chronic pain

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Naturopathic Physician & Acupuncturist

Chiropractor, Naturopathic Physician, Acupuncturist
& Certified Strength and Conditioning Specialist

Chronic Pain

Articles
by Geoff M. Lecovin

Therapy for Chronic Pain
and Sports Injuries

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Integrative Approaches to Chronic Pain

Pain is one of the most common reasons that patients visit a health professional. It is also one of the least understood phenomenon and consequently, is often mismanaged.

There is a tendency among physicians to assume that pain is a signal of "tissue damage." This assumption has resulted in the overuse and misuse of medications such as Non Steroidal Anti Inflammatory Drugs (NSAIDs), COX 2 inhibitors, analgesics, narcotics, antidepressants and anticonvulsants. These drugs have numerous side effects, some of which over time are irreversible. In addition, these drugs can inhibit cartilage formation and accelerate cartilage destruction, resulting in osteoarthritis and chronic pain.

Integrative approaches to pain differ from conventional therapies in that they are less invasive, have minimal side effects, focus on the cause, and are harmonious with the body's bioelectric healing processes.

There are three phases of pain:
1. Immediate (nociception)- information regarding damage to tissue is relayed by receptors via nerve tracts to the brain.
2. Acute (inflammation)- continued tissue damage stimulating the production of chemical agents. This phase of pain is characterized by swelling, redness, heat and altered function.
3. Chronic- may be due to ongoing tissue damage/inflammation, psychological problems or myofascial changes.

Myofascial changes include structural and functional alterations within the nerves, muscles and joints as a result of macro trauma such as a strain/sprain injury or car accident, or from repetitive micro traumas, such as fine motor movements involved with typing or using a computer mouse.

Studies show that myofascial pain is a primary cause of pain over 90 percent of the time and the sole cause of such pain as much as 85 percent of the time.

There are numerous perpetuating factors that can play a role in the development or maintenance of myofascial pain. These include:

1. Mechanical factors e.g. postural stresses
2. Nutritional deficiencies e.g. B vitamins, C, calcium, magnesium, potassium, iron
3. Dietary factors e.g. simple carbohydrates, dairy, caffeine
4. Metabolic and endocrine imbalance e.g. hypoglycemia, hypothyroid, menopause
5. Psychological factors e.g. depression, anxiety and stress
6. Lack of exercise

Myofascial pain has the following features:
1. Pain is present without ongoing tissue damage
2. Delayed onset after injury
3. Abnormal or unpleasant sensations
4. Mild stimulation is aggravating
5. Loss of joint range of motion

Myofascial pain is typically accompanied by changes in sensation and strength in the areas affected by the involved nerves. This process is commonly referred to as "neuropathy." There are many causes of neuropathy, but by far the most common is structural degeneration within the musculoskeletal system. These changes occur gradually over time usually as a result of accumulated trauma. Many of these traumas go unnoticed, until at some point nerves become injured, resulting in abnormal function.

The classic signs of Myofascial pain include:
1. Muscle shortening.
2. Tender and painful focal areas in muscles ("trigger points").
3. Changes in strength, sensation and nerve function in area supplied by the involved neuropathic nerves.

Muscle shortening/trigger points are the hallmarks of myofascial pain.
Trigger points are known to cause: headaches, neck and jaw pain, low back pain, and the symptoms of carpal tunnel syndrome.

Shortening of muscles in the extremities (i.e. wrists, elbows, shoulders, hips, knees and ankles) places mechanical stress at their insertions and can cause tendonitis, bursitis, etc. Shortening of muscles acting across a joint can upset alignment causing arthralgia (arthritis-like pain) and eventually degenerative changes. Muscle shortening across the spine can compress discs, narrow the holes where nerves exit and eventually lead to nerve irritation.

Trigger points cause problems as diverse as: earaches, dizziness, nausea, heartburn, false heart pain, heart arrhythmia, tennis elbow, tinnitus and genital pain.

Trigger points can also cause: colic in babies and bed-wetting in older children, and may be a contributing cause of scoliosis.
They are a cause of sinus pain and congestion. They may play a part in chronic fatigue, fibromyalgia, and lowered resistance to infection.

Because trigger points can be responsible for chronic pain and disability, they can also cause depression and anxiety.

Latent ("silent") trigger points tend to accumulate over a lifetime and appear to be the main cause for the stiff joints and restricted range of motion of old age. These latent trigger points can also overstress muscles, causing shortening, which affects attachments and causes irreversible joint damage.

Local muscles along with their spinal counterparts (i.e. those muscles in the spine where the nerves are exiting to go to the damaged area) are usually involved together. For example, in the case of extremity pain, there is muscle shortening locally at the sites of dysfunction as well as at the associated spinal muscles.

A "vicious cycle" develops whereby shortened spinal muscles cause pressure on nerve roots (neuropathy), leading to irritation and shortening of the muscles supplied by those nerves, which reflexively sends back information causing more spinal muscle shortening (perpetuating the cycle).

Mechanical stress caused by muscle shortening results in inferior collagen, leading to weaker tendons, cartilage and bone, thereby predisposing these areas to further injury, pain and dysfunction.

Effective approaches to chronic neuropathic pain include intramuscular stimulation (IMS), neuromuscular reeducation/soft tissue release, home corrective stretching and strenghthening exercises, self myofascial release with tennis balls, nutritional supplementation and specific dietary recommendations.

IMS is a form of acupuncture based upon fundamental orthopedics and neurophysiology. Fine needles are inserted into shortened muscles, causing a gradual release of muscle spasm. Needling creates minute injuries, resulting in bioelectrical changes, which stimulate healing at the cellular level. Local inflammation stimulates growth factors, which provide stronger and more durable collagen, thereby strengthening damaged tissue. Pain in tendons, ligaments and joints is lessened as shortened muscles acting upon them gradually relax.