“Its All in Your Head” Michael Raucci D.C., D.I.B.C.N.

Board Certified Chiropractic NeurologistInternational Academy of Chiropractic Neurologists

PAIN

Pain

• The unpleasant awareness of a noxious stimulus or bodily harm

Pain•Where is the Pain? •In the Hand?

The Mystery of Pain

• Where is the pain now?

• In the hand?

• Nociception

• Pain Perception

The Homunculus

The Phantoms Within Us

Phantom Limbs

Not Everything Works the Way you Would Expect

• Body maps• Distortion• Implications in

Athletics• Digit synesthesia

Fibromyalgia

• Pain in the muscles• Severe Fatigue• Depression/Anxiety• Deconditioning

Brain Disorder of Pain Perception

Anorexia Nervosa and Bulemia

• Body Image

• Neuronal Connections

Brain Disorder of Body Map/Image

Perception

How Plastic are we?

The Phantom Hand and Pinochio’s Nose

Plasticity

“Neurons that Fire Together, Wire Together”

• Neurons that fire apart, wire apart

• Associative connectionism

Media Violence

• The core network

• The ethics network

• For the most part, similar regions of the brain are activated, corresponding to the visual and auditory areas of the brain. But when we look at the difference between violent and non-violent scans, those areas are mostly cancelled out, and we are left with images showing the differences between viewing violent and non-violent videos.

• The next set of images shows only the difference between the violent and non-violent videos, which was the focus of this study.

• The differences in the paralymbic area (marked Par) in the right hemisphere indicate that the violent videos used significantly more emotional processing. The posterior cingulate nucleus (PCg) was also activated, indicating emotional memory retrieval. The hippocampus (Hipp) activation indicates episodic memory storage, suggesting violent videos are more likely to be remembered. Finally, the right amygdala (Amg), the center of the fear reflex, was also activated.

• Murray et al. argue that the activation of primitive regions of the brain such as the amygdala suggest that though children may be aware that violent media present no real danger, their brain's response is identical to situations when a real threat is present. The amygdala is also active in impulsive aggressive individuals, suggesting that children may have little control over their response to violent media. Since long-term memory regions are also affected by violent videos, it's possible that the effects of the videos extend beyond the viewing period.

The Rich Environment

Not Rich

Rich

Synaptic Growth in the Enriched Environment

The Safe Environment• The role of the

unconscious

• The Role of the Amygdala– Flashing pics– Fear pathways

“I Love Puppies”

Mirror Neurons

LEFT – PERFORMING AN ACTIVITY

RIGHT – THINKING ABOUT THE SAME ACTIVITY

Imitation is a strong form of learning

Mirror Neurons

• Swinging baseball bat• Watching someone

swing a baseball bat• Imagining swinging a

baseball bat• Reading about how to

swing a baseball bat

• Imparting skills

What counts as practice/exercise?

People Resonate to the Others Around Them

#1 Symptom• Pain is overwhelmingly the reason

people seek medical care• Training and the understanding of pain

is grossly unsatisfactory at healthcare training institutions

• Pain is a subjective complaint without an objective test

• Pain thresholds and tolerances vary greatly from person to person, and culture to culture

Types of Pain (Quality)• Sharp• Dull• Throbbing• Tearing• Squeezing• Cramping• Burning• Nauseating• Shooting• Heavy• “worst headache of

my life”

Types of Pain (Locality)

• Neuropathic• Nociceptive• Central– Sensitization– Psychogenic

• Superficial Somatic

• Deep Somatic

• Visceral

Referred and Radicular Pain

• Referred pain is pain that is present in a site other than where the injury is because of shared or adjacent neurologic structures in the afferent pain pathway (This often is the result of spillover in the dorsal horn of the spinal cord or adjacent structures in the brain)

• Radicular Pain is perceived as distal to a nerve irritation in the served neurotome or dermatome.

Gate Theory

• Melczak and Wall

• “The perception of pain is not a direct result of activation nocicpetors, but instead is modulated by interaction between neurons, both pain-transmitting and non-pain-transmitting.”

• The signal passes through gates which have the capacity to inhibit/dampen the signal

• The interplay among these connections determines when painful stimuli go to the brain:

• When no input comes in, the inhibitory neuron prevents the projection neuron from sending signals to the brain (gate is closed).

• Normal somatosensory input happens when there is more large-fiber stimulation (or only large-fiber stimulation). Both the inhibitory neuron and the projection neuron are stimulated, but the inhibitory neuron prevents the projection neuron from sending signals to the brain (gate is closed).

• Nociception (pain reception) happens when there is more small-fiber stimulation or only small-fiber stimulation. This inactivates the inhibitory neuron, and the projection neuron sends signals to the brain informing it of pain (gate is open). Descending pathways from the brain close the gate by inhibiting the projector neurons and diminishing pain perception.

• This theory doesn't tell us everything about pain perception, but it does explain some things. If you rub or shake your hand after you bang your finger, you stimulate normal somatosensory input to the projector neurons. This opens the gate and reduces the perception of pain.

Small nerve fibers (pain receptors) and large nerve fibers ("normal" receptors) synapse on projection cells (P), which go up the spinothalamic tract to the brain, and inhibitory interneurons (I) within the dorsal horn.

Why do we have Pain

• Pain is an evolutionarily important phenomena because it encourages an organism to disengage from a noxious or self-damaging stimulus, direct attention to an injured area, and promote healing.

Acute, Subacute, Chronic

Acute – day 1-3 - frank inflammation, sharp pain

Subacute – day 3-30

Chronic - 3+months

Chronic Pain

• Is more than a symptom. It is an illness in itself.

Pains effect on attention

Ice or Heat

• Rule #1 – You’re never wrong if you use ice

• Rule #2 – Ice a new or inflamed injury

• Rule #3 – Heat a muscle spasm when there has been no injury

Mobilize or Immobilize

• When appropriate mobilize ASAP

• Healing along lines of stress

• Immobilize when there exists instability

(P)RICE

• Protect• Rest• Ice• Compression• Elevation

Pain Scales

Nutrition for Pain Control