Ankle Sprains, Broken leg, Carpal Tunnel — One of these isn’t like the other
Posted Dec 23 2008 3:29pm
Which of these injuries is different? Ankle sprains, broken legs, and carpal tunnel syndrome all cause swelling and pain and need to be immobilized at times.
But the chronic pain syndromes like Carpal Tunnel behave very differently than acute injuries like an ankle sprain or broken bone.
A recent write-up in the Posture Blog describes the way acute injuries are usually diagnosed and treated — and why this model is wrong for chronic pain conditions. Although it focuses on Fibromyalgia and a couple related conditions, I think their findings also apply to other common pain problems, including the common repetitive stress injuries, from describing the problem with treating them, to the multiple general-health treatments that can help, to addressing the component of psychological depression that can come along with chronic pain:
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 physiotherapy rehabilitation to start, educating the patient about the pain they need to cope with as they exercise their joint every hour. The physio will work on passive, active and functional movements, reassuring the patient that the pain they are suffering is vital to their recovery.
The other pain syndromes exhibit all over body pain with hypersensitive areas in muscle bellies known as trigger points, which are very sensitive to pressure but can also run pain away from their origins. Physiotherapy treatment for CWP includes stretching, general exercise, positioning advice, acupressure and acupuncture. Fibromyalgia has the symptoms of CWP but adds IBS, mental difficulties with concentration, sleep problems, excessive tiredness on waking, hypersensitivity to pressure and a severe reaction to overactivity. This syndrome overlaps with chronic fatigue syndrome (CWP) or ME and can be exceptionally challenging for the sufferer.
Psychological interviewing of these patients is vital as having a long-term pain problem is very likely to produce low mood, depression and anxiety which in turn lead to poor coping and difficulties engaging with therapy.