One general way to define Chronic pain is: pain that continues past 12 weeks, or beyond the time that it takes tissue to heal from an injury. It can be called ‘unresolved’ pain because the pain persists after the injury(if there was an injury) has healed. There are several reasons for this that are amenable to treatment.
- one or more factors are continuing to irritate the tissue.
- the nervous system has adapted in such a way that symptoms persist.
Your nervous system runs the show. It basically provides the phone lines for messages coming in from nerve endings and messages going out to: 1. the muscles to make them contract to move your bones and change blood flow and 2. to organs such as your adrenal glands and stomach, heart, lungs etc. The nervous system also contains the brain or your spinal cord segments that interpret the information being sent and forms a response to it which may or may not involve making your conscious mind aware of it. They can both tell muscles to contract or hormones to be released. In a reflex, such as when you place your finger on a hot stove, your body reacts(at the spinal cord segmental level-not the brain) and muscles contract to pull your hand away before it even registers in your brain that you have pain.
The nervous system also interprets the environment and creates the tension in the muscles as the situation requires. You may have noticed that the tension of your muscles is quite different when you are relaxing at the beach versus when you are confronted with danger or stress. In the latter case, your nervous system is sending more electrical impulses(higher frequency) to the muscles to cause them to tighten in readiness for fight or flight. When stress or danger has passed, these muscle groups should come back to a more relaxed state. But often following an injury, they do not. They may remain stuck at the wrong level of tension as if you had set the thermostat in a house to 100 degrees. Effective treatment of chronic pain is much like resetting thermostats throughout the body.
If the nervous system has adapted in a way that provokes symptoms, there are generally tight and tender muscles and restricted joint motion that will make this evident. The muscle groups not only fail to function as a team (since some cannot relax and some are likely not coming on properly), but they will send messages in to the spinal cord saying that they are overworked and irritated. We used to think that this created a self perpetuating cycle when the nervous system responded by telling the muscles to tighten more to deal with the irritation. Research now tells us that components of the nervous system can actually physically change in response to repeated irritating signals. Nerves become more reactive and dormant connections between nerves are awakened. This makes the brain think that areas that are not injured or even touched are producing pain. This state can exist even when the injury is healed and there is no external stimulus causing those messages. What’s more, the system that normally dampens pain messages as they ascend to the brain lets more messages through to reach the brain. Research also shows that by removing aggrevating factors such as myofascial trigger points and postural overloading of muscles, the system can start returning to normal. It is important to remember that the nervous system is build to help us survive, not to help us feel great. While comfort is important to us, the nervous system is wired to protect us from the dangerous world around us and comfort doesn’t factor into it’s programming.
What can be done about chronic pain?
Find and remove the cause or symptoms don’t go away. For example, a client complains of knee pain and an evaluation finds myofascial(connective tissue joining and incasing muscles and bones) restrictions in the thigh or lower leg and a restriction of motion at the ankle or foot joints. Treatment would be to those areas….NOT the knee. Treatment of painful shoulder motion would likely focus on things such as the rib cage, collar bone and reflexes rather than you exercising the rotator cuff muscles.
Re-educating (or rebooting) the patterns in the nervous system is always part of dealing with chronic or acute problems. Osteopathic treatments developed over the last 120 years and, more recently, intramuscular manual therapy (the treatment of muscle trigger points with a needle but no medication) have proven to be tremendously powerful tools to treat chronic pain by way of the nervous system. There are also ways to trick the nervous system by using its own reflexes. All of these techniques require identifying what patterns have arisen and dealing with them one by one in the proper order. Treatments of medications or massage or adjustment that feel good initially, but do not last, didn’t reset that thermostat.
As the osteopathic community has taught for over 100 years, symptoms are generally found away from their root causes. For example, if you have previously been to physical therapy for a “herniated” disc and someone used traction or encouraged you to perform exercises to alter/change that disc or if a physician injected the region with a steroid, then you experienced someone treating your “injury”. But the best treatment might be to ribs that are not moving properly, other joints of the spine, fascial restrictions or troublesome muscles. This is where many readers think, “but I saw the MRI and the disc IS the problem”. So this is when I give them something to challenge their viewpoint: 40-42% of the population in the US is walking around pain free with one or more bulging and/or herniated lumbar discs. So there is often more to the picture.
Lastly, if exercise is needed it should focus on proper patterns of muscle cooperation after improper patterns have been broken down or released. Research now shows how pain limits muscles’ ability to strengthen. Simply doing exercises is often a fruitless approach to pain. If you don’t know what is wrong with the car, then you probably aren’t going to fix the problem by driving it faster.