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Medical Background

Medical Background. Central Nervous system. Peripheral Nervous system. Brain & Spinal Cord. The Human Nervous System. General Layout of the human nervous system:. Nervous System. Motor nerves. Sensory Nerves. Automatic Nerves. The Peripheral Nervous System. Peripheral Nervous System.

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Medical Background

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  1. Medical Background

  2. Central Nervous system Peripheral Nervous system Brain & Spinal Cord The Human Nervous System General Layout of the human nervous system: Nervous System Motor nerves Sensory Nerves Automatic Nerves

  3. The Peripheral Nervous System Peripheral Nervous System Automatic Nerves Motor nerves Sensory Nerves (sympathetic & parasympathetic) Myelinated Myelinated Myelinated Non-myelinated Myelinated Non-myelinated (C) (A - b) (A - b) (A - d) (C) (A - d) Small Large Warm Sensation Motivation, emotions, body’s basic physiology (H.R, B.P, sweating) Cold Sensation Function: Muscle Control Touch Pain Pain Vibration

  4. Sensory functions in peripheral nerve Fiber type Myelination Velocity (m/sec) Function Diameter (mm) 30-100 5-30 1-2.5 A - b A - d C + (Large) + (Small) - (Small) 6-20 1-5 0.5-2.0 Touch, Vibration, Proprioception Heat, Cold, First pain (sharp and localized) Warmth, Second pain (dull)

  5. Techniques for assessing the nervous system Nervous System Central Nervous system Peripheral Nervous system Brain & Spinal Cord Motor nerves Sensory Nerves Automatic Nerves Sympathetic & Parasympathetic Myelinated Myelinated Non-myelinated (A - b) (C) (A - d) R-R Interval Orthostatic B.P. Tuning fork Pin Bedside testing Cottonwool Autonomic laboratory Somatosensory Evoked Potentials VSA - 3000 TSA - II Laboratory techniques NCS / EMG

  6. Medoc’s Expertise Nervous System Central Nervous system Peripheral Nervous system Sensory Nerves Brain & Spinal Cord Motor nerves Automatic Nerves Sympathetic & Parasympathetic Myelinated Non-myelinated Non-myelinated Myelinated Myelinated Non-myelinated (A - b) (A - d) (A - d) (A - b) (C) PATHWAY VSA-3000 TSA-II

  7. Why QST ? * 70% of the peripheral nerve system aresmall fibers * Most existing diagnostic devices for the peripheral nerve system examine the large fibers only (EMG, NCV, and EP) * QST is the only clinical technique which can diagnose the small fibers

  8. Why QST ? * QST is a non-invasive, pain-free technique, which can assist inearly detection, therapy selectionandmonitoring progression/ recoveryof patients with peripheral disorders * Combined with theVSA-3000 Vibratory Sensory,the TSA-II offers comprehensive assessment ofsmall&largeperipheral nerve function

  9. Why QST ? * Thetransmission of pain sensationis done through the small-caliberA-Delta&C fibersonly *QST is the only technique which can diagnose thesesmall-caliber fibers, which constitute the“Pain Pathway” * In other words, Thermal testing is the only clinical technique which quantitatively assess the function of somatic small fibers –from peripheral receptors through their central nervous system connections

  10. Thermal Threshold (for normal subjects) Mediating fibers Sensation Warmth ~ 1-20c above adaptation C (30-320c) Cold ~ 1-20c below adaptationA - d (30-320c) Heat pain ~ 450c C, some A - d Cold pain ~ 5-150c C and A - d VibrationA - b Sensory modalities TSA & VSA quantify 5 sensory modalities:

  11. Range of Sensation Sensation Threshold Pain Threshold Pain tolerance Sensation threshold - the lowest stimulus intensity causing sensation Pain threshold - the lowest stimulus intensity causing pain Pain tolerance - the lowest stimulus intensity causing withdrawal

  12. QST – Scientific Findings Chronic Pain Painful Neuropathies Diabetic neuropathy Evaluation of Nerve Blocks Fibromyalgia Complex Regional Pain Syndrome (CRPS) Lumbar Radiculopathy Trigeminal & Facial Pain Headaches Central Pain Syndrome (CPS)

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