Pain Research

Why Do We Hurt?

Chronic pain is any pain that lasts for more than three months. At that point in time, any tissue that might have been damaged at the onset of injury will have healed and therefore, should no longer be painful. So why do we hurt?

Pain is an output of the brain. The possibility of pain starts when nerve fibers that transmit pain signals (nociception) send information to the brain. Then the brain decides if it is important or not, and what to do about it. To make this decision the brain incorporates all the information you have about pain and all the context around you (your environment). That context could include your beliefs and thoughts about your back (you think it’s weak, unstable, degenerative, etc), your history of injuries, memories of others who have had back injuries, the smell in the room, or the amount of lighting. Any credible evidence of danger to your body will modulate pain (a dark room will upregulate a pain response). If the brain determines there are more “danger cues” than there are “safe cues”, then the brain will say “yeah, we’re gonna make that hurt”.

After pain has been present for an extended time a couple things happen: 1. There is increased sensitivity to that area. In effect, your brain becomes better at creating pain, and 2.) There is decreased precision in deciphering the location of the pain whereby the pain starts to spread, move around, or changes in how it feels (achy, stabbing, etc.). These changes represent real and significant changes in the circuitry of your brain. It may be difficult for people with chronic pain to believe because their pain is 100% real but it no longer accurately signals damage to the tissues.

There is significant evidence that when people in pain are taught about the pain mechanisms of the body and brain, their pain will decrease. There is significant evidence that the brain can regain precision in the areas of chronic pain. The brain is plastic and does change and even the circuitry of pain can be retrained. “Movement is king” with retraining the brain to reduce pain. I often use a “stop light” analogy to guide patients. If there is no pain when doing an activity you have the “green light”. If you have some awareness or pain while doing an activity but there is no residual pain after doing the activity, you have the “yellow light” and can proceed with caution. If you have pain while doing an activity and residual pain after the activity, that is a “red light” and you should avoid that activity until a later time.

If you have questions or want to learn more feel free to contact Pro-Motion Chiropractic. Or, here are some links you may find helpful.

https://www.tamethebeast.org/

TedX talk with Lorimer Moseley

Central Sensitisation

I often have people come into my office who have been dealing with pain for a long time. These people suffering from chronic pain are often frustrated, depressed and anxious. Anything they do may set off their pain, they’ve tried “everything” and sometimes they feel there is no hope and that they just have to “live with it”. In the article “Where pain lives” the author discusses how science is learning that chronic pain isn’t just “acute pain that goes on and on”.

There are several possible mechanisms of how chronic pain starts, propagates and persists, but they all take into account that pain doesn’t equal tissue damage. Meaning that patients with chronic pain no longer have injured or damaged tissue (muscles, ligaments, discs, nerves) that might’ve have long ago been a mechanism for pain, but suffer from the brain creating “circuits” that constant re-live the pain or becoming hypersensitive to any form of stimuli, known as “central sensitisation”.

It is important for people living with chronic pain to understand what they are going through and the specific brain changes that have allowed their pain to continue and then take steps to rehab and strengthen their body knowing that “hurt does not typically mean harm”. There are no pharmaceutical means to treat this type of pain yet but there has been a lot of success using “Cognitive Behavioral Therapy” and graded “non-pain contingent” exercises. I have always said that my “ideal” practice includes a pain psychologist for this reason.

This article contains a lot more detailed information and deserves a read. I hope you will take the time and learn something from it and if you have more questions please feel free to contact me at Pro-Motion Chiropractic.

https://aeon.co/essays/to-treat-back-pain-look-to-the-brain-not-the-spine

The "Big 3", with Stuart McGill

 I just read a great q & a about the "Big 3" core stability exercises according to Stuart McGill. I have studied his books and followed his research for years and am excited to hear more and more about him in the media. It's a good read and you'll learn about some causes of lower back pain and how the "Big 3" help to alleviate it. Have a good one!

https://www.lifetimedaily.com/leading-back-pain-expert-reveals-fix-back-pain/

The Brain and Pain

I found a couple studies that I wanted to share with you. I often discuss the brains role in pain processing and changes that occur in the brain as a result of pain. The psychological effect pain has on us is immense and is just starting to be recognized and understood. Here are the studies that, I think, help shed some light on how we, as health care providers and manual therapists, can help our patients.

  • Bunzli, S., Smith, A., Schutze, R., Lind, I., & O’Sullivan, P. (2017). Making sense of low back pain and pain related fear. Journal of Orthopaedic & Sports Physical Therapy.

This narrative (not a study per se) is especially interesting to me because I deal with it all the time. The authors conclude that the Common Sense Model (CSM) can be used to cope with “fear-avoidance behaviors”. In the “Fear Avoidance Model”, patients foresee extremely negative outcomes of their pain and so they avoid any and all activity that might exacerbate the pain, which leads to disuse atrophy, depression and chronic pain. By using the CSM patients can 1.) identify the pain, 2.) know what causes the pain, 3.) understand the consequences of the pain, 4.) learn how to control it, and 5.) know how long it will last. With this knowledge the patient is able to better cope with and treat their pain.

  • Kregel, J., Coppieters, I., De Pauw, R., Malfliet, A., Danneels, L., Nijs, J. & Meeus, M. (2017) Does Conservative Treatment Change the Brain in Patients with Chronic Musculoskeletal Pain? ASystematic Review. Pain Physician, 20(3), 139-154

This study reviewed 9 different studies which used MRI to determine if functional and/or structural changes occurred in the brain of patients suffering with chronic musculoskeletal pain after a course of conservative care. They found that conservative care seemed to produce both functional and structural changes in the brain and also that these changes were associated with positive clinical outcomes (decreased pain, increased function).