Abstract
Spinal segmental sensitization (SSS) is a hyperactive facilitated state of the dorsal horn that develops in reaction to an irritative focus originating in peripheral sensitized tissues. The irritative focus usually consists of a small area of damaged or dysfunctional tissue where peripheral sensitization or irritation of the nerves generates the continuous nociceptive stimuli, causing sensitization of the central nervous system. The significance of SSS lies in the awareness that it is a consistent component of all painful conditions. Furthermore, it can be diagnosed and treated successfully in daily clinical practice if the special examination and treatment methods developed by Dr. Andrew Fischer are being employed. This groundbreaking, seminal scientific observation by Dr. Fischer has led to the development of the Segmental Neuromyotherapy (SNMT) model. The SNMT consists of a unique system of objective and quantitative examination methods that detect the basic pathophysiological components of pain. It provides not only a scientifically valid and reproducible diagnosis, but also an assessment of the efficacy of various treatment methods. Only the exceptional sensitivity of these methods, as compared with conventional techniques, makes the diagnosis of SSS in clinical practice possible. Based on the diagnosis of SSS, a more efficacious treatment plan can be formulated.
In this seminar, the concept of SSS and the segmental neuromyotherapy method will be introduced in treating myofascial pain syndrome. The presentation will focus on trigger points as an irritative focus leading to SSS and this sensitization can subsequently be clinically manifested in the dermatomes, myotomes, sclerotomes, and viscerotomes. This forum will emphasize the use of SSS as a framework in evaluating clinical manifestations of trigger points and the application of segmental neuromyotherapy on the diagnosis and management of pain caused by trigger points.
This will be followed by review of a case study of a 46 year old male who experienced nine years of right upper quadrant abdominal pain and gastrointestinal symptoms including nausea and vomiting. During this time period, traditional western diagnostic and treatment methods failed to identify the etiology of the gastrointestinal manifestations and to relieve the symptoms. At the time of presentation, his pain was evaluated using the SNMT and was found to have segmental sensitization in multiple thoracic dermatomal distribution and trigger points in these segmental levels. The thoracic segments were desensitized using thoracic paraspinal nerve blocks and the trigger points were inactivated. After four treatments, the patient’s gastrointestinal symptoms and right upper quadrant pain completely resolved upon reevaluation in 6 weeks and 2 years.
It is important to observe that the trigger points discovered were also acupuncture points used to treat gastrointestinal problems including Conception Vessel 12, Urinary Bladder 19, and Liver 13. It is interesting to note that by using segmental neuromyotherapy, the eastern based meridian acupuncture points were found. This suggests that acupuncture may share a similar mechanism as spinal segmental sensitization. Clinical studies are needed to investigate the clinical effects of segmental neuromyotherapy and to explore the relationship between meridian lines and spinal segmental sensitization.
Upon completion of this session, participants will be able to
Define and identify a trigger point Discuss the development of peripheral and central sensitization following a trigger point formation Develop an understanding of spinal segmental sensitization and discuss its relationship to peripheral and central sensitization Determine the reproducible physical manifestations of SSS in myofascial pain Discuss the role of paraspinal injections and local trigger point injections in the management of trigger points from a segmental desensitization approach
Get full access to this article
View all access options for this article.