Tissue injury (scraping) results in the release of inflammatory mediators from damaged cells - nitric oxide (NO), histamine, and other ions amongst others. Immune cells respond by releasing further mediators such as cytokines and growth factors. A type of anti-inflammatory cytokine that suppresses nitric oxide synthases (NOS1 and NOS2) then responds to the injury. The suppression of NO production leads to reduction in inflammation-related nociception. I have thus seen a temporary slight increase in pain due to immediate inflammation followed by a subsequent decrease in pain within 48 hours after the treatment has been performed. With this patient, he experienced an immediate decrease in his spinal pain perception.
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