Spine meets Brain - a love story

So is your love story one of harmony and balance or is it like Wuthering Heights and totally dysfunctional?

People with pain don't think about anything else but the pain so talking about brains when you first meet is not a good idea.  However while the spinal joints and their components do tear, swell and hurt the research is mounting that tells a story of the complex sensorymotor relationship between the spine and the brain and what happens to each when things don't work.  Moreover research tells the story that physically based treatments work primarily because of the effect they have on the way the brain senses or feels the spine and it's movements.

The brain moves the spine and in turn receives feedback about movement, pressure, pain and a myriad other things.  Both change in response to each other.  They improve together and decline together.  People with long term spinal pain demonstrate muscle wasting on the side of injury, poor local joint control, poor postural control, poor pain control and changes in parts of the brain concerned with emotions and thinking and autonomic changes.  The autonomic system is housed in the brainstem along with the mechanisms which are sensing and controlling the spine, balance (orientation) and posture.  They are both housed there because they talk to each other ALOT.

This is why a common presentation would be 'chronic neck/shoulder pain and stiffness, headache, head tilt, postural instability (disorientation), feeling 'out of it', trouble focusing, unable to follow a moving target without swaying, and the list can go on.  Many of these findings change with application of physically based treatments and studies are suggesting that these findings precede pain.  That's saying that in chronic cases the brain gets things wrong BEFORE a person experiences pain.

What do we mean by 'wrong'?  A person should stand upright, level and be stable but typically many chronic spine patients are crooked, unlevel and unstable.  So when treating people we look at pain control and changes in body orientation as well as another indicator of improvement.

Fibromyalgia (FM) - A new understanding

The following illustrates how research can dramatically improve outcomes for individuals suffering complex pain disorders.


Not long ago Fibromyalgia was thought to be an inflammatory condition of the muscles.  Individuals hurt pretty much all over.  They would also commonly have other conditions such as headache, gut disturbance and odd limb sensations and they would be prone to depression and anxiety.
These people were often labelled hypochondriacs and Dr shoppers and unfortunately the frustration and sense of helplessness often magnified the problem.

Now FM is classified as a genetically linked condition involving abnormalities in the dopamine pathways of the brain, resulting in widespread allodynia and multiple sensitivities.

Allodynia is a pain due to a stimulus which does not normally provoke pain so FM is actually a 'pain processing problem'

According to one FM website it still takes an average of 5 years for this collection of apparently unrelated symptoms (co-morbidities) to be recognised as manifestations of the single disorder.

What can a chiropractor offer?  There is a body of information regarding FM which should determine treatment choices irrespective of which profession the individual consults.

Officially there is actually a paucity of literature for the support of chiropractic care in the management of this condition.  According to Schneider et al "Strong evidence supports aerobic exercise and cognitive behavioral therapy. Moderate evidence supports massage, muscle strength training, acupuncture, and spa therapy (balneotherapy). Limited evidence supports spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification." (courtesy of CDI).

Perhaps the main role of physically based modalities in the co-managment of FM is to reintroduce normal movement in a non painful way.  Traditional spinal and joint manipulation is generally not tolerated well in these cases and usually leads to aggravation.  Gentle joint and muscle movements, often in areas of the body not badly affected are followed by more robust manouvers as tolerance increases.

Education and reassurance are vital while the individual gradually increases exercise and attends to any psychological issues which may exist.

What we have to offer is only part of a much broader approach and communication with the medical practitioner and other providers is essential to form a tailored, coherent and effective approach which gives the individual the tools to understand and effectively self manage their problem.

It's perhaps useful to consider that the brain is just one organ of the body and while it may malfunction we do possess the ability to control it's reactions.  Our responses to pain (technically nociception) is a function of many processes we cannot directly control however pain 'levels' are strongly determined by learnt responses.  In essence our minds experiences.

Ultimately we are in the drivers seat where the brain is concerned.

DS