Understanding Pain Management
By Robert Chatfield
Categories: Acupuncture, Chiropractic Care, Neuropathic Pain, Nociceptive Pain, Pain Management
The Basics of Pain Management
Pain can be categorized according to its duration, underlying cause of the original insult, and whether a secondary component has developed. An understanding of these different categorizations can help direct treatment decisions.
Pain can be classified as follows:
Acute vs. chronic
Acute pain is generally understood as a recent onset and is expected to resolve within a matter of weeks. Chronic pain is defined as any pain that does not resolve within 8 to 12 weeks from its original onset. Depending upon the severity and the cause of the pain, diagnostic testing may be employed to get a better understanding of the nature and extent of the condition. X-rays, MRI, and computerized tomography or CT, which is a digitized thin x-ray view of the affected region, are commonly employed. It is critical to find out the cause of pain early on and institute appropriate treatment because treating chronic pain can become much more difficult to treat effectively. Sometimes, despite all the diagnostic tools available, an answer to the cause of the problem is not apparent.
Neuropathic vs. Non-neuropathic Pain
Nociceptive pain is the most common type of pain and is caused by the detection of noxious or potentially harmful stimuli by the nociceptors or little relay centers, around the body. Nociceptors are receptors that are specifically designed to detect stimuli that may cause harm to the body, which may be mechanical, chemical or temperature related, in nature. For example, they may sense when there is physical damage to the skin, muscles, bones or connective tissue in the body, or when they are exposed to toxic chemicals or extreme temperatures. They usually have a high threshold, but when they are activated, they send electrical signals of pain to the central nervous system and the brain to deliver the perception of pain.
Neuropathic pain is associated with damage to the neurons in the body, following an infection of injury to the area, resulting in messages of pain being sent to the central nervous system and brain regardless of noxious stimuli. This type of pain is often described as shooting pain, as it travels along the nerves in an abnormal manner causing abnormal sensations of pain. Some patients with neuropathic pain report a constant sensation of pain, whereas other experience intermittent episodes, which may or may not be aggravated by stimuli or touch. The cause of nociceptive and neuropathic pain is a significant differentiating factor between the two types and is important to understand the appropriate management techniques for each. It is critical the understand the difference between the two in order to apply effective pain management.
Nociceptive pain occurs when pain receptors in the body detect noxious or irritating stimuli that have the potential to cause harm to the body. This includes mechanical pressure, chemical toxins and extreme temperatures, all of which may harm the body. The receptors then send electrical signals via the nervous system to the brain, leading to the perception of pain. Neuropathic pain is caused by damage to the neurons that are involved in the pain signaling pathways in the nervous system. There are a variety of circumstances that may lead to nerve damage, including certain infections, diabetes and surgery, among many others.
It is most desirable, as you see from the descriptions above, that effective treatment designed at true pain management, aimed at not just reducing the pain, which may be very important in the first 3 or 4 days, but actually getting at the cause of the pain and not simply masking the symptoms. This reduce the likelihood of long term nervous system injuries from chronic stimulation of pain pathways which would lead to neuropathic pain problems. These types of problems are usually much harder to deal with and should be avoided.
We have an epidemic of chronic pain sufferers, throughout the world today and it is mostly because of the choice of treatments given to those who suffer. In much of the world, we have an Opioid Epidemic because pain medication chosen as the number one choice for pain management, has not dealt with the actual cause of the pain and has mislead many as to how to effectively deal with their suffering. This choice of pain management has created an epidemic of physical suffering, as well as the emotional and social consequences of people losing their jobs, homes and families.
Recent research has shown that nonpharmaceutical choices to deal with pain management, have been far more effective, both short and long term, in getting at the true source of the pain and restoring normal physiology and function to the injured area.
Chiropractic care has a very effective track record at reducing pain and restoring better, more normal function, when it comes to neck or back injuries and compares very favorably when compared to medical care, physical therapy or massage. This is because when spinal injuries occur, it is the injury to one or more joints and the supporting soft tissues no longer function properly which alters messages to the brain. It is commonly believed that getting adjusted, resets the messaging from the joints and related tissues to the many different parts of the brain and more appropriately restores better movement and function to those areas of injury. No other modality creates this messaging so effectively, according to recent research. Chiropractic care can be very effective at pain management.
Acupuncture has been shown to effectively deal with chronic pain or neuropathic pain, when many other modalities may have failed. It may not deal with functional movement changes but can do a great job at shutting off chronic pain messaging to the brain and has been very effective, depending upon the case, at pain management.
Physical Therapy for Pain
If you’re like many patients with chronic pain, you’ve lost some of the physical conditioning that you had before your pain symptoms began. You might worry that physical therapy techniques could actually make the pain worse. In reality, physical therapy for pain promotes healing, relieves pain, and restores function for many patients who struggle with chronic pain. Many patients regain at least some of their ability to take pleasure in moderate physical activity. They begin to recover control of their lives. As you get stronger, you’ll grow more confident that you can manage your pain symptoms.
Massage for Pain
Like other movement therapies, massage serves to relax chronically tight or congested muscles, to restore better blood flow, circulation, movement and oxygen to the tissues that have become, damaged and been allowed to become glued together, if you will. By breaking up chronic adhesions in the connective tissue, fascia and related muscles, it brings in more oxygen to the tissues and allows better motion to all the surrounding tissues, letting things relax and pain to subside.
Effective pain management relies strongly on understanding which tissues have been injured and how to treat them most effectively. This is connected to an accurate diagnosis and then figuring out what to do next. Medication for pain, if that is your choice, while effective early on, should be transitioned into movement therapies that provide maximum movement of the joints, connective tissue and muscles and more accurate feedback from the areas of injury to the brain which resets feedback to the brain, which allows it to make proper adjustments for daily living.
By controlling how the tissues heal, through the phases of soft tissue healing, is an essential part of effective pain management so the scar that that is formed during the third stage (repair, which can go up to 6 weeks)) and fourth stages of soft tissue, remodeling, (which can go an additional 3 to 14 weeks or longer in more severe injuries) most closely resembles the normal tissue it replaces. This will greatly minimize the adverse potential of the need for further pain management.