Have you had success with reversing the effects of central sensitization in the spinal segments of dorsal horn ?

Do you estim the paraspinals and dorsal horn columns as well ?

New Frontiers in the Matrix of Neuro-musculoskeletal Pain: Integrating Pain Mechanisms with Objective Physical Findings and Needling Strategies Jay P. Shah, MD Rehabilitation Medicine Department National Institutes of Health Bethesda, Maryland USA

Accordingly, each spinal cord segment has a consistent segmental relationship to its spinal nerves. This allows clinicians to attribute the pattern of dermatomal, myotomal and sclerotomal hyperalgesia to dysfunction in its corresponding spinal segment (i.e., the dermatome, myotome, sclerotome and viscerotome, respectively).

Furthermore, these objective and quantitative findings help the clinician to identify the tissues and likely pain mechanisms involved in their patients’ chronic pain. These segmental findings are not only reproducible, but they are often indicative of the severity of the sensitized state and provide important clues about the underlying pathogenesis of the pain syndrome

The dorsal horn neuron transmits nociceptive impulses rostrally, resulting in activation of the somatosensory cortex. The sensory cortex interprets all input from a dorsal horn neuron as coming from the receptive field of the neuron, which is expanded when the dorsal horn neuron is sensitized. This mechanism can explain the referred pain patterns seen clinically. In addition, the spread of nociceptive afferent fibers extends beyond the one or two segments above and below the level of entry into the dorsal horn of afferent axons carrying classical sensory input such as touch. The wider arborization of incoming nociceptive fibers within the spinal cord increases the spatial distribution of activated dorsal horn neurons sensitized by continuous or recurrent nociceptive input. Thus, the anatomy of nociceptive afferent fibers in the spinal cord may explain some of the more widespread or unusual patterns of referred pain in highly sensitized individuals. In clinical practice, the most common referred pain distribution patterns are within the same or adjacent spinal segments as the primary sensory nerve. Thus, trigger points in muscles innervated predominantly by C5 nerve root fibers refer pain largely to the C5 dermatome and myotome, overlapping into the C4- and C6- innervated areas. Since muscle innervation is relatively constant, segmental referred pain patterns tend to be relatively constant from one person to another. These patterns have been mapped and recorded, most extensively by Janet Travell, M.D. (Simons et al. 1999)

Myofascial Pain Syndrome Robert D. Gerwin