Measurement Instruments of Central Sensitization
Added on 2020-05-28
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Running head: MEASUREMENT INSTRUMENTS OF CENTRAL SENSITIZATIONCLINICAL SENSITIZATIONName of the StudentName of the UniversityAuthor note
1MEASUREMENT INSTRUMENTS OF CENTRAL SENSITIZATIONMeasuring instrument for the nociception flexion reflexThe central sensitization is a state of the nervous system, which is involved in thedevelopment and maintenance of chronic pain. This situation activates the noxious and non-noxious stimuli to make the central nervous system hyperactive. This activation of the centralnervous system induces the feeling of pain in individuals. The Nociceptive Flexion Reflex (NFR)is a nerve reflex, which is released from the spinal cord to protect the body from the damagingstimuli (Ang et al., 2011). This is the withdrawal response of the body against any pain stimulusand the reflex action is measurable in clinical settings. Measuring NFR is an objective andreliable tool to measure the pain experience in central sensitization and chronic pain inindividuals. Desmeules et al. (2003) conducted a research to identify the neurophysiologicalevidences that lead to central sensitization in patients with Fibromyalgia (FM). Researchersconducted an experiment with total 164 outpatients were included using randomized controlledtrial method, in which, 85 patients were suffering from Fibromyalgia and 40 were non-FMpatients. The control group did not have any history of chronic pain. The physiotherapist selected18 tender points in the patient’s body and a digital force of 4 kg was forced on that tender pointto assess the myalgia score.The evaluating physician's global impression (PGI) of the patient'sgeneral status was recorded on a 5-point scale in which one is best or less pain felt (Desmeules etal., 2003). The tools used in this research were aimed to identify pain (nonspontaneous),assessment of the pain (using 2-fold subjective scale) and to access the nociceptive flexion reflexor NFR to measure the reflex due to chronic pain. The results indicated that due to increasedlevel of pain, the group of patients with FM had decreased level of tolerance to pain and the NFRlevel in those patients also decreased that determines the fact that decrease in reflex is associatedwith increase in pain intensity. To measure the NFR, a cutaneous electrode was applied to
2MEASUREMENT INSTRUMENTS OF CENTRAL SENSITIZATIONmeasure the muscular reflex. The nerve, which was chosen for stimulation, was the sural nerve.The NFR reflex test took very less time to perform however; several scales were used tostatistically analyze the measure of pain. The test needed very basic instruments used inphysiotherapy. Further, a trained or experienced physiotherapist can only perform the test as thenerves or points, which were used to stimulate and get reflex, are known to experiencedphysiotherapists. Another research done by Bezow et al. (2010) determined that continuousnociceptive input from peripheral myofacial structure induces central sensitization and usingNFR to determine the pain threshold in the patients of tension-type headache helped the group ofresearchers to measure the threshold of pain. Measurement instrument for the Hoffman reflex The Hoffman Reflex or H-reflex is the reflective reaction of the muscle after someelectrical stimulation of sensory fibers. The H-reflex test is done using electrical stimulator thatprovides results using a square wave current having short duration and long amplitude. Further,an electromyography machine or EMG is required to collect the data and record the response ofmuscles (Abeles et al., 2007). This method is used to assess the changes in the excitation level ofthe motor neuron pool. According to the research of Kumru et al. (2015), the researchers were toidentify the impact of spinal cord lesion level and severity of the injury on the level of H-reflexexcitability and recovery curve. Changes in the spinal cord reflexes can be originated fromdifferent issues including changes in the descending pathway, and to determine the reason, theychose 38 SCI or spinal cord injury patients and 18 normal individuals as control. They aimed toidentify the H-max responses and the recovery curve at interstimulus intervals and from 50-1000ms were recorded in the process. Subjects were seated in a room with temperature between 22-25degree Celsius As clinical assessment showed that nearly all of the SCI persons had equal
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