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Drugs (Pregabalin) Modulates Hyperexcited Neurons

Drugs (Pregabalin) Modulates Hyperexcited Neurons. *Does not affect Ca ++ influx in normal neurons. (4) Central Reorganization (Spinal Cord Injury). A b. Superficial. C. Dorsal root ganglion. Deep. After nerve injury.

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Drugs (Pregabalin) Modulates Hyperexcited Neurons

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  1. Drugs (Pregabalin) Modulates Hyperexcited Neurons *Does not affect Ca++ influx in normal neurons

  2. (4) Central Reorganization(Spinal Cord Injury) Ab Superficial C Dorsal root ganglion Deep After nerve injury  Sprouting of injury fiber alter the relationship and modified the pain between stimulant and response Woolf, 1994.

  3. (5) Loss of Inhibitory Control(Descending disinhibition) Central Descending local To brain NORMAL Dorsal horn neuron Central Descending Local To brain INJURED Innocuous ornoxious stimulus Exaggeratepain response Excitatory synapse Inhibitory synapse Mechanoreceptor Woolf, 1999.

  4. Brain-Gate Theory(閘門理論) • Melzack and Wall (1965) • Melzack-wall-Casey (1982)--- modified theory:cognitive control+ descending brain-stem control

  5. block NE and serotonin reuptake

  6. LISTEN Patient verbal descriptors,Q & A LOCATE LOOK Nervous systemlesion / dysfunction Sensory abnormalities,pattern recognition 臨床診斷(3L)

  7. 神經評估Neurological Assessment T4 • History: onset, duration, character… • Landmark of S level, distribution, location… • Intensity, quality of pain • Associated s/s, aggravated factors… T10 Holmes GM. Introduction to Clinical Neurology. Baltimore: Williams & Wilkins, 1952.

  8. 病史: 問診還是最主要的 Complete information regarding pain Use scales to aid in defining pain McGill pain Questionnaire Visual analog scale (VAS) Activities of daily living scales (ADS) Neuropathic pain scale (NPS) • Quality • Intensity • Location • pattern

  9. 也可利用疼痛問卷

  10. Visual Analog Scales (VAS-疼痛評分) Nopain Excruciatingpain 0 100 Completepain relief Nopain relief 0 100 Note: Lines must be exactly 100 mm long McQuay, 1998.

  11. Neuropathic Pain Scale (NPS) 1. Tell us how intense your pain is. The most intense pain sensation imaginable 2. Tell us how sharp your pain feels. The most sharp Not sharp sensation imaginable (“like a knife”) 3. Tell us howhot your pain feels. The most hot Not hot sensation imaginable (“on fire”) 0 1 2 3 4 5 6 7 8 9 10 No pain 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Dull, cold, sensitive, itchy Galer, 1997.

  12. 臉部表情評分表

  13. NCV(神經傳導)脕隧道症候群(Carpal tunnel syndrome) However, small fiber disease can not be detectable (亦即神經傳導正常,不代表神經沒有病變)

  14. EMG(肌電圖)(neurogenic or myogenic) Full Interference Intermediate Pattern Single Unit Pattern (肌電圖更難以判斷=正常反應,不代表神經肌肉正常)

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