14 Aug What is Chronic Pain? An Acupuncturist weighs in
One in 5 Australians live with persistent pain
What is chronic pain?
Pain management Association of Australia described Chronic Pain as the following;
“The terms chronic pain and persistent pain are often used interchangeably. Pain is said to be chronic if it persists beyond the normal healing time of about three months. ‘Chronic’ simply means ongoing and doesn’t tell us much about the severity or quality of the pain.
Many people are new to the notion of chronic pain because they are taught that pain goes away when tissues heal after an injury or illness. However, this is not the case for 1 in 5 Australians and pain may not lessen when the healing process is complete.
Sometimes, it is not possible for doctors to pin point the cause of the pain and it can be frustrating not to have a diagnosis. Chronic pain is complex because it involves the nerves and nervous systems, including the central nervous system made up of the brain and spinal cord.
Chronic pain occurs because of changes to the nerves or nervous system which keeps the nerves firing and signaling pain. However, there are likely to be other precipitating factors with chronic pain including genetics, gender and previous episodes of acute pain. Chronic pain can be intense and unrelenting, and lead to various degrees of disability if it is not managed well.
Chronic pain is a condition in its own right because of the changes in the nervous system unrelated to the original diagnosis or injury, if there was one” (1).
Most of us believe that when there is pain this would automatically correlate with an injury, degeneration. However did you know that the presence of degenerative changes, disc pathology, muscle wasting, even spondylolisthesis and spondyolysis, are common in those without pain and are poorly correlated with the signs and symptoms of low back pain (2).
Even diagnosing low back pain is a nightmare. It established that apart from the 15% of back pain cases which can be attributed to a specific spinal pathology, the majority of cases fall under the unsatisfactory umbrella label of “non-specific low back pain” (2). The most absolute way to know that something seen on an X-ray was the cause of pain was comparing previous results before the onset of pain.
So then what is Chronic Pain?
As discussed above Chronic Pain sometimes occurs when changes have occurred to the nervous system in the area, which mean these nerves are firing and signally pain but for no apparent reason. Sometimes yes this does occur in an area of structural changes, however in many cases this does not and the original cause of the pain has long since been healed.
If you have Chronic Pain yet no apparent reason then you are caught in what we term a sensory motor loop, meaning that your body has literally forgotten how to shut the pain down and stop these nerves from firing. This is due to a neuropathic problem where the nerve itself is swollen, firing continuously, sending incorrect information to the brain.
The second problem involves a survival mechanism that the brain evolved a very long time ago. Let’s take a knee injury as an example. When we bang our knee into something, the brain immediately takes measures to protect it. The brain doesn’t know what happened to the knee, but it assumes a worst-case scenario, that you are losing a lot of blood and thus the injury becomes in your brain life threatening.
What the brain does in this situation is restrict the blood supply going into the knee and the blood return coming out of the knee. This is actually a very intelligent choice. If a venomous snake bit you, reducing blood flow around the knee will lessen the chance that the poison will spread. And if you were cut badly, reducing the blood flow will lessen your chances of bleeding to death.
This phenomenon is known as “guarding”. One of the results of reducing blood flow to the knee is that it becomes stiff and weak. This was a great strategy before the advent of western emergency medicine. Almost everyone would prefer to lose function in his or her knee rather than death. But this isn’t a choice most of us have to make anymore, because when we cut our knee or get bitten by a snake we can go to the hospital and it can save our lives. And the problem is that cutting off blood flow to the knee – while it may have saved our lives in times past – dramatically limits the knee’s ability to heal.
So how does Acupuncture help?
Chronic pain is an area where Acupuncture seems clinically to have a lot of benefit especially when there is no structural reason for the pain. In Acupuncture by inserting needles into the skin at neurovascular nodes we create a series of events within the body;
Firstly it is believed that acupuncture insertion causes “jumps” at the neural threshold on the position nerve pathway, so that the signal can reach the brain. Once the signal reaches the brain a whole series of events occur including vasodilation (increased blood flow), release of enkephalins (the bodies own pain killers), and immune stimulation. However what isn’t quite understood is Acupuncture’s unique ability to stimulate areas that are not being touched by the needle, this is why most of the time your Acupuncturist will be using points seemingly unrelated to your area of pain.
Most pain relief from Acupuncture is very fast, sometimes you will experience pain relief during the first session! However after needling the pain will come back, but often to a much lesser extent. We use the analogy of the old habits, of which the nerve which has been chronically firing re-establishes itself to a normal state. The body, just like the mind, has a hard time breaking bad habits.
But if you return in a couple of days to get another treatment, the neural threshold will be jumped again. And if you keep jumping the neural threshold, eventually the central and peripheral nervous system figure out that it’s better to operate in the non-pain state than in the pain state. The technical term for this is re-establishment of neurological homeostasis.
Once this happens, the brain is no longer receiving pain signals from the knee. It no longer thinks the knee is injured or threatening the survival of the body. This is how Acupuncture helps in Chronic Pain. If you are interested in more information about your specific pain give us a call on (03) 8719 7373 to discuss if Acupuncture could be useful for you.
About the author
Lauren Lanzoni is the Acupuncturist, Chinese Herbalist and owner of Balanced Life Health Care. To find out more about Lauren click here and to make an appointment to see Lauren at her clinic in Ferntree Gully click here