New Secrets to Decoding Chronic Pain
Dr. Jeff Williams - Chiropractor Amarillo - discusses
When we think of chronic pain, we think about having pain beyond the point it should have disappeared. The fact is, it is so much more. Chronic pain is a beast and taming it is a process and a journey.
Did you realize that chronic pain costs us more than cancer, diabetes, and heart disease globally? In case you didn’t catch that, it costs us all more than those huge, very serious conditions COMBINED. All together. You might say that chronic pain is a problem.
It is important to understand that nerves come from the arms and legs and everywhere else and connect directly to our central nervous system. The central nervous system is made up of the brain and the spinal cord. When information comes in from the arms, legs, or anywhere else, the brain must make decisions about how important those signals really are. As a result, the brain determines whether or not to make it hurt and, if so, how badly it should hurt.
That is very important:
The brain is what decides whether something makes you hurt.
The ‘Pain Experience’ is a protection mechanism and this process is only a small part of the overall ‘Pain Experience’.
Chronic pain is due to several things and, as just mentioned, the brain plays a part. In fact, previous injuries suffered are imprinted in the brain and the brain uses that information when making future decisions about the stimuli that it continually receives. It uses that information when deciding if, or how much, one will hurt on a day to day basis.
The brain is the one that tries to predict the future likelihood of experiencing pain and sets the sensitivity in order to minimize our risks based on what the brain thinks is likely to happen. For example, the expectation of something being painful changes the way a person moves.
Another vital concept is that of ‘Neuroplasticity’.
Without getting too difficult, the term simply means that our nervous system can change in structure and function as it encodes new experiences. This means that not only can injury cause pain but that changes in the central nervous system also play an active part in maintaining the chronic pain experience.
That also means that treatment targetting the central nervous system has the potential to decrease pain and improve function.
So my pain is in my head?
When we discuss these points with patients, they think we’re telling them that their pain is all in their head. That is not the case.
What it means is that our perception of ourselves and our capabilities combine with our past pain experiences. Past pain experiences could include injury and/or surgery. That information combines with what we have been told by doctors about ourselves. For example, “You have the back of an 80 yr old.” These factors can pile up to produce what is termed an ‘up-regulated’ central nervous system. Some call it a ‘sensitized’ central nervous system.
This does NOT mean it is all in a person’s head. Far from it in fact. What it means is that your very real pain can be (and most likely is) made worse by your own central nervous system. The central nervous system that is in place to protect you.
Thanks to Dr. Anthony Nicholson and Dr. Matthew Long with Clinical Development International online continuing education, we can put this idea on paper. The title image to this article represents a simplification of the patient pain experience.
The arcs represent your body’s total ability. The bold red line is the point of tissue damage. Meaning that you can operate normally until you reach the tissue damage line. If you reach that line or go beyond it, you are likely to tear ligaments, muscles, etc.
The red dotted line represents the point of pain. We reach the point of pain just before we reach the point of tissue damage. Again, this is our body using pain as a protection mechanism.
If you notice, there is a little bit of space where the arc extends above the tissue damage line. That is the point where you can operate pain-free but you are damaging tissue. This is the space one operates in when they are picking a car up off of a child or performing some superhuman feat.
For most of us mere mortals, we are able to operate normally without a lot of pain as ‘A’ demonstrates. We have an expansive range wherein we are able to live, work, and play without hurting. If we get too close to tissue damage, we hurt enough to back us off and then we continue to live, work, and play pain-free again.
When we enter the realm of chronic pain syndrome, through all sorts of different influences, our pain point (our red dotted line) is moved down. We may have been told we will eventually need surgery no matter what we do to avoid it. We may have seen our parents deal with awful back pain and have a perception that we will suffer the same malady. Maybe we have had past pain experiences like some sort of prior surgery or an injury from years ago that we still have in our mind.
In this sort of scenario, your central nervous system moves that red-dotted line down to protect you. It moves it down because you have subconsciously told your body that you need to be protected. Now, as ‘B’ represents, you have much less space in which you can live, work, and play before you start hurting.
As mentioned before, this is a ‘sensitized’ nervous system. Also known as an ‘up-regulated’ nervous system. This is when more and more things that do not trigger pain pass through to the central nervous system and start causing a pain response.
Now, describing this to patients that are hurting can elicit a couple of big responses.
One response is that of relief. There is relief that we have helped put a name on what is going on. Relief that we have provided a path that just might lead out of it someday.
The other main response is that of anger. Anger because they believe that we are suggesting their pain is purely in their head. If it’s all in their head, then how could they hurt so badly? They also think we are suggesting they’re somehow crazy.
That could not be further from the truth. There is almost always a real reason for the onset of pain. But, the long-term maintenance of that pain is typically more centralized in the nervous system. That is exactly what chronic pain is. Chronic pain should be treated with methods that address centralized pain. Not with methods that treat pain in the arm or leg.
There are all kinds of ideas on how to treat centralized chronic pain. One physician with some great research and ideas in his arsenal is Dr. David Hanscom, MD. Dr. Hanscom is a spinal surgeon from Washington State. He has authored a book called ‘Back In Control’. Dr. Hanscom is actually a spinal surgeon who just happens to be on the war path against spinal surgery. To be more specific, he is against surgery for the wrong candidate.
Dr. Hanscom is very clear that too many back surgeries are happening. He states that so many of them are failures because the patient was not a good candidate for the surgery in the first place.
He shares a shocking statistic as an example. He cites research showing that, when a chronic pain sufferer undergoes surgery and EVERYTHING goes beautifully, the patient will STILL experience chronic pain at the new site of surgery in 60% of the cases.
That’s a 60% failure rate for successful surgeries! THAT’S a sensitized central nervous system!
He also has a website we recommend often at www.backincontrol.com. This is where he provides more clarification and therapy ideas. Some ideas are as smple as getting adequate sleep, creative writing, or what he has termed ‘active meditation.’
In addition to Dr. Hanscom’s book we typically recommend the patient undergo a broad treatment management strategy.
This broad management strategy typically includes spinal manipulative therapy. Spinal manipulative therapy is performed locally by me, Dr. Jeff Williams, your Amarillo Chiropractor - winner of Best Chiropractor in Amarillo.
Broad management could also include targeted exercise regimens. Regimens urging the patient to move in ways they have not moved in some time. As they build confidence in these new movements, their pain point (red dotted line) begins to rise back up and the patient begins to have more confidence. That gives them more space to live, work, and play before feeling pain.
Hurt vs. Harm
It is always important for the patient to remember the difference between ‘hurt’ and ‘harm’.
If an exercise or activity hurts, yet clearly shows improvement, it is likely worth continuing. If an exercise or activity is harmful, it should either be modified or avoided completely.
Broad management may also include
- proprioceptive rehab,
- balance rehab, as well as
- cognitive-behavioral therapy.
Chronic pain syndrome is a beast and the pathways in the nervous system laid down are permanent. That means there will always be work to do in order to stay above the pain and keep the red-dotted line as high as possible. But, with a toolbox of techniques to help, there is hope and there is a way to begin climbing back out of the hole.
If we can be of assistance in the Texas Panhandle region, call your chiropractor in Amarillo, Dr. Jeff Williams at Creek Stone Integrated Care.
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (http://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected]Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com.
Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.
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Jeff S Williams, DC, FIANM, DABFP