Pain specialist since 2003

Anesthesiologist since 1986

Pain specialist to H.E.

Governor of Gujarat

Having private clinic and

attached to Apollo Hospitals,

Ahmadabad

Faculty in national and

international conferences

Authored a chapter in

textbook on pain

Dr Rajeev HarsheMD (Anesthesiology)

Pain Consultant

Apollo Hospitals, Ahmadabad

(Hon. Pain consultant to H.E.Govorner of Gujarat)

Apollo Hospital

11 am to 5 pm

Consulting Room

―Relief‖ pain clinic

35/1,sector 2 A

Gandhinagar

9 to 11 am and 5 to 8 pm

Email: dr.harshe@gmail.com

Blog: drharshe.blogspot.in

Stiff muscle

Palpable taut band in muscle

Hyperalgesic muscle

Pain which can be unbearable

Pain not responding to analgesics

Pain lasting for long times

Emotional distress,Physical Distress

Abnormal muscle use

Give away at ―critical load‖

Spindle injured

Initiation of cascade

Deconditioning caused by lack of exercise

Inadequate muscle use

Impaired posture

General factors: Nutritional deficiencies,

electrolyte disorders, metabolic or endocrine

dysfunction, sleep disturbances, or other

concurrent illnesses.

Trauma and ischaemia of muscle leads to

Central sensitisation

Supersensitivity in muscle leads to

Muscle shortening

Muscle becomes sensitised to palpation; a

term sometimes referred to as allodynia or

myalgic hyperalgesia

Injured sarcomere – improper healing—

contracted state---trigger points

Sympathetic innervation of intrafusal fibres

play role

Uncontrolled contraction—ischemia—release

of autocoids--

Energy crisis theory

Muscle spindle theory

Motor end plate hypothesis

Release of calcium from injured sarcomeres—

sarcomere shortening—increased metabolism

and compromised local circulation

Disparity…increased energy demand and

reduced energy supply due to impaired

circulation—ENERGY CRISIS--- release of

autocoids--pain

Dysfunctional muscle spindle—highly

localized electrical activity---this is

maintained by sympathetically mediated

factors like emotional stress

Neuro muscular junction region

cause of trigger activity

Supported by

1. Clinical effectiveness of botox

2. Electrical activity noted in triggers by EMG

community

3. Length of propagation of spike potential

along length of taut band

Dr Rajeev HarsheMD (Anesthesiology)

Pain ConsultantApollo Hospitals, Ahmadabad

(Hon. Pain consultant to H.E.Govorner of Gujarat)

Mobile: 9825252100