet and very informative