Understanding Pain Sources and How They are Perceived in Your Brain

[vc_row][vc_column width="1/1"][vc_column_text]By: Dr. Corey Finan BSc., DC, CCSP, RMT, ART

I can’t tell you how many patients come into my office complaining of nerve pain, or a pinched nerve feeling, but it is a lot!  Most of the time it turns out they are having nociceptive pain (pain from a nociceptor activation, which is basically a pain fiber in their soft tissue that sends a signal back to the brain that we call “pain”).  Studies estimate that of the thousands of patients that suffer from chronic pain, 20% of them have neuropathic pain.  That leaves the other 80% to be of nociceptive origin.  Unlike nociceptive pain, neuropathic pain does not respond to anti-inflammatories or opioid medications as they are unable address the underlying mechanisms of the neuropathic pain.  To add insult to injury, the underlying mechanisms of neuropathic pain are often vague and hard to determine.

To understand each pain source better, let’s identify each of them.

Nociceptive pain is:

Neuropathic pain is:

As you can see the two are VERY different from one another.  Most people who come in to our clinic, and really any walk-in clinic will be typically presenting with nociceptive pain.  Neuropathic pain leads people to believe something drastic is going on with them, and they seek emergency medical attention.  Once they go through the battery of tests that show their pain is neurogenic and not something worse, they will come in for care.  Both types of pain can be treated conservatively, and both respond well to care.  Nociceptive pain can be further broken down by the tissue that is causing the pain.  Muscle pain is different than tendon pain, which is different than ligament pain and bone pain is different as well.  Muscle pain is often achy if it is tight or fatigued (overused), while ligament pain is very sharp.  Tendon pain can be a combination of sharp and achy depending on the reason it is sore.  Bone pain is often described as a “deep achy pain”.  Some nociceptive pain can be a sort of phantom pain, where the pain is felt in one part of the body (say along the outside of the knee or lower leg), but is generated by a trigger point in the hip.  Working on the knee and lower leg WILL NOT help this type of pain, ONLY working on the trigger point in the hip will resolve the leg pain.

This raises another important point in understanding pain, and that is understanding the timing of the pain.

When does it hurt?

Neurogenic / Neuropathic pain is generally a constant pain (the nerve fiber is constantly irritated, thus sending off constant pain signals to the brain), while nociceptive pain often comes and goes.  Sometimes the pain is present at rest, consistent with tightness in the muscles that when not being used, and therefore lacking blood flow and warmth will tighten.  This tightening leads to a pulling of the tendon where it attaches to the bone.  This will lead to an achy sensation at the tendon-bone interface.  This is a common presentation of patellofemoral syndrome, where the quadriceps gets tight through activity, but while using it, it becomes more pliable and does not cause pain.  Once activity is complete, blood flow through the muscle diminishes, and the muscle begins to tighten (shorten), causing a pull at the tendon-bone interface again, leading to that achy pain down at the knee cap, or at the tibial tuberosity where the patellar tendon attaches.  This is basically what patellofemoral syndrome is.

The emotional side of pain...

Most people think pain is simply a physiological phenomenon.  It is however a multi-factorial collection of several ongoing processes including, but not limited to, contextual, psychological, and socio-cultural factors.  What this means for the average pain sufferer is that not all pain is the same person-to-person.  A stubbed toe for you may feel like a 2 out of 10 achy pain, while for another person it could feel like an 8 out of 10 excruciating pain.  This interpretation of the pain level often has an emotional component to it, and may be influenced by emotional scars from childhood, or other experiences in your life.  We all know people who have an unexplained fear of things such as spiders, snakes, thunderstorms, etc., these people have been primed emotionally to fear such things because of prior experiences or hearing about tragedies involving whatever it is they fear.  This is an emotional tag placed on the object they fear.  They associate whatever they are afraid of with something bad that could happen to them (a spider bite, getting struck by lightening, etc.), and so they have a heightened sense of fear around those things.  The same can work with pain.  People have an eversion to pain.  I’ve been working on patient’s dry needling them, and they burst into tears, not due to pain from the treatment, but rather from the fear of the needles.  When I ask them if it is painful they deny that it is, and they often cannot explain why they are crying.  They just are afraid of the needle damaging them.  They are almost paralyzed with fear, while another person can carry on a conversation with me as if we were sitting having coffee instead of me inserting dry needles into them.  Our experiences in life shape how we perceive things, and it is no different with pain.  Perception of pain is really what we are looking at here, not just pain.

So, what is the takeaway?

There are many faces to pain.  We all suffer from pain at one point in our life, usually we get over the pain, sometimes it lingers.  No matter what the cause, pain is usually and end stage of damage to tissues, and is the body’s “smoke detector” telling us there is a fire.  We can use the pain to guide our activities and avoid doing further damage to the tissue, or we can take pain meds to decrease the pain.  This is like taking the batteries out of the smoke detector in order to stop the alarm going off.  However, the fire is still there.  Naturally, it is important for everyone to find their comfort level, and do what you feel is important for yourself.

If you are unsure what is causing your pain, it is important to seek out professional advice from a musculoskeletal specialist to get a proper assessment and figure out exactly where the pain is coming from, and the most effective way to treat your particular pain.

At AST we are experts in musculoskeletal pain, and can take care of any pain you present with, be it acute, chronic, of unknown origin, and unrelenting.  We are here to help, and happy to do so.

If you are in pain and want to get an accurate diagnosis and treatment plan to help, please call to book in today.

*This blog is not intended to officially establish a physician-patient relationship, to replace the services of a trained physician, naturopathic doctor, physical therapist or chiropractor or otherwise to be a substitute for professional medical advice, diagnosis, or treatment.  [/vc_column_text][/vc_column][/vc_row]

What is Intramuscular Stimulation (IMS)

[vc_row][vc_column width="1/1"][vc_column_text]By: Active Sports Therapy

Intramuscular Stimulation (IMS) is an effective treatment for chronic pain of neuropathic origin. This technique uses needles similar to the needles used in acupuncture to find and diagnose muscle shortening in deep muscles. This technique is great because it has very few side effects.

IMS was developed by Dr. Chan Gunn while he was a clinic physician at the Worker’s Compensation Board of British Columbia in the 1970’s. He is presently President of iSTOP and clinical professor at the University of Washington’s Multi Disciplinary Pain Center in Seattle. Dr. Gunn has been awarded The Order of British Columbia as well as The Order of Canada, the nation’s highest honor, for his contributions towards solving chronic pain. He has also been elected Honorary Fellow of Peterhouse Cambridge University. Although IMS uses implements adapted from traditional acupuncture, it is based on scientific, neurophysiological principles. The acupuncture needles used are very thin (much thinner that the hollow needle used to inject medicine or take blood samples). You may not even feel it penetrating the skin, and if your muscle is normal, the needle is painless. However, if your muscle is supersensitive and shortened, you’ll feel a peculiar sensation – like a muscle cramp or Charlie Horse. This is a distinctive type of discomfort caused by the muscle grasping the needles. Patients soon learn to recognize and welcome this sensation. They call it a “good” or positive pain because it soon disappears and is followed by a wonderful feeling of relief no longer tight, you no longer feel it. What has happened is that the needling has caused your abnormal muscle shortening to intensity and then release. It is important that you experience this sensation in order to gain lasting relief.

“Neuropathy”- or- what happens when nerves start to go wrong…

Doctors usually have no difficulty in treating pain caused by injury (a fracture, for example) or inflammation (such as rheumatoid arthritis). But they are perplexed by pain that shows no sign of tissue damage or inflammation, such as headaches, “whiplash”, backache, tennis elbow or frozen shoulder.

Dr. Gunn had introduced “neuropathic pain”, to describe this type of pain. Typically this occurs when nerves malfunction following minor irritation. Nerves and nerve-endings become extremely sensitive and cause innocent, harmless signals to be exaggerated and misperceived as painful ones. (This characteristic is known medically as supersensitivity). The result is pain, even when extensive medical tests show there is “nothing wrong”. Until recently, supersensitivity has received little attention in medical circles.

The Effects of IMS

The effects of IMS are cumulative – needling stimulates a certain amount of healing, until eventually, the condition is healed and the pain disappears. Some patients treated with IMS have remained pain-free for over 20 years.

Frequency of Treatments

Treatments are usually once a week (but can be spread out to two weeks) to allow time between treatments for the body to heal itself. The number of treatments you require will depend on several factors such as the duration and extent of your condition, how much scar tissue there is (usually increased after previous surgery) and how quickly your body can heal, the rate of healing depends on the condition of your nerves (young people usually heal more quickly, although older is not necessarily slower). If the pain is of recent origin, one treatment may be all that is necessary. In published studies of patients with low back pain, the average number of IMS treatments required was 8.2.

Treating Neuropathic Pain

Supersensitivity and muscle shortening cannot be operated on and “cut away”. “Pain killers” and other analgesic pills only masks the pain. The goal of treatment is to release muscle shortening which presses on and irritates the nerve. Supersensitive areas can be desensitized and the persistent pull of shortened muscles released.

If you think IMS could be the right treatment for you, please book in for an assessment.

*This blog is not intended to officially establish a physician-patient relationship, to replace the services of a trained physician, naturopathic doctor, physical therapist or chiropractor or otherwise to be a substitute for professional medical advice, diagnosis, or treatment.  




Is Your Stress Contributing to Your Pain?

[vc_row][vc_column width="1/1"][vc_column_text]By: Active Sports Therapy

If you’re dealing with an injury or pain, studies show that there is a direct link between an individual’s stress level and the amount of pain that they feel. Stress and pain are considered to be closely linked so you may find it beneficial to journal your pain level and your stress level to find out if, personally, there is a correlation for you.

Stress is actually a natural reaction to the world and experiences that we are a part of and everyone will feel stress occasionally. The difficulty arises when a person has elevated stress levels that are persistent to the point where it begins to take a toll on the body.

For example, here is how stress plays out in the muscular system. When you enter a state of stress, a common response for the body is for muscles to tense up. It does this to protect you from injury in a dangerous situation and under normal circumstances, the muscles will relax again. However, if you’re always under stress, your muscles will not get the opportunity to let go and relax, leaving you with tight shoulders, a sore back, and even general muscle pain. The muscles of the neck and shoulders can often be connected to frequent headaches, sometimes referred to as tension headaches.

The good news is, there are many things that you can do to work toward reducing your stress levels.

Active Release Therapy, offered here at AST, can help alleviate the tension in your neck, back and shoulders, often with only a couple of treatments. This treatment combined with these stress relieving tips can make a huge difference when applied.

Sleep – This is so important for people suffering from high stress levels. A good nights sleep will help you to face the day in a more relaxed, energetic, and clear-headed state.

Learn to relax – Relaxing means different things to different people. Aim for an activity that you can incorporate into your daily routine. Reading before bed instead of watching TV is helpful for some. Guided meditation can teach techniques of meditation and there are some great apps out there! Check out The Daily Calm as it’s one of our favourites. Restorative yoga or simply challenging yourself to learn deep breathing techniques can all contribute to the de-stressing process.

Identify what triggers your stress – Is it work, relationships, or an overwhelming schedule? Becoming aware of your biggest stressors can help you to make a plan to manage it. For example, if you have an overwhelming schedule, you might be the type of person that has a difficult time saying ‘no’ to functions, volunteering, etc. and that might be an item in your life that needs tackling.

Ask yourself if you need support – Talking to a mental health professional can help you to deal with your stress and put you on a path to success with therapy, tools and techniques.

Balance – We all have busy lives so learning proper time management skills and ensuring that you have stress relief built in as a priority will help. This could be daily exercise, down-time or quiet time after work, putting a non-negotiable monthly massage in your calendar and budget, or time with friends. Think about what makes you happy, and then do more of that!

We hope these tips are helpful!

Please call us to book an appointment with one of our Active Release Technique certified chiropractors.

*This blog is not intended to officially establish a physician-patient relationship, to replace the services of a trained physician, naturopathic doctor, physical therapist or chiropractor or otherwise to be a substitute for professional medical advice, diagnosis, or treatment.  [/vc_column_text][/vc_column][/vc_row]