Textbook of Pain Electrodiagnosis
Pain Fiber Nerve Conduction Study - pf-NCS
Evidence Based Medicine
Second Edition

Author: James Hedgecock, PhD

Publishing, Copyright, and Contributor Information

Table of Contents
Pain Battle Continues

Introduction

Pain Physiology - Pain's Paradox

CHAPTER I

Part I: Basic Anatomy & Physiology
Overview
Motor Bias
Somatosensory Cortex
Nerve Fiber Types
Biochemistry of Pain
Proprioception
Afferent Pathways
Paleospinalthalamic Pathway
Neospinalthalamic Pathway
Ion Channels
Voltage-Gated Channels

Part II: Pathological Considerations
Withdrawal Reflex
Epicritic & Protopathic Phases
Paradoxical Pain Physiology
Pathological Phase
Sensory Radiculopathy
Proprioceptive Dyskinesia - RPD
A-delta Mechanoreceptivity
Referred Pain
Painless Pathology
Prostatitis & Vulvadynia
Diabetic Amputations

Brief History of Electricity in Medicine

CHAPTER II

Part I: Pioneers
Franklin, Volta, and Fere

Part II: World War II & EMG/NCV
Understanding Convention EDV
EMG Exam Protocol
EMG Cannot Test Pain Fibers
Surface EMG
MRI

PART III: Developing pf-NCS
Post WWII - EDX

Part IV: Electromotive Force
Discovery of Voltage-Gated Channels
Misconception
Acupuncture Connection
Nerve Centers
Who Discovered Acupuncture?
Transcutaneous Stimulation
Electrical Impedance
Neuroselectivity
Waveform Modulation
Detecting Malingering
Proving pf-NCS Efficacy
A-delta Neuroselective Frequency

Part V: Developing The Analysis Algorithm
Bell-Shaped Curve vs. Nomogram
Nomogram Rating Zones
Sympathetic Pain
Deviation Index
FDA Clearance & Patents
LSU Demonstration

Recent Advances in Pain Physiology

CHAPTER III

Part I: Pain and Glia
Glia Cells
A-delta Down-Regulate
Targeting For Pain Relief
Teamwork
Receptors Families
P2X Subtypes
P2 & P2Y
P1
P2 Antagonists
We Are Not Alone

Performing pf-NCS

CHAPTER IV

Part I: Basic
Step #1
Step #2
Step #3
Step #4

Part II: Recruitment
Technical Misconceptions

Part III: Detecting Malingering
Exception to Turning Back to 10
Inter & Intra-Operator Repeatability
Lidocaine Paradox

Part IV: Patient Setup
The pf-NCS is not a dermatome test
The pf-NCS is not a QST
Patient History
Patient Instructions
Test Sites
Blemishes
Anatomical Position

Part V: Examination Protocols & Test Sites
Review - Typical pf-NCS Exam
Cervical Plexus
Cervical Sites
Lumbosacral Sites
Alternate Ground Placement
Potentiometer Electrode Placement
Upper Extremity
Lower Extremity
Neuroma
Trigeminal
Thoracic
Custom Examination
Warning

Part VI: Trouble Shooting
Calibration
Ground Sponge
Pacemaker
Potentiometer
Avoid Patient Confusion

Part VII: Sympathetic Pain - Allodynia
General Considerations
Testing - Baseline Data

Analysis

CHAPTER V

Part I: Software Assisted Analysis
Analysis Types

Part II: Radiculopathy Analysis
General Concept of Averaging
Averaging
Hypo-Function
Variation
Graph Alignment
Graph Layout
Deviation Index
Averaging Demonstration
Correction Factor
Understanding Averaging
Mirroring

Part III: Three Analysis Rules
Rule #1 Highest Detects Pathology
Rule #2 Deviation
Rule #3 Patterns

Part IV: Disinhibition - Chronicity
Chronicity
Bilateral Disinhibition
Radiographic Correlation
Manipulation
New Prospectives

Part V: Upper Extremity Graphic Analysis
Graph Layout
Median Nerve
Anatomical Considerations
Wrist Entrapment
Cubital Tunnel Example

Part VI: Peripheral Nerve Studies
General Considerations
Trigeminal
Lower Extremity
Neuroma
Custom
Thoracic

Evidence-Based Medicine

CHAPTER VI

Part I: Conservative Protocols
Early Diagnosis - Early Intervention
Cure & Prevention
Early Intervention Algorithm
Choosing The Right Specialist

Part II: Proving Nerve-Root Pathology
Neurological Evaluation
Anatomical Evaluation
Balance
Short Leg Syndrome
AP Lumbosacral Evaluation
AP Lateral Bending
Lateral Lumbosacral View
Anterior Tilt
Cervical Radiology
AP View Evaluation
Oblique Views
Lateral View
Taking Lateral Bending Views
Analysis

Part III: Conservative Treatment Protocol
Conservative Algorithm
Ice Packs
Traction - Cervical & Lumbar
Water Exercises
Acupuncture
Manipulation
Cervical Pre-Manipulation Tests
Cervical Post-Manipulation
Lumbosacral Pre-Manipulation Tests
Lumbosacral Post Manipulation
Polyneuropathy

Analysis Review

CHAPTER VII

Recent Studies
References
Index