I'm making this blog as in depth as possible without writing a book. It's such a big subject, with so many different groups interested in the subject. So much being studied and still so much that still is not understood about pain. In simplist terns, pain is complex and I don't think that will ever change. But there is hope, each year new steps are taken, new technology is developing helping towards pain, gadgets, medication, exercises, psychology and "neuro hacks". It's a mine field, but it's interesting none the less.
Pain, as a complex and multifaceted phenomenon. Pain is much more than a simple sensory experience. It involves not only physical, but also emotional and cognitive (mental process) elements, interwoven into the fabric of our being. Understanding pain is a journey through the mysteries of the human body and mind, and recent advances in pain science have shed light on its intricate workings (within reason). Why chronic pain persists is still, not entirely a mystery.
The Nature of Pain
Pain can be broadly categorized into two types: acute and chronic. Acute pain serves as a warning system. You hit your thumb with a hammer, it hurts, you swear but the main positive is you know not to do that again. Pain alerts us to injury or disease, prompting defensive actions. Chronic pain, on the other hand, is often a condition in itself, persisting long past the healing of an injury and sometimes arising without any apparent cause. Chronic pain is diagnosed after 3 months. Many arthritis conditions have a chronic tendency. But some people can have chronic lower back pain that scans, examinations and blood tests cannot detect.
The Gate Control Theory
One of the seminal theories in pain science is the Gate Control Theory, proposed by Melzack and Wall in 1965. It suggests that there is a “gating mechanism" in the central nervous system that regulates the flow of pain signals to the brain. Factors such as stress or attention can influence this gate, potentially increasing or decreasing the perception of pain. Some believe this is an outdated model, but it did lay the foundations for more research.
What are the different types of pain?
Pain can be classified by its duration, source, or the mechanism causing it. Here’s a summary:
1. Acute Pain: Short-term, usually due to injury. It often serves as a warning signal and resolves with healing in most cases. BUT, and there is always a but, sometimes the body can over react to trauma. Complex regional pain syndrome can be a reaction to an injury.
2. Chronic Pain:Long-term, persisting beyond normal healing time. It can be due to ongoing conditions like arthritis or nerve damage. Or as mentioned an unknown reason for long term pain.
1. Nociceptive Pain: Caused by damage to body tissue. It's what you feel when you cut yourself or have an inflamed joint. Think of this as an ouchy pain.
Visceral: Related to internal organs. Often described as deep, aching, or pressure-like, may refer to other body parts. Some may liken this to a tooth ache.
Somatic: Originates from skin, muscles, or bones. Tends to be localised and described as sharp or throbbing. Many muscle spasms can create a feeling that something terrible has happened yet a muscle spasm is not a serious medical issue.
2. Neuropathic Pain: Caused by damage or disease affecting the nervous system. It's commonly described as burning, shooting, or like an electric shock.
An original AI depiction of Neuropathic pain
1.Inflammatory Pain: Associated with tissue damage and inflammation. It is part of the body's healing process. Research is showing that the more inflammation we have in our body the bigger the pain.
2. Pathological Pain: Arises from diseases or conditions, such as diabetes causing diabetic neuropathy (pins and needles, weakness).
1. Functional Pain: Pain with no obvious organic cause or clear evidence of disease, as in conditions like fibromyalgia. These are often the most difficult. Test cannot diagnose then and often the sufferer is given multiple medications that can cause other side effects. Some believe childhood trauma, prolonged stress, mental health issues and genetics play a role. They are often a silent illness. With a silent illness a sufferer often have been told "it's all in your head". Leaving feelings of abandonment and helplessness.
2. Psychogenic Pain: Pain affected by psychological factors, possibly where physical pain without a clear cause persists due to mental or emotional issues.
3. Cancer Pain: Occurs in patients with cancer, can result from the disease, treatment, or diagnostic procedures.
4. Phantom Pain: Felt in a part of the body that is no longer there, common in amputees.
Understanding pain is crucial for proper treatment and management. In a chiropractic setting, we need to understand the different pain generators. And adjust our treatment accordingly.
The Neuroscience of Pain:
At the neural level, pain is transmitted through specialized nerve fibers. Nociceptors, the sensory receptors for painful stimuli, detect noxious events and send impulses through the spinal cord to the brain. The brain itself has no pain receptors and relies on these peripheral signals to interpret discomfort. Because the brain has no pain receptors, often brain surgery is performed on an awake patient. Fascinating right?! We are literally organic computers sending information here there and everywhere.
The Role of the Brain
Our brain plays a pivotal role in the perception of pain. Once the pain signals reach the brain, they are processed in multiple areas, including the thalamus, the limbic system, and the cerebral cortex. This processing goes beyond mere sensory perception; it intertwines with emotions, memories, and even the anticipation of pain. We learn what pain is from a young age. Like a child touching an iron, they learn never to do that again. When puberty is reached, a teen may have their heart broken for the first time (hopefully never again!). A sporting injury, a car accident, the death of a loved one, failures and emotional trauma. Most adults have had most of these types of pain. We just do not realise how varied and all encompassing it can be. But with better knowledge and experience we learn to sail through the different types of pain...mostly.
The Biopsychosocial Model
The biopsychosocial model of pain acknowledges that pain is not just a biological phenomenon but is also influenced by psychological and social factors. Stress, anxiety, and depression can amplify pain perception, and social support (or the lack thereof) can modify the intensity and quality of pain experienced. Practicing here in Cardiff, this is one of my approaches. If a patient visits me with a back spasms from playing squash then it's simple and quickly fixed. If someone is coming to see me with unexplained back pain, a history of poor sleep, childhood trauma, 20 years of taking medication and generally struggling with life, then it's a different approach. We need to help what's going on upstairs as well as the physical pain.
Pain Management Strategies
Success in pain management relies on a holistic approach that might include medications, physical therapy, psychotherapy, and lifestyle adjustments.
Analgesics, from nonsteroidal anti-inflammatory drugs (NSAIDs) to opioids, are common in pain management. However, each class of drug comes with its own risks and benefits, and the potential for addiction, particularly with opioids. Opiods has led to an ongoing public health crisis. You can watch dope sick on Disney for a hell of a watch.
Psychological strategies, such as cognitive-behavioral therapy (CBT), can help patients manage pain by changing their pain-related thoughts and behaviors. Mindfulness and relaxation techniques can also help decrease muscle tension and reduce stress, influencing the perception of pain.
Physical therapies, including exercise, massage, and heat treatment, can relieve pain by stimulating the nervous system and improving muscular function.
The Future of Pain Science
Advancements in imaging technology and neuroscience are paving the way for a better understanding and new treatment modalities. The growth of personalized medicine, where treatment is tailored to the individual's genetic profile, lifestyle, and preferences, is particularly promising.
Stem cell therapy and tissue engineering have the potential to heal or replace damaged tissues, addressing the source of pain in cases like degenerative joint disease.
Technologies such as Transcranial Magnetic Stimulation (TMS) and spinal cord stimulation are non-invasive ways to modulate the nervous system's pain signals, offering hope for those with treatment-resistant chronic pain.
Can Chiropractic Help?
Yes and no. If we could rid everyone completely of their pain we would literally be mythacle pain releiving creatures. Sadly in a world where we do not have to wait for much, pain has a different story. Chronic pain in particular is a tricky beast. But we have many tools in our toolbox. We need to not overload a patient with information too quickly. Gradually educate, getting them to make slow changes. Change can be scary. Small steps lead to bigger one's. What we can do is make most chronic pain sufferers more comfortable. We can get them to lower pain medications which reduces sides effects. We can motivate a patient to become more active. We get the body moving better which tells the brain (that controls nearly everything) that, hey we can do more that we thought. We iron out kinks, soften tight muscles, get weaker muscles stronger and we do it because we actually care. The first session is an hour. That's a lot more than a 10 minute orthopedic consultation in a hospital, or a 7 minute visit in a doctors office. We give the patient a voice also. We have to read between the lines because they want to actually be listened to. Our approach for pain, here in Cardiff is holistic without the tuning forks and crystals.
Pain is a puzzle that science is diligently working to solve. The future holds promise, with the potential for pain to be treated more effectively, more safely, and in a more personalized fashion. Understanding pain requires an appreciation of the body and mind's interconnectedness, and with further research, we can hope to manage it better.