NMS

6/14/99

CES (facilitation)

• Sensory
• Autonomic (sym/para)
• Motor

Sensory

• Feinstein-Inman—30,40,50's—sclerotomal pain
• Mooney—1978 The facet syndrome (orthopedic surgeon)
• Nerve function was normal
• Injected saline solution into facet joint (voluntary prisoners)—an irritant
• Monitored where the pts perceived the pain
• Pain in lumbar facets radiated down the leg
• Cervical spine radiated down the arm
• Somatic causes of back pain (mechanical causes)
• Sclerotome
• Ct, fascia
• Periosteum
• Embryological derivations
• Segmental relationship
• If facet happens to be the that fires, sends pain message into the cord
• Severe/chronic—create CES w/lots of neurotransmitter
• A fibers block out the C fibers
• C fibers to not make it to the cortex
• Stimulate nearby related nerves from extra NE in the cord

Sclerotome Pain

• Originates from somatic tissue
• Never nerve or visceral
• Purest pattern from somatic tissue that is paraspinal ex: whiplash

1. deep, dull, achy
2. poorly localized
3. never paresthesia
4. seldom radiates below the knee or the elbow
5. negative neurological tests
6. difficult to reproduce the pain

• referred pain
• compression--neurological
• dermatome if at nerve root
• tinnel sign
• irritation
• sclerotome
• trigger points
• visceral