PAIN is reliable in an unreliable way

The guys at The University of South Australia have put a great deal of work into the study of chronic pain.

Acute pain (as we might experience when we step on a nail or twist an ankle) is straight forward.  Do this - get that.  But what about pain which persists?  And what about pain which comes and goes or changes it's nature and location?  Confused?  Welcome to the world of chronic pain and the way it colours injury and dysfunction.

Health professionals still overwhelmingly deal with pain as if it were acute and something was damaged or broken.  Patients who present with continuing pain are told that their nerves are still healing or perhaps they have re injured the injury.  Is this accurate?

Chiropractors tend to see people with chronic or long term complaints.  Their problem often began yrs before but in the early stages their pain and dysfunction was brief and self limiting.  Furthermore it was aggravated by specific things, usually an awkward movement such as lifting and twisting.  Recently though the patient reports that their pain came from "nowhere".  "I slept wrong", "It just went out and now it's not going away".  In short their brief, self limiting problem has become chronic, 'unstable' and aggravated by trivial movements.  Additionally the pain has changed. It was sharper and "here".  Now it's sometimes sharp, often a dull ache or burning and it's spreading.  It feels like it could just "go" on me.

The patient has developed chronic pain.  The brain learns and changes through repetition and the repetition of pain can do interesting things with a plastic or moldable neurology.  Pain itself is a complex experience suffice to say it's important to pin down what originally triggered the problem (the disc, joint, bone, distortion - the diagnosis) and what may have led to it weakening (usually a combination of injury, sensation disturbance, lifestyle and of course genetics/epigenetics).

Ref   Apkarian et al. (2004) Chronic back pain

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.