Pain syndromes cover a wide variety of presentations all involving an experience of pain. Chronic pain typically lasts for more than 3 months or beyond normal healing time. This pain may be widespread or come and go for no apparent reason. Pain itself is a very complex process and can involve neurological, psychological and social factors. Sometimes these pain processes can be associated with a particular condition such as fibromyalgia or other autoimmune conditions such as Lupus. In other cases, there may be no apparent cause.
Causes of Pain
While there are many types of pain, they can be classified into approximately 3 main categories:
Nociceptive pain arises from various kinds of injury to body tissues, reported to the brain by the nervous system. This is the most familiar type of pain which results from damage to tissues from trauma or cuts. This type of pain can change according to movement or load.
Neuropathic pain arises from damage to the nervous system itself, either in the brain or peripheral nervous system either from disease, injury, or physical irritation. Conditions like sciatica result from damage to the sciatic nerve. Other conditions like multiple sclerosis, alcoholism and chemotherapy can also damage the nervous system and cause pain.
Chronic Pain This is a broad and non-specific category which basically means you have pain which continues for longer than 3 months. In this case little is known definitively about why this occurs in some people and why it continues for so long. We do know that the experience of prolonged pain can change how the pain process works resulting in more pain with less provocation. This is sometimes referred to as central sensitisation.
What is pain?
Pain is a complicated warning system designed to protect us from harm, thus pain can occur with both real and perceived circumstances. This system works well for acute pain such as when we cut ourselves, this is when your nervous system sends signals to your brain which then interprets how much danger there is. This is then experienced as pain. However, in chronic conditions such as arthritis where pain signals are sent to the brain all the time then those parts of the brain that send and receive danger signals become more sensitive. Thus, in some people, the more the brain processes pain the more sensitive it gets until it ends up operating all the time on high alert. This process can also occur where an injury has healed but the pain signals can keep firing.
A complex array of pain processing takes place throughout the body from the stimulation of pain nerves to its interpretation in the brain. Pain itself often modifies the way the central nervous system processes pain, so that a patient can become more sensitive and gets more pain. As explained above, this is called central sensitization because it involves changes in the central nervous system i.e the brain and spinal cord.
The characteristic feature of some pain syndromes is that they are not caused by a specific injury and often imaging techniques do not identify a cause. In fact, sometimes imaging can lead to erroneous causes of pain leading to many futile medical procedures. In other cases, a pain process may amplify the pain caused by a particular condition making the pain experience more intense.
Because pain is processed and understood in the brain our attitudes, beliefs and behaviors can have an impact on how pain is experienced. This is not to say that pain is all in your head. Physical changes in pain pathways occur so that no amount of positive thinking on its own will change these. However, a multi-faceted approach to pain can cause an improvement in the physical nature of these pain pathways over time.
Osteopathic Approach to Pain
Our osteopathic approach to pain involves a broad approach involving education, specific and appropriate exercises, manual therapy and breathing techniques.
Because Osteopathy is by its nature a whole of the body approach, manual therapy seeks to reduce the amount of pain input into the pain pathways generally to reduce the overall load going into the system. This will give the system a chance to adapt in a healthier direction and allow exercises to be introduced which previously may have caused more pain.
Joint and muscle tightness can have a widespread effect on the body altering movement and causing compensatory changes which can exacerbate pain. Manual therapy is also designed to have a general effect by improving both lymphatic, circulatory and neural pathways.
