Doctor who is passionate about acupuncture

I love what I do, I am good at it and I am always there for my patients. If you come and see me, you will know why I am standing out. .

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Leading acupuncture specialist for facial rejuvenation, pain relief, stress relief, fertility, fatigue, anxiety.
Based at Kensington and Chelsea at Central London. Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

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https://anamayahealth.blogspot.com/2018/03/dr-maggie-ju-talks-about-vulvodynia.html

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M Ju. (2015) What Part Does Acupuncture Play in IVF?
The Journal of Chinese Medicine And Acupuncture Volume 22 Issue 1 March 2015 P21
M Ju (2014) Current opinion in acupuncture on stroke rehabilitation
The Journal of Chinese Medicine And Acupuncture Volume 21 Issue 1 September 2014 P9

Thursday, 17 May 2018

What is referred pain?

Referred pain is the pain felt in somewhere in the body other than in the site of origin. For example, teeth pain can be felt during heart attack. This teeth pain is referred pain, not the source of pain. The presence of pain in the teeth or jaws doesn't mean that there is any dental condition that needs to be treated, if there is no dental pain history. This is a typical example of referred pain which is pain felt at a site distant from the site of origin. Referred pain is frequently found in patients with chronic musculoskeletal pain (for example, temporomandibular disorder (TMD). In patients with TMD muscle and/or jaw joint pain could refer to the teeth. Patients and clinicians alike can become convinced that the pain is actually due to some form of dental problems. In these circumstances, treating teeth has no effect on the pain.

Pain referral has a neural basis. Specific pathways and neural connections in the brain are thought to lead to the possibility of pain referral.

One group of nerve fibres conduct information about touch and another group conduct information about tissue damage or noxious stimulation via different sensory nerves. Many sensory fibres from different parts of the different area can terminate on the same set of second order neurons. The second order neurones are part of the pathway that sends sensory information to higher centres for perception. However, since there is so much convergence of sensory information from different body parts onto the same second order neurones, these second order neurones may provide ambiguous information as to the exact location of the noxious stimulus. This neural mechanism is thought to be one way whereby the higher centres of the brain can become "confused" as to the exact location of the noxious stimulus.

Another explanation of pain referral is the activating of silent or latent synaptic connections. When there is prolonged and/or intense noxious stimulation, some of these ineffective synapses may become effective connections. The information is transmitted from other parts unrelated to the source of the pain. The brain therefore can become confused as to the correct location of the pain.

There is a simple diagnostic test that can be done to help distinguish referred pain to a tooth. Clinicians can use a diagnostic local anaesthetic to produce a neural inactivation at the site where the patient complains of the pain, e.g. a tooth. If the pain being felt in the tooth is referred pain, then the pain should persist despite the local anaesthetic. Locating the origin of pain is a key step for further treatment.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327510/

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