Novel Approaches for Chronic Pain

Abstract

Abstract'Chronic pain' describes a syndrome lasts for more than 3 months. characterized by persistent physical pain, disability, emotional disturbance, and social withdrawal symptoms, existing together and influencing one another in what Bandura termed 'reciprocal determinism'. If original pain is not treated completely, the repeat pain signals lead to change in the central nervous system becomes hypersensitivity. This is the novel concept of central sensitization for chronic pain. Desensitization of the segment consists of local injection with anaesthetic agents for blocking posterior branch of the dorsal spinal nerve along the related paraspinal muscles, together with local anaesthetic injection directly to the trigger points, Extracorporeal Shock Wave Therapy (ESWT) and High intensity laser therapy for desensitization of trigger point foci and area of sensitization. All are novel therapies for chronic pain.

Update of Extracorporeal Shockwave Therapy in Myofascial Pain Syndrome

“…[9][10][11][12][13][14] Extracorporeal Shock Wave Therapy (ESWT) can be nowadays approved as an effective, safe, noninvasive therapy for many musculoskeletal diseases and many conditions where regenerative effects are desirable. It is the novel therapy for applications in the fields of regenerative medicine, tissue engineering and cell therapies.…”

“…[9][10][11][12][13][14] b. Shock waves effect on soft tissue and musculoskeletal tissue are as the follows i.…”

“…Animal studies show that ESWT has an influence on pain transmission by acting on substance P, calcitonin gene-related peptide (CGRP) expression in the dorsal root ganglion and on neurovascular sprouting. [9][10][11][12][13][14][18][19][20][21][22][23] ESWT uses biphasic acoustic energy that goes from positive high peak pressures (10-100 MPa (mega pascals) for fESWT;0.1-1 MPa for rESWT) to negative phase (10 MPa); short rise times (10-100 ns for F-ESWT;0.5-1 ms for rESWT), short duration (0.2-0.5 ms for fESWT;0.2-0.5 ms for rESWT). Focused and radial shockwaves are generated in different ways.…”

“…Focused shockwaves are generated electrically, either within the applicator (electrohydraulic technique), or externally to it in the focal zone (electromagnetic or piezoelectric techniques), and then propagate to a designated focal point in order to treat it. Radial shockwaves are ballistic pressure waves generated at lower pressures over a longer time and propagate divergently within the tissue [9][10][11][12][13][14][18][19][20][21][22][23] The induced energy is propagating in the tissue and converges into a focal or radial area, depending on the equipment used and the settings selected for intensity, angle and other parameters. The effect varies, depending on the tissue through which the wave passes and how it absorbs, reflects, refracts or transmits the energy, depending on the specific impedance.…”

“…Extracorporeal shockwave therapy (ESWT). [9][10][11][12][13][14] And High Intensity Laser (HTL) 15 also play a role as desensitization. Kinesio Taping (KT) 16 and Fascial manipulation 17 are increasing evidences support.…”