CLINICAL ELECTROANALGESIA

- , -

-Neural circuitry and neurochemistry, pain control-

Best

. (Neural circuitry and neurochemistry)

1969 Reynolds rat periaqueductal gray(PAG)

Mayer (1971)
SPA(stimulation-produced analgesia) , 1975 Hughes, Kosterlitz
pentapeptide SPA OA(opiate analgesia)
, , .


.
1. (Spinal segmental mechanisms)
CPN(C polymodal nociceptor)
C
(substantia gelatinosa cell) .
wide dynamic range(WDR)
(spinoreticular tract) .
-
(low-threshold mechanoreceptor) A
- (high threshold mechanonociceptor)
A
.
1)A (Pain control mechanism of the A fiber)
- A (tactile receptor)
(dorsal column)
. A
, .
-aminobutyric
acid(GABA), (enkephalin), (dynorphin)
.
WDR .
2)A (Pain control mechanism of the A fiber)
- A (mechanical
nociceptor) (marginal cell) .
(spinothalamic tract) .
(enkephanergic neuron)
, A
C
.

2. (Supraspinal mechanism)
1)A (Pain control mechanism of the Afiber)
(Serotonergic system)
- A (mechanical
nociceptor) (marginal cell) .
(spinothalamic tract) (VPL)
(thalamic nucleus) .
PAG(periaqueductal grey) , A PAG
nucleus raphe magnus(NRM) . NRM
,
C
WDR . PGA
(endorphinergic
fiber) endorphin ,
ACTH(adenocorticotrophin hormon) cortisol
.
(noradrenergic system)
- A (mechanical
nociceptor) (marginal cell) .
(spinothalamic tract) (VPL)
(thalamic nucleus) . A
arcuate nucleus , PAG
NRM . NRM
.
WDR C .
PGA
(endorphinergic fiber) endorphin ,
ACTH(adenocorticotrophin hormon) cortisol
.
A
,
nucelus paragigantocellularis(nPGC) locus coeruleus(LC)
arcuate nucleus
LC . LC

.
Diffuse noxious inhibitory controls
A
subnucleus reticularis dorsalis
, . - A

 .
2)C (Pain control mechanism of the C fiber)
C polymodal nociceptor C
, (paleospinothalamic tract)
(reticular formation), , (MIT), (limbic system)
. C arcuate
nucleus , PAG NRM .

(central biasing system)
,
(endorphinergic fiber)
endorphin .
(autonomic sensory afferent)
(autonomic response regulatory mechanism)
.
3. (Neurochemistry of the pain control)

(endogenous morphin like substance; endorphins)
.
Prohormone
POMC

Peptide

-endorphin

-endorphin

ProENK A

Leu-enkephalin

ProENK B

Dynorphin

Met-enkephalin
Heptapeptide
Methorphamide

No. of
Receptor
aminoacids
31

17
5
5
7
7

17
Dynorphin 1-8
8
-neoendorphin
10
Dynorphin B
13

 ,
.
.
Opioid peptide

Function
Activation
Segmental analgesia A,,C
Rapid onset(20M.)
Brief action(2Hr.)
Vascular control

Dynorphin

Segmental analgesia A,
Rapid onset
Brief action

Leu-ENK

-endorphin

General analgesia A, C
Anti-inflammatory
Slow onset(1Hr.)
Prolonged action(8Hr.)

. (SELECTIVE ELECTRICAL STIMULATION)

1. (Selective activation of the target tissue)

.
.
(parameter) .
Recruitment Target Diameter Amplitude Phase Charge
order
tissue

duration
Membrane Very lowest Longest Lowest
1st

6-12

Lowest

Shortest Lowest

2nd

2-8

3rd

1-6

4th

<1

Highest

Longest Highest

2. (Strength-duration curve of the excitability tissue)

(rheobase)
(chronaxie) , .

. C
. A A
. A .
.
Target
Membrane

Pulse rate
pps
0.5-300

Pulse duration
/*
1-5,000*

Intensity
level
Very lowest
(subsensory)
Lowest
(sensory)

80-120(100)

50-100(80)

2-15(4)

200-400(250)

Highest
(motor)

2-5(4)

100-200(150)*

Highest
(Noxious)

3. (Activation of the endorphins

according to excitatory tissue)

,
.
Target
Pain modulation
Biochemicals
Membrane Subsensory analgesia Cyclo-oxygenase
inhibitors
A

Sensory analgesia

ENK & dynorphin

Motor analgesia

ENK & dynorphin

-endorphin
ACTH(Cortisol)

Noxious analgesia

ENK
-endorphin

. (Clinical electroanalgesia; CEA)

1. (Clinical electroanalgesia according to

selectivr electrical stimulation)
(comfortable sensation)
(subsensory) (sensory), (discomfortable sensation)
(motor), (noxious) .
, , ,
(optimal stimulation site; OSS) (optimal stimulation
procedure; OSP) .
(subsensory analgesia)
Ca==
(intracellular mechanism)
, . ,
, , .
(sensory analgesia) A

, .
- .
(motor analgesia) A
,

, ,
. ,
- , .
- (motor -sensory analgesia) A A
( 15pps)- ( 2pps)- (
100pps)
(synergistic effect) .
(noxious analgesia) C


, , .
, , (electrical
hyperstimulation analgesia) .

P h y s i o l o g i c a l Pain
Biochemical
Pharmacology Action
response level modulation substance
Cellular-tissue Subsensory Cyclo-oxygenase- Steroid
Anti-inflam.
inhibitors
NSAID
Nocigenic
Motor
ACTH(cortisol)
Steroid
Segmental

Sensory ENK, DYN, GABA

Motor
ENK & DYN
Noxious
ENK

Opiates
Opiates
Opiates

Systemical

Motor
Noxious

Opiates
Opiates

-endorphin
-endorphin

Neurogenic
Nocigenic

2. (OSS and OSP)

,
.

.
Acces
Direct

Site
Lesion
Segmental

Mechanism
Spinal segmental

Indirect Remote
Supraspinal
Extrasegmental

Clinical
Procedure
Standard
Reflexology

-.,
-, -., -. .

Feel
Comfort

Pain
Response
modulation level
Subsensory Cellular
Tissue

Clinical
modalities
MENS
PEMS
LASER
PUS

Clinical effect
Acute & chronic pain
(inflammatory with)
Tissue & wound healing

Nerve Block Cellular

Tissue

ENB

Acute pain
(localized & segmental)
Local anesthesia
Spasm & spasticity
Sympathetic block
Chronic pain
(memory metrix pain)

Sensory

Segmental

CTENS
(HR/LI)

Acute & chronic pain

(localized & segemental)
Post-op pain

Central

Systemical

CET

Chronic pain
(Generalized & multi-seg)
Sedation & Relaxation

Discomfort Motor

Segmental
Systemical

ATENS
(LR/HI)

Chronic pain
(General-multisegmental)
Acute Inflamm. with pain
Tissue healing
Visceral control

Noxious

Segmental
Systemical

EHA
(LR/NI)

Chronic & acute pain

Neurogenic pain(memory pain)
Autonomically related pain

3. (Multi-dimensional application)
, (neural
network)
.
,
.
, (electric analgesics)
(electric aspirin) .


NSAID(non anti-inflammatory drug)

 , , , ,
(opiate analgesics) .
(local anesthetics) ,
cortisol corticosteroid .


.

NSAID
,
-
endorphin cortisol
.