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10 Articles in Volume 9, Issue #4
Application of Spinal Segmental Physiology to Evaluating Chronic Pain
Dental Consequences of Pain Management
Facility Profile: Casa Palmera
Intellectual and Moral Tasks in Intersection—Part 2
Milnacipran: A New Treatment Option for Fibromyalgia
Neuroma Pain of the Foot Successfully Managed with Laser Therapy
Opioid Treatment Longevity Study: Interim Report
Pain Management in a Palliative Care Setting
Precursor Amino Acid Therapy
Prolotherapy for Sacroiliac Joint Laxity

Application of Spinal Segmental Physiology to Evaluating Chronic Pain

A simple dermatomal screening process is used to help isolate the location of an offending segment when spinal ‘segmental facilitation’ is the cause of a chronic pain disorder.
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Sometimes the terms ‘balance’ and ‘posture’ are used interchangeably, but this is a misuse. Balance, as used in these articles, refers specifically to the location of the body center of mass relative to the axis of gravity.9 Neuroposture, on the other hand, incorporates survival-related behaviors into the concept of balance. ‘Posture’ is ‘balance’ with an attitude.

Osteopathic medicine, chiropractic, and manual physical therapy have stepped into the void left by ineffective medical treatments for spine pain. Physicians, in general, have no explanation for concepts such as “the facilitated segment” or “vertebral subluxation” or “segmental sensitization.” What do these specialists know that we don’t know in allopathic medicine? Physicians become skeptical when the chiropractor addresses cardiac problems with spinal manipulation. Are we missing something here? Is there logic in these concepts to help the physician make sense of all of this?

Figure 1. Classic neurospinal segmental anatomy. Adapted from Purves et al. (2008).7

Spinal Segmental Theories and Chronic Pain

This article addresses how to use sensory-motor integration phenomena—taking place at the spinal cord level—as a diagnostic tool to determine possible causes of chronic pain conditions. This second stage of the P.A.N.E. Process is for the patient who fails the “Wall Test” for postural imbalance, but does not exhibit central regression in the motor hierarchy (i.e., primitive reflexes).3 The next priority of conditions that can cause this combination of findings is “spinal segmental dysfunction.” Herein lies the answers to some of the questions concerning alternative healthcare.

All Physicians are trained in physical segmental anatomy and neuroanatomy of the human spine (see Figure 1). Indeed, much of our diagnostic efforts in evaluating the patient with chronic back pain are directed at locating pathoanatomic and compressive neurological pathology.15 The AMA Guides, 5th Edition, defines a motion segment of the spine as two adjacent vertebrae, the intervertebral disk, the apophyseal or facet joints, and the ligamentuous structures between the vertebrae.16 Unfortunately, this definition is limited in encompassing the diverse range of possibilities of causes of chronic pain.

It is agreed in neurophysiology that the spine is far more than a simple conduit of neurological flow between the brain and the body.17 Significant active sensory motor integration (processing) takes place at the spinal level, hence functional pathology is possible without visible anatomic changes (see Figure 2#). Furthermore, the flow of information is not only up and down the cord, but also transversely such that one side of the body affects the other side in certain circumstances.12 Thus, segmental relationships are complex and variable from a dynamic neurological standpoint.

A brief review of the developmental biology of the spine is necessary to understand what the author believes is the central issue in Allopathic Medicine concerning limited diagnosis of spinal pain: failure to recognize the extent of involvement of the autonomic nervous system in spinal physiology. At four (4) weeks of gestation, there are identifiable neurocytes gathering around the primitive notochord, migrating from the neural crest of the embryo in a process known as neurulation (see Figure 3). This migration ultimately forms the sympathetic chains running along either side of the vertebral column. Further, progression of autonomic development extends the spinal ganglia to the viscera (see Figure 4). Thus, the early spinal development of the spine, the autonomic nervous system, and organ functioning are all closely interrelated.

Korr has defined the ‘facilitated segment’ of the spinal cord as a segment with a low-motor reflex threshold, i.e. it represents a hyper-excitable segment of the cord.21 It is the author’s opinion, based on his experience with neuropostural motor reflex testing, that the basis for the “facilitated segment” of osteopathy is derived from autonomic segmental influences. Certainly the role of adrenergic physiology related to “fight or flight” functions in the brain are well known and so it would seem logical that similar physiology would extend to spinal processing. Thus, relationships between spinal segmental physiology and survival functions in the somatic body are neurologically likely. The issue here is not whether the clinician can treat heart disorders with spinal manipulation, but whether this is a better way. In consideration of the established physiological fact that sympathetics control blood flow distribution throughout the periphery, it is likely that disturbance of spinal autonomic regulation can have far- reaching effects on organ functions. We contend that allopathic neurology’s continued blindness to autonomic physiology is a major reason for difficulties in the management of chronic pain.21

In this physiological debate, osteopathy and chiropractic are not free of criticism either. The author contends that the autonomic nervous system is a reflexive system. All reflexes have to have a beginning, middle, and end to be a reflex. Concerning segmental physiology, the spinal components presumably are the “middle” of the autonomic reflex arc (where are the afferent limbs?). All of us have experienced the patient who goes to his chiropractor for endless manipulations, has a brief improvement, and then lapses back into the old chronic pain problems. The author attributes this to the failure to identify and treat the beginning of the reflex loop. The P.A.N.E. Process, on the other hand, can help the clinician locate the “beginning” of the reflex loop so as to change unwanted reflex processes resulting in chronic pain. Chronic pain is a reflex22 and is always best treated at its source.

Figure 2. Sensory motor integration at the spinal level. Adapted from Shepherd (1994).18 Figure 3. Development of autonomic ganglia in early development. Adapted from Rao and Jacobson (2005).19

Still pending in this series is an article describing a new concept called “postural injuries.” These are conditions that invoke unwanted changes in the body’s homeostasis—far beyond the local extent of the disorder—by affecting inherent “survival” mechanisms. Examples of common postural injuries that cause this systemic effect are peripheral nerve entrapments, certain gastro-intestinal disorders, headaches, dizziness, upper respiratory obstruction, allergies, TMJ/TMD, etc.

Figure 4. Distribution of autonomic innervation to the body. Adapted from Pansky and Allen (1980).6

Last updated on: January 6, 2012
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