Chronic Pain Syndrome
Chronic pain is the persistent, non-acute, sometimes disabling pain in the body. Any pain that last for more than 3 months can be called chronic pain. It may or may not associated with a previous injury. If so, it outlasts the reasonable healing time of the damaged tissue. It loses its function in protective warning, becomes a health problem and affects the adaptability of the body.
The cause is the overexcited nociceptive pathway in the central nervous system (central sensitization). It occurs in fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, postsurgical pain, vulvodynia, multiple chemical sensitivity, and visceral pain hypersensitivity disorders like irritable bowel syndrome, overactive bladder, etc.
Nociceptive Pain
The body is constantly sending two types of signals to inform the brain of its current status:
- Proprioception: the sense of the orientation of the body parts in space.
- Nociception: the sense of damage of tissue.
Nociception is an adaptive, protective alarm response. As such, it has to ensure only those nociceptive signals that are linked to actual or potential tissue damage can turn on the siren. To achieve this reliable task, it utilizes the constant input of the proprioceptive signals and the descending control signals from the brain to modulate the transmission.
Examples:
- with proprioceptive input: If you rub or shake your hand after you bang your finger, you increase the proprioceptive input, and reduce the pain.
- with descending pain-influencing pathway: If you consciously distract yourself, you don't think about the pain and it bothers you less.
Causes
Brain: National Institute of Health, Wikimedia Commons
Causes of chronic pain:
- As more and more nociceptive signals travel to the brain, the nociceptive pathway becomes highly efficient. Pain can be easily be turned on.
- If a body part does not regain full function, if there is scarring, or nerves have been severed, or there is damage that does not heal, the normal proprioceptive signals never resume. Lacking inhibition, the pain signals continues on and on.
- Psychological stress and learned behavior are important factors leading to the development of "Chronic Pain Syndrome." Negative emotions and beliefs also make the pain worse. Chronic pain suffering also causes depression and pain behaviour which in turn fortifies the vicious cycle of chronic pain.
Characteristics
The main features of chronic pain are:
- pain can be easily triggered, even normal non-noxious stimulation can cause discomfort: e.g. sensitive to touch and pressure (weight of clothes on shoulders), heat, cold, light, sound, and smell,
- associated dysfunctional pain behaviors: facial grimacing, rubbing or touching the affected area and groaning or sighing, alterations in posture, limping and guarded movements, and
- self-limitation in activities of daily living.
The patients may complain of any kinds of pain, from joint pain, muscle pain, headache, neck pain, low back pain, shoulder pain, sciatica, fibromyalgia, to "failed back syndrome". They may experience loss of appetite, depression, anxiety, exhaustion and sleep disturbance. The pain subsequently provokes changes in their behavior, and the development of fear-avoidance strategies. As a result, they become physically deconditioned and socially isolated.
Treatment
The treatment of chronic pain addresses the multifactorial nature of the problem.
- Patient education - to be knowledgeable in understanding and managing their pain.
- The sensors of the postural systems, namely the eyes, inner ears and the upper neck, play an important role in the treatment of chronic pain. The proper function of these sensors provides proprioception and descending inhibition on the pain pathway. It constitutes the basis of training and rewiring of the brain for longlasting pain relief and the general wellbeing of the patient. Upper cervical misalignment problem requires specific adjustment; inner ears/eyes problems, then audio and/or visual stimulation is appropriate.
- To alter the subjective experience of pain - relaxation, breathing exercise, postural training and resuming normal daily activities.
Prevention
The best treatment for chronic pain syndrome is prevention. At any phase of care, patients should be:
- examined for abnormal functioning of the postural system,
- encouraged to carry out normal activities once the pain is tolerable.
Common pains, including chronic pain, have a prevalent cause: the derangement of sensory input for postural equilibrium, which leads to irritational stress and results in sensitization of pain.
