{"id":2404,"date":"2012-01-28T02:23:59","date_gmt":"2012-01-28T01:23:59","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bjsm\/?p=2404"},"modified":"2012-02-16T18:36:55","modified_gmt":"2012-02-16T17:36:55","slug":"letter-to-the-editor-gate-control-pain-modulation-theory-explains-the-effectiveness-of-prolotherapy","status":"publish","type":"post","link":"http:\/\/stg-blogs.bmj.com\/bjsm\/2012\/01\/28\/letter-to-the-editor-gate-control-pain-modulation-theory-explains-the-effectiveness-of-prolotherapy\/","title":{"rendered":"Letter to the Editor: Gate control pain modulation theory explains the effectiveness of prolotherapy"},"content":{"rendered":"

E-letter by:
\n<\/strong><\/tt>Dr. Stavros Saripanidis,<\/strong><\/tt> <\/span>Consultant in Obstetrics and Gynaecology, <\/tt>Private Surgery, Thessaloniki, Greece<\/tt>
\n<\/tt>In response to:<\/strong><\/tt><\/h2>\n


\n<\/strong><\/tt>Simon Petrides. 2011.\u00a0The use of prolotherapy injections for elite athletes<\/strong>. <\/tt>Br J Sports Med ; 45: 2 (Electronic pages).<\/tt><\/a><\/span><\/h2>\n

<\/tt><\/h3>\n
\"\"
Photo of 'Spine' in Millennium Square, Bristol by Davecpayne, Flickr cc<\/figcaption><\/figure>\n

Dear BJSM Editors,<\/tt><\/p>\n

The dorsal horns are not merely passive transmission stations but <\/tt>sites at which dynamic activities (inhibition, excitation and modulation) <\/tt>occur. [18]<\/tt><\/p>\n

Via a series of filters and amplifiers, the nociceptive message is <\/tt>integrated and analysed in the cerebral cortex, with interconnections with <\/span><\/tt>various areas. [1]<\/tt><\/p>\n

The processing of pain takes place in an integrated matrix throughout <\/span><\/tt>the neuroaxis and occurs on at least three levels, at peripheral, spinal, <\/tt>and supraspinal sites. [9]<\/tt><\/p>\n

Knowledge of the modalities of pain control is essential to correctly <\/span><\/tt>adapt treatment strategies (drugs, neurostimulation, psycho-behavioural <\/tt>therapy, etc.).<\/tt><\/p>\n

Dysfunction of pain control systems causes neuropathic pain. [1]<\/tt><\/p>\n

Spinal Cord Stimulation modalities evolved from the gate-control <\/tt>theory postulating a spinal modulation of noxious inflow. \u00a0 [16] [2] [7] <\/tt>[11] [12] [15] [17] [20] [22] [23] [24] [25] [26]<\/tt><\/p>\n

It has been demonstrated in multiple studies that dorsal horn <\/tt>neuronal activity caused by peripheral noxious stimuli could be inhibited <\/tt>by concomitant stimulation of the dorsal columns. [8]<\/tt><\/p>\n

Pain relief was more prominent at pain ascending through C fibers <\/tt>than pain ascending through Adelta fibers. [21]<\/tt><\/p>\n

Many theories on the mechanism of action of Spinal Cord Stimulation <\/tt>have been suggested, including activation of gate control mechanisms, <\/tt>conductance blockade of the spinothalamic tracts, activation of <\/tt>supraspinal mechanisms, blockade of supraspinal sympathetic mechanisms, <\/tt>and activation or release of putative neuromodulators. \u00a0[14]<\/tt><\/p>\n

At present, Spinal Cord Stimulation is a well established form of <\/tt>treatment for failed back surgery syndrome, complex regional pain <\/tt>syndromes (CRPS), low back pain with radiculopathy and refractory pain due <\/span><\/tt>to ischemia. [4] [3] [8] [13]<\/tt><\/p>\n

Stimulation produced analgesia can provide a level of analgesia and <\/tt>efficacy that is unattainable by other treatment modalities. [19]<\/tt><\/p>\n

Spinal Cord Stimulation for the treatment of chronic pain is cost-<\/tt>effective when used in the context of a pain treatment continuum. [14]<\/tt><\/p>\n

Precise subcutaneous field stimulation is targeted to specific areas <\/tt>of neuropathic pain. [6]<\/tt><\/p>\n

We aim at attenuation or blockade of pain through intervention at the <\/span><\/tt>periphery, by activation of inhibitory processes that gate pain at the <\/tt>spinal cord and brain. [9]<\/tt><\/p>\n

Segmental noxious stimulation produces a stronger analgesic effect <\/tt>than segmental innocuous stimulation. [10]<\/tt><\/p>\n

That is exactly what intradermal sterile water injections do!<\/span><\/strong><\/tt><\/p>\n

This therapeutic approach should not be limited only to elite <\/tt>athletes.<\/tt><\/span><\/strong><\/p>\n

<\/strong><\/p>\n

It can work for every patient with back pain.<\/span><\/tt><\/strong><\/p>\n

References<\/strong><\/tt><\/p>\n

[1] Prog Urol. 2010 Nov;20(12):843-52. Epub 2010 Oct 20. <\/span><\/a><\/tt>Anatomy and physiology of chronic pelvic and perineal pain. <\/span><\/tt>Labat JJ, Robert R, Delavierre D, Sibert L, Rigaud J. <\/span><\/tt>Centre federatif de pelviperineologie, clinique urologique, CHU Hotel-<\/tt>
\nDieu, 1, place Alexis-Ricordeau, 44093 Nantes, France.<\/tt><\/a>
\n
\n<\/span>
\n[2] Int J Rehabil Res. 2010 Sep;33(3):211-7. <\/span><\/a><\/tt>Effect of transcutaneous electrical nerve stimulation on sensation <\/tt>thresholds in patients with painful diabetic neuropathy: an observational <\/tt>study. <\/span><\/tt>Moharic M, Burger H. <\/span><\/tt>Department of Physical and Rehabilitation Medicine, Linhartova 51, SI-1000<\/tt>Ljubljana, Slovenia.<\/tt><\/a><\/p>\n

<\/tt><\/p>\n

[3] Conf Proc IEEE Eng Med Biol Soc. 2009;2009:2033-6. <\/span><\/a><\/tt>Spinal cord stimulation for complex regional pain syndrome. <\/span><\/tt>Shrivastav M, Musley S.<\/tt>Medtronic Neuromodulation, 7000 Central Ave NE, Minneapolis, Minnesota, <\/tt>55432 USA.<\/tt><\/a><\/p>\n


\n<\/span>
\n[4] J Clin Monit Comput. 2009 Oct;23(5):333-9. <\/span><\/a><\/tt>Spinal cord stimulation: principles of past, present and future practice: <\/tt>a review. <\/span><\/tt>Kunnumpurath S, Srinivasagopalan R, Vadivelu N. <\/span><\/tt>St George's School of Anaesthesia, Tooting, London, UK.<\/tt><\/a><\/p>\n

<\/tt><\/p>\n

[5] Brain Res Rev. 2009 Apr;60(1):149-70. Epub 2008 Dec 31.<\/a><\/tt>Chloride regulation in the pain pathway. <\/span><\/tt>Price TJ, Cervero F, Gold MS, Hammond DL, Prescott SA.<\/tt>
\nUniversity of Arizona, Department of Pharmacology, USA.<\/tt><\/a><\/p>\n

<\/tt><\/p>\n

[6] Curr Pain Headache Rep. 2008 Jan;12(1):28-31. <\/span><\/a><\/tt>Peripheral nerve stimulation for chronic pain.<\/tt>Henderson JM.<\/tt>Stereotactic and Functional Neurosurgery, Stanford University School of <\/tt>Medicine, 300 Pasteur Drive, Edwards Building\/R-227, Stanford, CA 94305, <\/tt>USA.<\/tt><\/a><\/p>\n


\n<\/span>
\n[7] Schmerz. 2007 Aug;21(4):307-10, 312-7. <\/span><\/a><\/tt>From Descartes to fMRI. Pain theories and pain concepts.<\/tt>Handwerker HO.<\/tt>Institut fur Physiologie und Pathophysiologie, Universitat <\/tt>Erlangen\/Nurnberg, Deutschland.<\/tt><\/a><\/p>\n


\n<\/span>
\n[8] Pain Physician. 2002 Apr;5(2):156-66. <\/span><\/a><\/tt>Spinal cord stimulation.<\/tt>
\nStojanovic MP, Abdi S.<\/tt>Interventional Pain Program, MGH Pain Center, Department of Anesthesia and <\/span><\/tt>Critical Care, Massachusetts General Hospital, Harvard Medical School, <\/tt>
\nCambridge, MA 02135, USA.<\/tt><\/a><\/p>\n

<\/tt>
\n[9] J Bone Joint Surg Am. 2006 Apr;88 Suppl 2:58-62.<\/a><\/tt>Basic science of pain.<\/tt>
\nDeLeo JA. <\/span><\/tt>Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, Neuroscience<\/tt>
\nCenter at Dartmouth, Department of Anesthesiology, Lebanon, NH 03756, USA.<\/tt><\/a><\/p>\n

[10] Pain. 2005 May;115(1-2):152-60. <\/span><\/a><\/tt>Segmental noxious versus innocuous electrical stimulation for chronic pain <\/span><\/tt>relief and the effect of fading sensation during treatment. <\/span><\/tt>Defrin R, Ariel E, Peretz C. <\/span><\/tt>Department of Physical Therapy, School of Allied Health Professions, <\/tt>Sackler Faculty of Medicine, Tel-Aviv University, 69978 Ramat Aviv, <\/tt>Israel.<\/tt><\/a><\/p>\n

[11] Annu Rev Neurosci. 2003;26:1-30. Epub 2003 Mar 6. <\/span><\/a><\/tt>Pain mechanisms: labeled lines versus convergence in central processing. <\/span><\/tt>Craig AD. <\/span><\/tt>Atkinson Pain Research Laboratory, Barrow Neurological Institute, 350 <\/tt>W.Thomas Road, Phoenix, AZ 85013, USA.<\/tt><\/a><\/p>\n

[12] Sports Med. 2002;32(4):251-67. <\/span><\/a><\/tt>Return-to-work interventions for low back pain: a descriptive review of <\/tt>contents and concepts of working mechanisms. <\/span><\/tt>Staal JB, Hlobil H, van Tulder MW, K?ke AJ, Smid T, van Mechelen W.<\/tt>Department of Social Medicine and Research Centre on Work, Physical <\/tt>Activity and Health, VU University Medical Center, Van der Boechorststraat <\/span><\/tt>7, Amsterdam, The Netherlands.<\/tt><\/a><\/p>\n


\n<\/span>[13] Curr Pain Headache Rep. 2001 Apr;5(2):130-7.<\/a><\/tt>Stimulation methods for neuropathic pain control. <\/span><\/tt>Stojanovic MP. <\/span><\/tt>MGH Pain Center, Department of Anesthesia and Critical Care, Massachusetts <\/span><\/tt>General Hospital, Boston, MA 02114, USA.<\/tt><\/a><\/p>\n


\n<\/span>
\n[14] Curr Rev Pain. 1999;3(6):419-426. <\/span><\/a><\/tt>Spinal Cord Stimulation: Indications, Mechanism of Action, and Efficacy. <\/span><\/tt>Krames E. <\/span><\/tt>Pacific Pain Treatment Centers, 2000 Van Ness Avenue, Suite 402, San <\/tt>Francisco, CA 94109, USA.<\/tt><\/a><\/p>\n

<\/tt><\/p>\n

[15] Ann Pharm Fr. 2000 Mar;58(2):77-83. <\/span><\/a><\/tt>Pain and its main transmitters.<\/tt>Costentin J.<\/tt>Unite de Neuropsychopharmacologie Experimentale, ESA 6036 CNRS, Institut <\/tt>Federatif de Recherches Multidisciplinaires sur les Peptides=IFR 23, <\/tt>Faculte de Medecine et Pharmacie, 22, bd Gambetta, F 76000 Rouen.<\/tt><\/a><\/p>\n

[16] Neurol Res. 2000 Apr;22(3):285-92.<\/a><\/span>Mechanisms of spinal cord stimulation in neuropathic pain. <\/span>Meyerson BA, Linderoth B. <\/span>Department of Clinical Neuroscience, Karolinska Institute, Stockholm, <\/span>Sweden.<\/span><\/a><\/p>\n


\n<\/span><\/p>\n

[17] Pain. 1999 Aug;Suppl 6:S149-52.<\/a><\/span>Regulation of spinal nociceptive processing: where we went when we <\/span>wandered onto the path marked by the gate. <\/span>Yaksh TL.<\/span>Department of Anesthesiology, University of California, San Diego, USA.<\/span><\/a><\/p>\n

[18] Pain. 1999 Aug;Suppl 6:S121-6. <\/a><\/span>From the gate to the neuromatrix. <\/span>Melzack R. <\/span>Department of Psychology, McGill University, Montreal, Quebec, Canada.<\/span><\/a><\/p>\n


\n<\/span><\/p>\n

[19] J Clin Neurophysiol. 1997 Jan;14(1):46-62. <\/span><\/a><\/tt>Stimulation of the central and peripheral nervous system for the control <\/tt>of pain. <\/span><\/tt>Stanton-Hicks M, Salamon J. <\/span><\/tt>Anaesthesia Pain Management Center, Cleveland Clinic Foundation, OH 44195, <\/span><\/tt>USA.<\/tt><\/a><\/p>\n

<\/tt><\/p>\n

[20] Percept Psychophys. 1996 Jul;58(5):693-703. <\/span><\/a><\/tt>An investigation of the gate control theory of pain using the experimental <\/span><\/tt>pain stimulus of potassium iontophoresis.<\/tt>
\nHumphries SA, Johnson MH, Long NR. <\/span><\/tt>Department of Psychology, Massey University, Palmerston North, New <\/tt>Zealand.<\/tt><\/a><\/p>\n

[21] J Peripher Nerv Syst. 1996;1(3):189-98. <\/a><\/span>Pain relief by various kinds of interference stimulation applied to the <\/span>peripheral skin in humans: pain-related brain potentials following CO2 <\/span>laser stimulation. <\/span>Kakigi R, Watanabe S. <\/span>Department of Integrative Physiology, National Institute for Physiological <\/span>Sciences, Okazaki, Japan.<\/span><\/a><\/p>\n


\n<\/span><\/p>\n

[22] Nurs Stand. 1993 Jul 28-Aug 3;7(45):25-7. <\/a><\/span>Pain: opening up the gate control theory. <\/span>Davis P.<\/span><\/a><\/p>\n


\n<\/span><\/p>\n

[23] Bull Acad Natl Med. 1989 Oct;173(7):855-60; discussion 860-1.<\/a><\/span>Gate control of the nociceptive message: applications to the treatment of <\/span>pain. <\/span>Cambier J.<\/span><\/a><\/p>\n


\n<\/span><\/p>\n

[24] Brain Res. 1983 Dec 5;280(2):217-31. <\/span><\/a><\/tt>Thalamic nucleus ventro-postero-lateralis inhibits nucleus <\/tt>parafascicularis response to noxious stimuli through a non-opioid pathway. <\/span><\/tt>Benabid AL, Henriksen SJ, McGinty JF, Bloom FE.<\/tt><\/a><\/p>\n

<\/tt><\/p>\n

[25] Psychosom Med. 1979 Mar;41(2):101-8. <\/span><\/a><\/tt>A signal detection analysis of the effects of transcutaneous stimulation <\/tt>on pain. <\/span><\/tt>Malow RM, Dougher MJ.<\/tt><\/a><\/p>\n

[26] GATE CONTROL OF ION FLUX IN AXONS. <\/a><\/span>GOLDMAN DE. <\/span>J Gen Physiol. 1965 May;48:SUPPL:75-7.<\/span><\/a><\/p>\n

Conflict of Interest: <\/span>None declared<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

E-letter by: Dr. Stavros Saripanidis, Consultant in Obstetrics and Gynaecology, Private Surgery, Thessaloniki, Greece In response to: Simon Petrides. 2011.\u00a0The use of prolotherapy injections for elite athletes. Br J Sports Med ; 45: 2 (Electronic pages). Dear BJSM Editors, The dorsal horns are not merely passive transmission stations but sites at which dynamic activities (inhibition, […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1105,1,188,373],"tags":[],"class_list":["post-2404","post","type-post","status-publish","format-standard","hentry","category-e-letters","category-uncategorized","category-guest-posts","category-letter-to-the-editor"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/2404","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/comments?post=2404"}],"version-history":[{"count":0,"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/2404\/revisions"}],"wp:attachment":[{"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/media?parent=2404"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/categories?post=2404"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/tags?post=2404"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}