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The physiology of pain






 

" Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (International Association for the Study of Pain: Pain Definitions). Pain is a natural feeling that disturbs human being more or less since the birth till the end of one's life. According to biological origin pain can be physiological and pathological. Chronic pain, being pathological, affects not only the person, suffering from it, but also affects people who surround him or her (Parsons, 1972). Pain is a psycho-physiological response of animals and humans to damage stimuli that causes organic or functional disorders. Pain causes defensive reaction aimed to safe and protect life of any human being. (Kolokolov & Salina, 2014.)

The process of pain can be divided into 4 stages: transduction, transmission, perception, modulation. Transduction starts when the nerve endings are injured and inflammation occurs as a result. During transmission impulses are sent to dorsal horn of a spinal cord, then to the brain stem and thalamus. During modulation brain can change the sending of further nerve impulses. It can make the release of neurotransmitters more or less. In chronic pain the process of modulation is changed. It does not function correctly. It may cause the reason of producing too much pain on regular stimuli. This phenomenon occurs in chronic pain (Wood, 2008).

According to pathophysiology pain is classified in three groups: nociceptive pain, neuropathic pain, dysfunctional pain. Nociceptive pain is caused by direct tissue damage such as skin, joints, muscles and activation of peripheral pain receptors. The example of nociceptive pain can be myofascial pain. Neuropathic pain occurs in injury affecting the somatosensory nervous system. The example of this type of pain can be sensory abnormalities, such as hyperalgesia. Dysfunctional pain is formed as a result of neural disorders in the central nervous system. The traditional examination of such patients are unable to detect organic disease that could explain the origin of the pain. The main factors contributing to the development of dysfunctional pain is psychological, social problems and emotional stress. (Kolokolov & Salina, 2014.)

Pain can be classified by the intensity (Table 4). Numeric Rating Scale can be used by adults and children (> 9 years old). According to this scale, patients have to describe the pain they are feeling right at the moment (Figure 5). (Webpage of National Institutes of Health Warren Grant Magnuson Clinical Center, Pain Intensity Instruments 2003)

Table 4. Numeric Rating Scale. (Webpage of National Institutes of Health Warren Grant Magnuson Clinical Center, Pain Intensity Instruments 2003)

Intensity Score
No pain  
Mild pain 1-3
Moderate pain 4-6
Severe pain 7-10

Figure 5. Demonstrates a pain scale. (Website ofNational Institute of Clinical Studies, Emergency Care Pain Management Manual 2011)

Pathophysiology of nonradicular lumbar pain is usually uncertain. Moreover, non-specific etiology is one of the defining features of this disease. Pain can occur from different sites such as spine, muscles, joints, ligaments or fascia. Any sudden not expected force can cause tearing or rapture, for example after whiplash or lifting heavy things. However, muscle spasm is an essential etiology of low back pain that could be either a cause or effect of back injury, has not been proved. (Kerry& Levin, 2010.)

The concept of Red flags indicates the possibility of serious health conditions that need further medical treatment (Table 5). Red flags were developed for use in acute low back pain. The concept of Yellow flags indicates psychosocial factors that develop risk of long-term disease progression. Yellow flags were developed for use in acute low back pain. However, they can be used more widely to examine the possibility of developing long-term chronic pain Yellow flags describe more the psychological site of the patient and include the beliefs of patient, his or her attitude, motivation etc. Yellow flags play an important role in chronic low-back pain treatment, because they give the whole picture of the medical history of the patient. (Website of Medical Practice Guidelines, Hunter Integrated Pain Service, 2005)

 

Table 5. Flags concept. (Website of Medical Practice Guidelines, Hunter Integrated Pain Service, 2005)

Red flags Yellow flags
Major trauma (car accident, falling down accident) Patient's belief in severity of his/her disease
Minor trauma in elderly or osteoporotic Low motivation
The age of onset of the disease-less than 20 years old or more than 50 years old Belief in passive treatment (medical treatment, not an active and physical one)
Medical history: cancer, IV drug use, immunosuppresion Avoiding physical activity because of pain fear
Bacterial infections and bladder dysfunction  
Constitutional symptoms (high fever, weight loss)  
Progressive or strong sensory changes  

 

Chronic pain is very common among different people all over the world and the reason for such type of pain is usually unknown. Nowadays researchers found out that the brain plays an important role in a pain process. There are two important areas in the brain: the thalamus and the prefrontal cortex. The thalamus is a gateway between spinal cord and brain centers. If any acute injury occurs, the gateway opens in thalamus, letting the information from the injured part get to the brain. This process makes person with an acute injury to relax and to protect him or herself. This gateway should close after the damaged part is healed. However, in chronic pain the thalamus gateway stays open for a long period of time after acute pain has gone. The volume of the thalamus gets down, leading to a decrease of a neurotransmitter: gamma-aminobutyric acid. The result is that this gateway is always open, every signal becomes more intensive, causing ongoing pain. The prefrontal cortex area controls emotions of a human being and social behavior. It was discovered, that patients, suffering from any chronic pain have the reduction of volume in that region of brain. As a result, people with chronic pain start to feel anxious, depressed and they start to experience fear of pain. (Malcolm& Willis, 2016).

Chronic pain is a pathological process, consisting of specific reactions to pain stimulus. However, those reactions lose the original protective and adaptive nature, as they are used in acute pain. Incorrect reactions in chronic pain cause the disturbance in antinociceptive activity regulation. Chronic pain is a complex overall reaction to damaging effects of environmental factors. This process has metabolic, functional changes, leading to decrease body's adaptability to environmental conditions and limit ability (Kolokolov & Salina, 2014.)

 

5 KINESIO TAPING

5.1 What is Kinesio taping?


Kinesio tape is an elastic tape designed to support muscles, tendons and ligaments and to decrease pain. Kinesio taping is a part of the kinesiology science. The principle of kinesiology is to treat the muscles in order to help the body be cured naturally by itself. (UKG) Kinesio tape was founded by Japanese Dr. Kenzo Kase in 1973. He set a goal to develop a new method of taping that would not restrict the freedom of movement as a standard tape did. In 1988, at the Olympic Games in Seoul, the World learnt about a new method of Dr. Kase. Later on, Dr. Kenzo Kase founded an International Kinesio Tape Association and the aim of this organization was to find out clinical effects of Kinesio taping and develop new methods and techniques. (Website of Kinesio.UK).

Nowadays Kinesio Tape is widely used all over the world. Kinesio tape is an elastic, adhesive, non-latex tape made from 100% cotton. It is covered with a hypoallergenic acrylic adhesive layer which is activated with a body temperature. Flexibility of Kinesio tape allows to stretch it up to 30-40 % from its original length. It is usually applied with 10 % of stretch. Cotton base of Kinesio tape allows skin to breathe and makes the tape easily tolerated. Elasticity of tape does not restrict range of motions and it helps to support muscles and reduce fatigue. (Website of Kinesiology taping guide).

Dr. Kase together with his colleagues found out several benefits of using Kinesio tape: 1) Improving blood and lymph circulation. Kinesio tape, applied to the skin, lifts the upper layer of skin and creates more space between skin and underlying muscles. More space decreases pressure on lymph channels and produces more area for circulation. It helps release swelling and decrease pain in the injured parts. Moreover, it helps to increase blood flow circulation and as a result, it increases the amount of oxygen and nutrients that are important in the repairing of damaged tissues and removing of waste products when muscles are fatigued. 2) Pain release. Kinesio tape releases neurological and physical the pain by lifting, which decreases the pressure on the pain receptors, located under the skin. 3) Muscle function correction by strengthening the muscle. 4) Provides anatomical support and not limited range of motion. 5) Increasing proprioception. Proprioception improves through the increased stimulation of cutaneous mechanoreceptors. Different methods of Kinesio tape application can effect on improving joint alignment and can increase the function of a joint by affecting on opposing muscle groups and joint mobility. (Website of Football Medicine, 2010)

 


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