Smertespecialisterne, Dr. Muskel og Radio24syv

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Jeg har været så heldig at blive inviteret til et radioprogram på Radio24syv med Dr. Anders Nedergaard, PhD. Du kan lytte til programmet via nettet her, eller som et podcast via iTunes her.

Dr. Nedergaard er en af de personer som har påvirket mig i en helt utrolig stor grad, og som jeg har lært meget fra, og fortsat lære meget fra. Anders var min underviser på min fitness-instruktør uddannelse tilbage i 2007. Dr. Anders Nedergaard har en PhD i muskelbiologi fra Institut for idrætsmedicin ved Bispebjerg Hospital, han er forfatter og har også en meget populær blog på kropblog.dk. Så holder han foredrag og workshops om træning, fitness, ernæring og livsstil.

Det er en utrolig stor ære for mig at blive spurgt om jeg ville deltage i et radioprogram med Anders. Programmet hedder Fitness M/K og sendes på Radio24syv, afsnittet som jeg deltager i er om træning og smerte.

Du kan lytte til programmet via nettet her, eller som et podcast via iTunes her.

I starten af programmet kommer jeg ind på den officielle smerte definition af hvad smerte er fra The International Association for the Study of Pain (IASP). IASP er det største organisation indenfor smerteforskning, og IASP udgiver også det største videnskabelige tidsskrift (PAIN) om smerte og smerte forskning.

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” The International Association for the Study of Pain (IASP)

Her synes jeg det er særligt vigtigt at bemærke ordne “actual or potential tissue damage” som meget fanger det jeg gerne vil have bliver forstået af lytterne.

24-7-smerter

Dette er nogle af de citater som jeg kommer ind på i programmet:

“Det er fundamentalt for organismens selvbeskyttelsesevne, at smertegrænsen ligger inden belastningsgrænsen. Uden smerteoplevelse, ingen mulighed for at holde legemet intakt og helt.”  Finn Bojsen-Møller, Bevægeapparatets anatomi, 12. udgave, 2001 

“Pain can be conceptualised as a conscious correlate of the implicit perception that tissue is in danger” Lorimer Moseley, Professor of Clinical Neurosciences and Chair in Physiotherapy, School of Health Sciences, University of South Australia

“Pain is an unpleasant conscious experience that emerges from the brain when the sum of all the available information suggests that you need to protect a particular part of your body” Lorimer Moseley, Professor of Clinical Neurosciences and Chair in Physiotherapy, School of Health Sciences, University of South Australia

Jeg nævner i programmet at nociception og smerte ikke det samme, og det er vigtigt at vi adskiller de to ting, noget som smerteforsker Patrick Wall også er inde på herunder:

“Tissue damage and pain are not so intimately linked that the two can be considered equivalent. We must therefore be very cautious and use one set of words for a stimulus event and another for a perceived sensory event.” Dr. Patrick Wall

Så en ting er dette faresignal (nociception) og noget andet er oplevelsen af smerte. Men det er vigtigt for mig og der syntes jeg selv, at jeg ikke var klar nok i programmet. At dette bliver sagt: I et velfungerende alarm system, bør en øget styrke og grad af dette faresignal føre til oplevelsen af smerte. Prof. Moseley nævner selv dette (i flere af hans foredrag) at nociception er en stærk modulator (en faktor som påvirker) smerte.

“Pain is usually triggered by messages that are sent from the tissues of the body when those tissues are presented with something potentially dangerous.  The neurones that carry those messages are called nociceptors, or danger receptors. We call the system that detects and transmits noxious events “nociception”. Critically, nociception is neither sufficient nor necessary for pain. But most of the time, pain is associated with some nociception.”  Lorimer Moseley, Professor of Clinical Neurosciences and Chair in Physiotherapy, School of Health Sciences, University of South Australia

Sidst i program taler jeg om fund på elite tennisspillere uden smerte i skulderen, der laver jeg en fejl. Det studiet jeg omtaler (Alyas et al 2007) omhandler ikke skuldre, men degenerative forandringer. Dog er der andre studier som stadig viser positive fund på folk uden nogle skuldersmerter. Her kan nævnes Sher JS et al. 1995 og Girish et al. 2011.

Hvis man vil læse om de to mest populære smertemodeller er der en kort analyse her, og vil man læse om skader og degenerative forandringer er der en artikel her. En kort artikel om effekten af søvn på smerte kan man læse her, samt en forsknings-baseret smerte-definition her.

Håber at I nyder programmet og kan bruge denne information. I er velkommen til at skrive til mig, via Smertespecialisternes facebook gruppe.

Jeg har nedenunder prøvet at samle sammen de videnskabelige studier og reviews som er belæg for mine udtalelser. Du kan lytte til programmet via nettet her, eller som et podcast via iTunes her.

 

Ref.:

Moseley, G. Lorimer. Reconceptualising pain according to modern pain science. Physical Therapy Reviews 2007; 12: 169–178.

Nat Genet. 2015 Jul;47(7):803-8. Epub 2015 May 25.Transcriptional regulator PRDM12 is essential for human pain perception. Chen et al. 

Congenital insensitivity to pain: an update. Nagasako EM, Oaklander AL, Dworkin RH. Pain. 2003 Feb;101(3):213-9.

Neuron. 2007 Aug 2;55(3):353-64. Nociceptors–noxious stimulus detectors.Woolf CJ1, Ma Q.

J Clin Invest. 2010 Nov;120(11):3760-72. Epub 2010 Nov 1.Nociceptors: the sensors of the pain pathway.Dubin AE1, Patapoutian A.

Prev Med. 1997 Sep-Oct;26(5 Pt 1):616-21. Nocebo: the power of suggestibility. Spiegel H.

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Pain. 2009 Sep;145(1-2):136-41. Epub 2009 Jun 27.Activation of the prostaglandin system in response to sleep loss in healthy humans: potential mediator of increased spontaneous pain. Haack M1, Lee E, Cohen DA, Mullington JM.

J Pain. 2013 Dec;14(12):1539-52. The association of sleep and pain: an update and a path forward. Finan PH1, Goodin BR, Smith MT.

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Pain Physician. 2014 Sep-Oct;17(5):447-57. Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain.Nijs J1, Torres-Cueco R, van Wilgen CP, Girbes EL, Struyf F, Roussel N, van Oosterwijck J, Daenen L, Kuppens K, Vanwerweeen L, Hermans L, Beckwee D, Voogt L, Clark J, Moloney N, Meeus M.

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Am Psychol. 2014 Feb-Mar;69(2):119-30. Interdisciplinary chronic pain management: past, present, and future.Gatchel RJ1, McGeary DD2, McGeary CA2, Lippe B3.

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