cortical ascending pain information pontine medullary
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2 The problem.
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5 cortical ascending pain information pontine medullary spinal Pain signal According to Fields HL, Basbaum AI, Heinricher MM: Central nervous system mechanisms of pain modulation; in McMahon S B, Koltzenburg M (eds): Wall and Melzack s textbook of Pain. 5th edn., Amsterdam, Elsevier Churchill Livingstone, 2005, pp
6 cortical expectation stress pontine descending pain modulatory pathways medullary spinal Pain signal According to Fields HL, Basbaum AI, Heinricher MM: Central nervous system mechanisms of pain modulation; in McMahon S B, Koltzenburg M (eds): Wall and Melzack s textbook of Pain. 5th edn., Amsterdam, Elsevier Churchill Livingstone, 2005, pp
7 Subcortical mechanisms. Wide Dynamic Range (WDR) neurones in the spinal cord, Gate-Control und Diffuse Noxious Inhibitory Controls (DNIC)
8 According to LeBars D: The whole body receptive field of dorsal horn multireceptive neurons. Review. Brain Research Reviews 2002;40:29-44.
9 According to Le Bars D. The whole body receptive field of dorsal horn multireceptive neurons. Brain Res Brain Res Rev 2002;40: WDR-spinal interneuron EF Aδ / C Stimulation Firing rate of the WDR neuron (Glutamate dependent / NMDA Receptor)
10 According to Le Bars D. The whole body receptive field of dorsal horn multireceptive neurons. Brain Res Brain Res Rev 2002;40: WDR-spinal interneuron Gate-Control segmental, homotopic mechanosensitive Aβ stimulation (faster than the pain fibre) IF IF EF Aδ / C Stimulation Firing rate of the WDR neuron
11 also: Neurons in the caudal medulla additional noxious (Aδ / C) Stimulation heterotopic (from somewhere!) WDR-spinal interneuron LTD LTP Head DNIC EF Contralateral extremity Aδ / C Stimulation According to Le Bars D. The whole body receptive field of dorsal horn multireceptive neurons. Brain Res Brain Res Rev 2002;40: Firing rate of the WDR neuron
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13 cortical pontine medullary Pain signal spinal According to Le Bars D. The whole body receptive field of dorsal horn multireceptive neurons. Brain Res Brain Res Rev 2002;40:29-44.
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16 The Context determines, how bright a surface appears Brightness is an active perceptual effort of the visual system! Mach-bands-illusion Simultaneous contrast!
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20 DNIC and Acupuncture?
21 According to LeBars D, Willer J-C: Pain modulation triggered by high-intensity stimulation: implication for acupuncture analgesia? International Congress Series 2002;1238:11-29.
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25 Does Acupuncture induce DNIC?
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29 Does Acupuncture induce DNIC?? o It cannot be ignored that DNIC is very likely to add to the overall effect of acupuncture related pain control! o It is probably stronger in acute clinical pain and in experimental laboratory pain as compared to chronic pain. o It cannot be the only mechanism, since e.g. chronic pain patients show a reduced DNIC response. However, acupuncture may provide retraining of DNIC in chronic pain.
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31 Implications for experimental setups (mostly performed in healthy controls) Always test acupuncture on an experimental pain stimulus!
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34 cortical expectation stress pontine descending pain modulatory pathways medullary spinal Pain signal According to Fields HL, Basbaum AI, Heinricher MM: Central nervous system mechanisms of pain modulation; in McMahon S B, Koltzenburg M (eds): Wall and Melzack s textbook of Pain. 5th edn., Amsterdam, Elsevier Churchill Livingstone, 2005, pp
35 Top down Expectation Stress Placebo descending, pain modulatory pathways Pain Bottom up DNIC / HNCS Acupuncture Pain
36 SETT is a valid tool to measure acupuncture effects
37 Top down Expectation Stress Placebo descending, pain modulatory pathways Pain Bottom up DNIC/HNCS Acupuncture Pain
38 Top down Meditation descending, pain modulatory pathways Bottom up Pain Acupuncture Pain
39 Choi KE, Rampp T, Saha FJ, Dobos G, & Musial F. Pain modulation by meditation and electroacupuncture in experimental submaximum effort tourniquet technique (SETT). Explore (NY). [Research Support, Non-U.S. Gov't] Jul-Aug;7;4:
40 Choi KE, Rampp T, Saha FJ, Dobos G, & Musial F. Pain modulation by meditation and electroacupuncture in experimental submaximum effort tourniquet technique (SETT). Explore (NY). [Research Support, Non-U.S. Gov't] Jul-Aug;7;4:
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42 Choi KE, Musial F, Amthor N, et al. Isolated and combined effects of electroacupuncture and meditation in reducing experimentally induced ischemic pain: a pilot study. EvidBasedComplement AlternatMed. [ /2011/ doi]. 2011;2011
43 Pain signal (SETT) Acupuncture Hegu (Li 4) Shousanli (Li 10) A B Acupuncture Zusanli (St 36) Taichong (Lv 3) A Fasciculus gracilis (lower extremity) B Fasciculus cuneatus (upper extremity)
44 pain tolerance non-med (n=13) meditators (n=10) no acup. acup arm acup leg Choi KE, Musial F, Amthor N, et al. Isolated and combined effects of electroacupuncture and meditation in reducing experimentally induced ischemic pain: a pilot study. EvidBasedComplement AlternatMed. [ /2011/ doi]. 2011;2011
45 !
46 Meditation and acupuncture were similarly effective in controlling experimental tourniquet pain
47 Top down Meditation descending, pain modulatory pathways Bottom up Pain Acupuncture Pain
48 The celebrity among Top Down processes: Placebo A role in acupuncture analgesia?
49 Placebo effects: group of subjects regression to the mean natural history true placebo response The effect is small to nonexistent! (Hrobjartsson A, Gotzsche PC. Placebo interventions for all clinical conditions. Cochrane Database of Systematic Reviews. [ARTN CD003974;DOI.1002/ CD pub3]. 2010;1. Placebo response: individual reaction variability / signal to noise relation expectation conditioning suggestion beliefs etc. neurobiological basis Musial, Klosterhalfen & Enck, WJG, 13(25) (2007) :
50 Placebo effects: group of subjects regression to the mean natural history true placebo response The effect is small to nonexistent! (Hrobjartsson A, Gotzsche PC. Placebo interventions for all clinical conditions. Cochrane Database of Systematic Reviews. [ARTN CD003974;DOI.1002/ CD pub3]. 2010;1. Placebo response: individual reaction variability / signal to noise relation expectation conditioning suggestion beliefs etc. neurobiological basis Musial, Klosterhalfen & Enck, WJG, 13(25) (2007) :
51 Standard-paradigm in placebo research: Submaximal Effort Tourniquet Test (SETT) For example: Benedetti, Pain, 64 (1996) Amanzio & Benedetti, The Journal of Neuroscience 1999, 19(1):
52 Benedetti, Pain, 64 (1996)
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54 Han Neurosci lett 2004; 361(1-3):
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56 Yes NOTHING
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58 expectation Stress descending pain modulatory pathways Expectation Stress Meditation DNIC / HNCS etc. Pain signal According to Fields HL, Basbaum AI, Heinricher MM: Central nervous system mechanisms of pain modulation; in McMahon S B, Koltzenburg M (eds): Wall and Melzack s textbook of Pain. 5th edn., Amsterdam, Elsevier Churchill Livingstone, 2006, pp
59 What is the perfect acupuncture (setting)
60 Top down Expectation descending pain modulatory pathways Bottom up Pain DNIC/HNCS Pain
61 Many Thanks to Research TCM clinic Anna Choi Tim Gabriel Nadine Amthor Thomas Rampp Steffi Geidis Iven Tao Steven Wang and the extremely patient collegues up Front
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This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and
This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution
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