vSim D YoungBear Clinical Packet

DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process) Chronic pain is pain that lasts longer than 3 to 6 months. In many cases, this means that pain continues even after the injury or condition that first caused it has healed. The cause of chronic pain is not always clear. Sometimes it is caused by an ongoing medical problem, such as arthritis or diabetic neuropathy (a form of nerve damage from diabetes). But doctors cannot always find the cause of chronic pain. Pathophysiology: Pain is mediated by nociceptors, specialized peripheral sensory neurons that alert us to potentially damaging stimuli at the skin by transducing these stimuli into electrical signals that are relayed to higher brain centers. Nociceptors are pseudo-unipolar primary somatosensory neurons with their neuronal body located in the dorsal root ganglion. If the noxious stimulus persists, processes of peripheral and central sensitization can occur, converting pain from acute to chronic. Central sensitization is characterized by the increase in the excitability of neurons within the central nervous system, so that normal inputs begin to produce abnormal responses. Central sensitization occurs in a number of chronic pain disorders, such as temporomandibular disorders, low back pain, osteoarthritis, fibromyalgia, headache, and lateral epicondylalgia. Despite improved knowledge of the processes leading to central sensitization, it is still difficult to treat. Peripheral and central sensitization have a key role in low back pain chronification. In fact, minimal changes in posture could easily drive long-lasting inflammation in the joints, ligaments, and muscles involved in the stability of the low back column, contributing to both peripheral and central sensitization. Furthermore, joints, discs, and bone are richly innervated by A delta fibers whose continuous stimulation could easily contribute to central sensitization.