Chronic Pain
Classically any pain that persists for more than 3 weeks is classified as chronic pain. So chronic pain refers to the length of time one has his or her pain rather than as commonly mistaken the amount / severity of pain.
Chronic pain treatment is sometimes difficult and hence why pain perhaps develops into being chronic.
Few common features such as the mode of onset, the character of pain and treatment modalities used are described below.
The Onset:
The onset of chronic pain does not have a particular feature.
An unresolved physical trauma can set up chronic pain. An example could be a dull ache around the lower back and coccyx (bottom of the spine) aggravated by sitting more than few minutes and relieved by movement away from sitting upright. This is a common problem that may have set up following a fall on the buttocks. The trauma may have been weeks, months or indeed years before one becomes apprehensive of discomfort and a chronic pain.
Factors that lead to late onset of pain may include normal ageing, growth spurts of the body, a new job or a new environment. Our bodies have to constantly adapt and compensate for weaknesses we carry as excess baggage in our lives. Some of these include remnants of major or indeed minor traumas. Therefore old traumas become apparent in months or years to come depending on aging and lifestyle.
Of course alternatively there may be no gap between trauma and onset of chronic pain depending on the level of damage and adaptability of the body to the damage.
Another and perhaps growing number of chronic pains are as a result of repetitive minor traumas. These are called RSI (repetitive strain injury). Mis-using the body leads to trauma. When compensation mechanisms of the body react to these traumas, they may just manage to avoid a massive reaction to the trauma. A massive reaction to trauma is instant inflammation and associated pain development. However this massive reaction may be avoided in case of low levels of trauma or a higher strength compensation (adaptive) mechanism. Yet gradually the damage can accumulate to a degree following which the person becomes fully aware of having a problem as inflammation and pain sets in at a noticeable level.
Depending on the nature of a damage or irritation, pain is experienced. One should also remember pain is the perception of damage or potential for damage. This means the brain and other control mechanisms such the adaptive mechanisms can as well as dampening the perception, heighten the experience of an oncoming sensation of damage or potential for damage.
Some chronic pains are directly as a result of an ongoing pathological condition which has not been resolved, such as those in a stomach ulcer. Here 3 types of chronic pain may be present:
a) Stomach pain due to acid levels increasing and irritating the stomach lining.
b) Back pain and other musculo-skeletal pains, due to repetitive irritation of the spinal cord with constant bombardment of the cord by the incoming nerve signals from the stomach reporting damage or potential for damage. The spinal cord being irritated by excessive neural activity (not by shear physical pressure), leads to that part of the cord becoming sensitive, termed by osteopaths as facilitated segment. As a result that relevant part of the back may become painful. So the person with stomach ulcer may report mid back pain. In addition any other nerve in that area of the back may become affected by the extra activity of the facilitated segment in the region and therefore create abnormal sensation or function in other areas of the body supplied by the affected part of the spine. This is called referred pain.
c) Mechanical compensation because of the ulcer one may create an un-manageable posture in which mechanical repetitive strains may lead to chronic pain. So a person with an stomach ulcer may hold himself slightly bent due to the pain and psychological need to protect his stomach region. This simple postural change compromises how body reacts to normal external forces that the body usually deals with unaffected, such as the forces that pass through the body during a run or even walking or heavy coughing.
From the above example of the stomach ulcer you may notice that pathology does not have to be present for chronic pain to set in. In (b) above, it is explained how a facilitated segment may be set up. All is needed is constant stimulation of a section of the spinal cord by nerves that convey signals from an injured area or an area that is perceived to be injured. These signal to the cord are carried by pain fibres. These are nerves that are stimulated when there is damage to an area. These pain fibres travel from all areas of the body to our spinal cord.
Once these pain fibres enter the spinal cord their message great or small, is manipulated by nerves that come from our brain and other areas of the body. So we may end up perceiving pain when in actual fact there is no damage. Here through some complex feedback mechanisms having had the perception of pain in an area, inflammation in that area may set up and create real pain. This is a theory for psycho-somatic type of pain and disease.
In conjunction with psych-somatic activities, chronic pain and inflammation may be set up by any pain inducing activity. After the initial pain transmission, becoming pain free depends on how effectively the damage is repaired and how effectively our neural activity has returned to normal.
Treatment through Osteopathic Manipulation
A recent study published in the New England Journal of Medicine concluded that patients who suffered from chronic lower back pain benefited equally from osteopathic manipulation compared to ones treated by drug administration and active physical therapy, [Gunner BJ, et. al.: The New Engl. J. Med. (341) 19, pp 1426-31, 1999].
The study has been very encouraging for the use of osteopathic manipulation for the management of chronic pain. When compared to the treatments using painkillers, osteopathy offers an overall cheaper and safer approach (considering associated drug side effects). There have been many more studies that offer encouraging results for the use of osteopathic manipulations to alleviate chronic pain.
On the basis of chronic pain aetiology (cause of onset), as described above, the root of the problem needs to be traced back. By understanding the biomechanical (structural) relationships and physiology (how the body functions), a picture of progression of patient's dis-ease is developed by the osteopath.
Evaluation is made as to which tissues are damaged or causing pain followed by an evaluation of other supporting and compensatory factors in the dis-ease progression.
Treatment is based on determination of the extend of help that the patient may gain by physical therapy (osteopathic manipulations). Once the therapist is satisfied with safety issues relating to treatment modalities available, a plan for treatment is set and explained to the patient. Often with most chronic pains a patient has to take an active part in the therapy by performing corrective exercises and life style changes. Therefore patients education about their health and taking interest in self-help are prioritized by most osteopaths today.
Osteopathic manipulations aim to allow:
Above put together should address most chronic pains. The degree of improvement of course would depend on many factors. However considering the aims above and that the treatment is not of a complex, intrusive nature, then often there are no barriers to the use of some osteopathic manipulations in most chronic pains. It is inevitable that in some cases the treatment may not alleviate the pain but the procedure of having an assessment and treatment should be at least educational and assist in further diagnosis of the condition.