We grow up with the medical model of injury and disease in our heads, its our way of understanding what happens to us. When a pain or other problem occurs, the doctor investigates and pins down the fault to a particular organ or body system, targeting the treatment to improve the malfunctioning of the part. The problem then goes away or is managed such as healing in a fracture, recovery from pneumonia after antibiotics and replacing an arthritic joint. However, there is a group of pain conditions which do not fit well into this system and are not widely recognised or treated.
Normal tissue injury pain occurs when the injured area transmits a volley of pain impulses up towards the spinal cord nerves in the back, which take the signals and carry them on towards the brain. The volleys of incoming pain excite the spinal cord nerves strongly and they react by amplifying their reactions to them, giving us higher levels of pain. We then protect the area, it settles and heals and the system settles down to its normal state. However, some conditions do not fit this picture, do not have a precipitating injury or event and do not settle down with time, fitting poorly into the normal picture. These pain syndromes are not well understood or diagnosed.
Examples of pain syndromes are fibromyalgia syndrome (FMS), chronic widespread pain (CWP) and complex regional pain syndrome (CRPS). A minor or moderate wrist or ankle injury, followed by immobilisation, can develop into a tight, stiff, swollen and painful joint with very poor function, leading to the diagnosis of CRPS. The plaster or splint should be removed as soon as possible to allow Osteopathy rehabilitation to start, educating the patient about the pain they need to cope with as they exercise their joint every hour. The Osteo will work on passive, active and functional movements, reassuring the patient that the pain they are suffering is vital to their recovery.
Chronic widespread pain occurs, as the title implies, all over the body, with multiple trigger points in muscle bellies. Trigger points are areas of acute sensitivity to pressure which occur in specific places in muscles and can refer pain away from those sites causing a persistent pain condition. Osteopaths treat trigger point pain with acupuncture, acupressure, stretches and positional advice. Fibromyalgia syndrome occurs mostly in women, and consists of widespread pain, fatigue, hypersensitivity to pressure, poor sleep, feeling unrestored in the morning, brain fog, IBS, reduced physical ability and pain unpredictability.
Anger, depression, anxiety or low mood are common accompaniments to a chronic pain syndrome, necessitating the skills of a clinical psychologist if the patients are to be successfully managed. Patients find sticking to a treatment plan very challenging and exhibit anger, irrational thinking, poor coping, non-assertive communication and negativity. FMS patients often disclose an abuse history either as children or in adult relationships and this can be the dominating feature of their presentation. Isolated Osteo treatment is unlikely to work and the psychologists input is vital.
A FMS pain management programme covers several psychological skills and strategies, including pacing activity, realistic and negative thinking, assertiveness and communication skills, mindfulness and acceptance, goal setting and planning, validation of the reality of the condition and reduction of isolation by meeting others with the same condition. Passive communication with families, friends and others is very common and this leads to anger and frustration as they are unable to make their needs clear. The overall very negative nature of the pain experience leads to a negative bias in thinking about the world and their problems.
Pain syndromes are not amenable to normal medical management but medication can be helpful if it does not increase mental confusion or fatigue. Drugs such as amitriptyline, used initially for depression, are given to reduce pain and improve sleep. A graded exercise programme, guided by a Osteopath, can improve strength, fitness and so functional ability. Patients report stretching is helpful and especially so if the pain is severe enough to preclude exercise. Pain syndrome sufferers benefit from a multi-disciplinary approach and a structured strategy.
Andrew Mitchell, editor of the Osteopath Network, writes articles about physiotherapists in Harpenden , back pain, neck pain, injury management. Andrew is interested in many aspects of alternative medicine.
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on Apr 1 2011. Filed under .
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