The truth about sports, nutrition and pain!

Posts tagged ‘chronic pain’

Why does pain move?

I have already talked about pain numerous times, in fact three times (pain part 1,2,3), but this is a subject that people have a hard time understanding. So, I will do one more post to try to clarify things. The most important thing about pain that people should know is that pain is an output of the brain and that pain does NOT EQUAL TISSUE DAMAGE (1-5). It sounds almost crazy and scary but it is true. That is why sometimes you see people with lots of arthritis that have no pain and other people who have very little arthritis and have lots of pain. Pain depends on the situation, I will give an example: Imagine a soldier at war and a professional soccer player at a match, and they both experience the same devastating knee injury. For those two people the significance of their injury is going to mean two completely things. For the soldier it means he can get the hell out of there and go home, for the soccer player it means good-bye to his professional career and maybe even income. Take a wild guess and think who is going to experience more pain??

But anyway, let us get back to the topic at hand and try to clarify why pain moves. Pain is basically controlled by the nervous system, so imagine something happens to your back,  ¨nociceptors¨will send  this information to your spine and from there to the brain. Now, let us suppose this ¨injury¨ keeps bothering you for a while, and these ¨nociceptors¨ will be firing away 24/7 during this whole time. At the end, the pain becomes centralized. Now, this is where it gets interesting. Your spine is also receiving at the same time information from all the different parts of the body. Once the original pain has become ¨centralized¨, the spine can sometimes make an error and get confused with all the different types of information that it is receiving from its nerves (6). This confusion can lead to the pain moving from one place to another. Now, when this happens it doesn´t mean that you have injured yourself in a new area,  it just means that your central nervous system has made an error in its processing of the information.

 

Hope you liked it.

 

  1. Flor H, Nikolajse Li, Stachelin Jensen T. Phantom limb pain: a case of maladaptive CNS plasticity.Nat Rev Neuroscience 2006 Nov;7(11):873-81.
  2. Flor H, Braum C, Elber T, BIlbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neuroscience 1997: March 7.224(1)5-8.
  3. Ren K, Dubner R. Central nervous system plasticity and persistent pain. J Orofac. Pain.1999.Summer.13(3):155-63.
  4. Kim S, Lee Hoo T, Lim Mee S. Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 1: Lumbar Spine. Journal of Korean Neutrosurgical Society 2013 January;53(1): 31-8.
  5. Kendrick D, Fielding K, Bentler E, Kerslake R, Miller P, Pringle M. Radiography of the lumbar spine in primary care patients with low back pain: Randomized controlled trial. BMJ 2001;322:400-05.
  6. Hargrove T. A guide to better movement.  Better movement 2014. pg 101-4.

 

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Pain part 3

So we have talked already about how pain is produced in the brain, how posture really doesn´t affect pain and how pain can be divided into acute and chronic pain. Acute pain being pain that last 3 to 6 moths and chronic pain, pain that last more than 6 months. So how do you treat the different kinds of pain?

With acute pain it is usually quite easy, the pain is associated with the tissue injury that has been produced and, in many cases, pain medications do work reasonably well. For example, NSAIDs (Nosteroidal anti-inflammatory drugs) have been shown to be effective for injuries (like ankle sprain), and after surgery. But for chronic pain, medications are only slightly effective and this is due to the fact that pain can change your nervous system (1,2).

It has always been said that the brain and the nervous system couldn´t change. But since a decade ago we know that the brain is plastic and can indeed change, it´s called NEUROPLASTICITY. Scientists have seen from imaging and animal studies that persistent pain or pain which last for months and years can change the pain pathway, in other words we become more sensitive. This hypersensitivity causes the brain to interpret anything related to those tissues to be highly threatening. So basically the nervous system and the brain have become more efficient in producing and maintaining pain (3-5). You could say that in chronic pain, the pain has moved up to the nervous system and now has very little to do with the initial damage to the tissues that caused the pain.

Let´s try to clear this up and make it easier to understand with an example: John, age 45, has had lower back pain for the last 2 years. Everytime he bends down to pick up something he experiences pain, so he stops doing that. We know that tissues or bones usually heal in between 3 to 6 moths, so there is really nothing wrong with him from a anatomical point of view. And everytime he bends down it doesn´t mean that he got hurt again or that he re-injured himself. It is just that Johns brain and nervous system have become so good at constructing pain that the slightest of triggers – even those that don´t cause damage, cause pain. So how do we deal with this?

The most important thing would be to educate John about pain, to teach him the role of the brain in pain, and to explain to him that pain doesn´t always equal to damage. When education about pain physiology is included into physiotherapy treatment of patients with chronic pain, pain and disability are reduced (6,7). After this, the next thing would be to gradually expose John to the feared activity (bending down) without causing pain and thereby lowering the threat level in the brain. So we would teach him first how to bend down correctly and to only bend till the point before the pain starts. This process would start to decentralize his pain and eventually make his pain disappear.

To finish I want to hopefully think that people now understand a little bit more of how pain acts and how to deal with pain. These last 3 articles have been difficult and maybe hard to understand but I would be satisfied if people took at least these 3 points home:

  1. Damage does not equal pain; not all damage leads to pain, and not all pain is caused by damage. Example: a study in the journal Arthritis & Rheumatism looked at the relationship between knee osteoarthritis and pain (8). They found out that some people had little arthritis and high pain, and some people had severe arthritis but low pain. The researchers concluded that the level of knee pain was due to central sensitization, rather than the level of osteoarthritis. In other words, the level of pain had more to do with changes in their nervous system, not changes in their knee structure.
  2. You can have a bulged disc or degenerated spine, maybe even impinging on one of your nerves, and still not have pain. Or you could have none of these problems, and still have persistent pain (9-12).
  3. The International Association for the Study of Pain defines pain as an emotion. That is, pain is a perception rather than a sensation. Unless and until the brain senses danger or threat, nothing can cause pain.

To finish I will post 2 links.

In one of them Lorimer Moseley describes how to explain pain to patients and in the second one, which is quite long (44 minutes), he talks about the whole process of pain. Enjoy

http://www.youtube.com/watch?v=jIsF8CXouk8

http://www.youtube.com/watch?v=-3NmTE-fJSo

In my next blog we will change the topic drastically and talk about food. Is food a drug?? Can you get addicted to food? We will see and explain in my next blog. See you then.

Bibliography

1. Ekman EF, Ruoff G, Kuehl K, Ralph L, Hombrey P, Fiechtner J, Berger MF. THe COX-2 sècific inhibitor Valdecoxib versus tramadol in acute ankle sprain: a multicenter randomized, controlled trial. Am J Sports Med. 2006 JUn;34(6):945-55. Epub 2006 Feb 13. PubMed PMID: 16476920

2. Buvanendaran A, Kroin JS, Tuman KJ, Lubenow TR, Elmofty D, Moric M, Rosenberg AG. Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor on pain management and recovery of cuntion after knee replacement a randomized controlled trial. JAMA. 2003 Nov 12,290(18):2411-8. PubMEd PMID: 14612477.

3.Flor H, Nikolajse Li, Stachelin Jensen T. Phantom limb pain: a case of maladaptive CNS plasticity.

Nat Rev Neuroscience 2006 Nov;7(11):873-81.

4. Flor H, Braum C, Elber T, BIlbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neuroscience 1997: March 7.224(1)5-8.

5. Ren K, Dubner R. Central nervous system plasticity and persistent pain. J Orofac. Pain.1999.Summer.13(3):155-63.

6.Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J pain 2004. Sept 20(5): 324-30.

7. Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. Aust J Physiotherapy 2005: 31(1):49-52.

8.Dallinga JM, Benjaminse A, Lemmink KA. Which screening tools can predict injury to the lower extremities in team sports?: a systematic review. Sports Med. 2012 Sep 1;42(9):791-815.

9. Johnson C. Modernized Chiropractic reconsidered: beyond foot-on-hose and bones-out-of-place. J Manipulative Physiol Ther. 2006 May;29(4):253-4. PubMed PMID:

10. Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manage. 2008 May;35(5):544-62. Epub 2008 Feb 14. Review.

11. Homola S. Chiropractic: history and overview of theories and methods. Clin Orthop Relat Res. 2006 Mar;444:236-42.

12. Good CJ. The great subluxation debate: a centrist’s perspective. J Chiropr Humanit. 2010 Dec;17(1):33-9. Epub 2010 Sep 21.

Pain part 1

It´s a complex and mysterious thing. I always thought that pain came from an injury or damage caused by misaligned joints, weak and tight muscles, ruptured disks, bad posture and so on. But recent studies have shown that to be false. Pain is produced 100% of the time in the brain and depending on the situation, your well being, your emotions and a thousand other things, that pain is going to be more intense or less intense. In some situations you may have an injury and not even feel the pain.!!….surprised? So am I, so let´s try to explain it.

Pain before was often thought of as a reflex mechanism, meaning that when you got hurt, pain receptors would send signals to the brain and we would sense that pain. But it doesn´t really work that way. What we have are called ¨nociceptors¨, and these nociceptors are similar to other receptors that sense pressure and temperature. The only difference being, that you need a bigger stimulus to activate these ¨nociceptors¨.

So when these nociceptors are activated they send warning signals to your brain and it´s up to your brain to decide whether it is a real danger or not. So you will not feel pain unless and until the brain believes that there is a threat to the body.

Pain can be divided into 2 different types of pain:

  1. Acute pain is the one you experience after a broken bone, a cut, a surgery, a burn, and such pain usually goes away when the underlying injury has been treated or healed. It might last for a few seconds, hours, weeks or, at the most, 3-6 months, which is the time it takes to heal and remodel connective tissue.
  2. But in a few people, even after the tissues had enough time to heal, pain persists for years, this is called chronic pain.

This could be a little complicated, so let´s stop here, analyze the information and take a look at a couple of videos that I think will help you understand the concept of pain better.

http://www.youtube.com/watch?v=Wk5k5_y-zJY&list=PLE5A36FF98DF8EB01

http://www.youtube.com/watch?v=gwd-wLdIHjs  The second video is about Lorimer Losley. He is the author of ¨Explaining Pain¨, a great book I recommend.

I will stop here for today and continue next time with the second part of pain, where I will talk about how to treat pain. Hope I made you think.

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