Abstract
Pain management is simplified when it is realized that after injury there may be three sequential states - immediate, acute and chronic. These are distinct clinical entities with their own somatic and behavioural responses.
The immediate phase of nociception is the perception of a noxious input. This is transient unless there is tissue damage to cause the second phase, or inflammation, when algesic substances are released sensitizing higher threshold receptors. Both these states are easily recognized.
Chronic pain may be persistent nociception or prolonged inflammation but more often it is hyperalgesia when ordinarily non-noxious stimuli are rendered excessive through supersensitive receptors according to Cannon’s Law of Denervation in the presence of neuropathy or radiculopathy.
To treat nociception, the offending source should be eliminated. Inflammation may be soothed by drugs or physical means. In contrast, supersensitivity requires desensitisation which involves the correction of neuropathy as well as its cause. Desensitisation follows the input of a source of energy. Commonly used modalities are now employ ed on an impirical basis - e.g., massage (mechanical), heat (thermal) ultrasound (sonic), or T.N.S. (electrical). Probably the best source of energy is the current of injury induced by acupuncture.
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