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Anatomy of Acupuncture Important Pathways for Pain Control & Acupuncture Relief.

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Presentation on theme: "Anatomy of Acupuncture Important Pathways for Pain Control & Acupuncture Relief."— Presentation transcript:

1 Anatomy of Acupuncture Important Pathways for Pain Control & Acupuncture Relief

2 Spinal Cord A. Spinal cord anatomy 1. Protection and coverings 1. Protection and coverings a. Vertebral column a. Vertebral column b. Meninges b. Meninges 2. External anatomy of the spinal cord 2. External anatomy of the spinal cord 3. Internal anatomy of the spinal cord 3. Internal anatomy of the spinal cord B. Spinal cord physiology B. Spinal cord physiology 1. Reflexes 1. Reflexes 2. Reflex arc and homeostasis 2. Reflex arc and homeostasis a. Physiology of the stretch reflex a. Physiology of the stretch reflex b. Physiology of the flexor (withdrawal) b. Physiology of the flexor (withdrawal) reflex and crossed extensor reflexes reflex and crossed extensor reflexes C. Spinal nerves C. Spinal nerves 1. Composition and coverings 1. Composition and coverings 2. Distribution of spinal nerves 2. Distribution of spinal nerves 3. Dermatomes 3. Dermatomes

3 The Spinal Cord 1. is continuous with brain 2. mediates spinal reflexes 3. is site for integration 4. provides the pathways

4 Protection and Coverings 1. vertebral canal 2. meninges 3. cerebrospinal fluid

5 Meninges and Spaces 1. epidural space 2. dura mater 3. subdural space 4. arachnoid membrane 5. subarachnoid space 6. pia mater -- denticulate ligaments -- denticulate ligaments

6 External Anatomy 1. cylindrical 2. flattened A-P 3. foramen magnum to L2 4. differential growth 5. cervical enlargement 6. lumbar enlargement 7. conus medullaris 8. filum terminale 9. cauda equina 10. functional segments

7 Internal Anatomy 1. gray matter 2. white matter 3. gray commissure 4. central canal 1. gray matter 2. white matter 3. gray commissure 4. central canal

8 Gray Matter 1. nuclei 2. horns a. dorsal -- sensory a. dorsal -- sensory b. ventral -- motor b. ventral -- motor c. lateral -- autonomic c. lateral -- autonomic

9 Spinal Cord Grey Matter Spinal Layers Spinal Layers Spinal grey matters divided into 10 layers Spinal grey matters divided into 10 layers Substantia Gelatinosa Substantia Gelatinosa Composed of a layer of cell bodies running up and down the dorsal horns of the spinal cord Composed of a layer of cell bodies running up and down the dorsal horns of the spinal cord Receive input from A and C- fibers Receive input from A and C- fibers Activity in SG inhibits pain transmission Activity in SG inhibits pain transmission

10 Spinal Nerve Roots 1. dorsal root (axons of sensory neurons) -- dorsal root ganglion (cell bodies of sensory neurons) -- dorsal root ganglion (cell bodies of sensory neurons) 2. ventral root (axons of motor neurons) Dorsal root ganglion Dorsal roots Ventral roots

11 White Matter 1. columns a. anterior a. anterior b. posterior b. posterior c. lateral c. lateral 2. tracts a. ascending a. ascending b. descending b. descending Posterior columns Anterior columns Lateral columns

12 Tracts of the Spinal Cord

13 The Spinal Cord Has Two Essential Functions 1. convey impulses between the periphery and the brain 2. provide integrating centers for spinal reflexes

14 Reflexes are… 1. inborn 2. unlearned 3. unconscious

15 Somatic Reflexes Versus Visceral Reflexes Somatic reflexes involve the somatic nervous system. Visceral reflexes involve the autonomic nervous system.

16 Reflex Arc 1. receptor 2. sensory neuron 3. integration center 4. motor neuron 5. effector sensory receptor sensory (afferent) neuron center of integration with association neuron motor (efferent) neuron effector sensory receptor sensory (afferent) neuron center of integration with association neuron motor (efferent) neuron effector

17 THE REFLEX ARC AS A FEEDBACK SYSTEM CONTROLLED CONDITION A stimulus or stress disrupts membrane homeostasis by altering some controlled condition RECEPTOR The receptors in a reflex are sensory neurons associated with a receptor device (transducer) and which relay nerve impulses to a central control center CONTROL CENTER The control center is an integrating center of neurons in the CNS. It relays the information to motor neurons EFFECTORS The motor neurons initiate some response by an effector (muscle or gland) to counteract the stimulus that originally disrupted homeostasis RETURN TO HOMEOSTASIS The action of the effector returns the body process to within its normal homeostatic range

18 Stretch Reflex 1. monosynaptic 2. muscle spindle 3. muscle tone 4. ipsilateral 5. reciprocal innervation

19 The Flexor and Crossed Extensor Reflex Intersegmental Polysynaptic Contralateral Pain receptor Role of association neurons Reciprocal innervation excitatory neurons inhibitory neurons Intersegmental Polysynaptic Ipsilateral Pain receptor Role of association neurons Reciprocal innervation

20 The Nervous System and Pain Somatosensory System Brain Somatosensory Cortex Thalamus Spinal Cord Dorsal Horn Ventral Root PNS Afferent Neuron Efferent Neuron A-delta Fibers C-Fibers

21 Pain Pathways – Going Up Pain information travels up the spinal cord through the spinothalamic track (2 parts) –PSTT Immediate warning of the presence, location, and intensity of an injury –NSTT Slow, aching reminder that tissue damage has occurred

22 Pain Pathways – Going Down Descending pain pathway responsible for pain inhibition

23 The Neurochemicals of Pain Pain Initiators Pain Initiators Glutamate - Central Glutamate - Central Substance P - Central Substance P - Central Brandykinin - Peripheral Brandykinin - Peripheral Prostaglandins - Peripheral Prostaglandins - Peripheral Pain Inhibitors Pain Inhibitors Serotonin Serotonin Endorphins Endorphins Enkephalins Enkephalins Dynorphin Dynorphin

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25 Theories of Pain Specificity Theory –Began with Aristotle –Pain is hardwired Specific pain fibers bring info to a pain center –Refuted in 1965 Gate Control Theory

26 Gate-Control Theory – Ronald Melzack (1960s) Described physiological mechanism by which psychological factors can affect the experience of pain. Neural gate can open and close thereby modulating pain. Gate is located in the spinal cord. –It is the SG

27 Opening and Closing the Gate When the gate is closed signals from small diameter pain fibres do not excite the dorsal horn transmission neurons. When the gate is open pain signals excite dorsal horn transmission cells

28 Three Factors Involved in Opening and Closing the Gate The amount of activity in the pain fibers. The amount of activity in other peripheral fibers. Messages that descend from the brain.

29 Conditions that Open the Gate Physical conditions –Extent of injury –Inappropriate activity level Emotional conditions –Anxiety or worry –Tension –Depression Mental Conditions –Focusing on pain –Boredom

30 Conditions That Close the Gate Physical conditions –Medications –Counter stimulation (e.g., heat, massage) Emotional conditions –Positive emotions –Relaxation, Rest Mental conditions –Intense concentration or distraction –Involvement and interest in life activities

31 Mechanisms that Regulate AP Inhibitor of AP –Cholecytokinin Enhancer of AP –L-phenylalanine

32 Conclusion Knowledge of the functional anatomy of the nervous system may be useful in determining how acupuncture works since all evidence suggests that the effects acupuncture can be explained only by its affects on the nervous system.


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