Chronic Pain - A brain issue

This video explains the mechanism of chronic pain.

One thing to point out is that injury to the body does not neccessarily heal and 'go away' after 6 months as the video suggests.  This is particularly so with the densely packed nerves of the spine (which sense and control movement and detect injury)

These nerves do not automatically return to normal following both the initial injury and the protracted period of inactivity which often accompanies it.

It is recommened that both the original injury (and the subsequent local scarring and joint movement dysfunctions that accompany it) AND the central brain mechanism which can enhance or 'amplify' the signal are attended to.  Often this uses a combination of approaches including physically based treatements, medication and education.

Chronic pain is extremely common and often underdiagnosed.

Office Hours

Douglas Scown will be working every second Saturday starting this weekend (1st September 2012)

Groin pain and hip joints

While chiropractors are known as 'back' or spine people we deal more accurately with issues associated with the axial (or midline) skeleton and it's mechanisms of support.

Groin pain is a very common presenting complaint in a chiropractors office and can be a challenge to accurately diagnose.

While there are many possible causes of hip/groin pain the most common sources of discomfort are either in or around the hip joint itself.  Less common are sources which refer pain into the groin.  Hip problems themselves can also refer pain to the pelvis, back, thigh and knee.

The very sensitive sacroiliac joint ligaments can also be responsible for 'hip' pain.

One of he most common source of pain in the groin is considered to be a pinching of the sensitive material surrounding the hip joint (FAI).  This can be mild or severe, acute or chronic and be brought on by athletic injury, repetitive movements, degeneration, dysplasia, hypermobility or a combination.  Sensitive structures can be nipped and irritated leading to inflammation and in some cases destruction of the cartilage.

It is very common for these patients to present with pain and stiffness generally in the pelvic girdle (which is functionally interwoven with the spine) which contributes to dysfunction and disability.

In most cases patients respond very well to education and rehabilitation which principally involves groin, hip and pelvic mobility and avoiding deep flexion (eg deep squats and lunging).  In some cases where pain is severe or an athlete wishes to return to activity rapidly CT guided injections into the hip can help.

Sitting is deadly

This is a must see episode from catalyst

We still believe in the myth that injury and illness are caused by overdoing things.  Well there is overwhelming evidence that it is inactivity which is the principle cause of not only reduced life expectancy but a dramatic increase in almost every form of chronic disease and illness.

Sitting is actually OK.  It is prolonged inactivity which harms us.

The human body and brain evolved first and foremost as a complex mobile organism.  It's joints are designed to perform movements which are intricately controlled by the nervous system.

Prolonged inactivity sees a breakdown not only in the physical structure of the body but the mechanisms which control it's varied functions.

National Geographic pointed out the irony in their Death by Convenience article a few years ago (which I cannot seem to find online).

Move it or lose it.

DS

Do I have inflammation?

If you watch too much TV you could end up thinking that all pain was due to 'inflammation'.  Interestingly while there are certainly times when the physical tearing of connective tissues occurs most spinal pain is not generated by the significant swelling of the joints.  Even arthritis is mostly non inflammatory.

And thank goodness for that because some people do have conditions which produce significant inflammation, joint irritation and destruction.

Rheumatology is a lifetime of study but there are useful tips which may help guide the individual towards recognising the more complex (and likely) inflammatory conditions which tend to involve amongst other structures, the spine (spondyloarthropathies)

These are typical presentations.  If there are any suspicions it is recommended that you seek advice.  The diagnosis of these conditions often only becomes apparent over time and may involve various blood tests.  Other clues are unusual joint problems in the family. In clinical practise these patients will not respond in the expected manner.  For example response to treatment will vary and lifestyle factors become far more important.

1. Males look out for Seronegative spondyloarthropathies such as Ankylosing Spondylitis

They are inflammatory arthritides affecting the axial skeleton.

Usually present in patients under 40 years of age
Commonly include thoracic pain (commonly with an advancing stoop) , sacroiliitis (low back/pelvis) and enthesopathy - inflammation of tendon insertions in the legs and problems with other connective tissues (the eyes, gut, etc)

Are often more problematic at night with morning stiffness taking > 30 minutes to dissipate.

2. Females are more likely to be affected by Rheumatoid Arthritis which typically begins to affect the hands and is not so evident in the spine.

Our main contribution in these cases is to help improve overall mobility and quality of life.  In some cases education and reassurance are the most significant things we can offer.

DS

EDIT:  Try these links for more recent dietary approaches to AS.

http://www.kickas.org/londondiet.shtml

http://paleohacks.com/questions/7392/did-paleo-improve-your-ankylosing-spondylitis#axzz24DorTDGu

Diagnosis - just a label? A patients perspective

There is always a risk of over diagnosis and over 'medicalisation' of what may indeed just be parts of 'normal'.

Using hypermobility as an example (we can also use Idiopathic Scoliosis, Asbergers Syndrome and ADHD/DD) a patient recently remarked "We all know flexible people.  Isn't it just normal?"

I responded by saying she was correct - labels are only useful if you understand their limitations.  However a diagnosis (an accurate one) if used wisely can dramatically influence the overall health and wellbeing of an individual over their entire life.  As in any situation if we can identify strengths and weaknesses we can more effectively navigate our way through life's challenges.  Or we can ignore them and hope for the best.

Fortunately research continually expands our knowledge base and our understanding of the phenomena which affect us. 

Perhaps that is how we should view diagnosis.  In many cases (those where life and death is concerned for example) it is quite apparent that an accurate diagnosis is essential. However it is also apparent that most things which ail the population do not involve death but rather they affect the quality of life and it is just as important to accurately determine how specific types of conditions manifest themselves in each unique individual.

Hypermobility - is it 'normal'?

One of the most underdiagnosed conditions are the family of genetic disorders which affect collagen, the proteins which form the skin, ligaments and tendons, blood vessels and other structural body parts.

But is it even a disorder?  It's thought to affect 10-20% of Western populations and is even more common in people of Indian, Chinese and Middle Eastern origin.

Ehlers-Danlos Syndrome (Marfans Syndrome is related but somewhat unique) occupies the extreme end of what is becoming accepted as a spectrum of collagen synthesis disorders.  The most common is Familial Joint Hypermobility Syndrome in which the most obvious trait is the ability to 'contort' the joints (see scale at left).  At the other 'end' of this spectrum individuals display traits which simply blend into the population norm.
Being a disorder of collagen formation individuals can also display vascular fragility, dislocate joints easily, be prone to uterine prolapse and typically suffer from diffuse musculoskeletal pain. There is a tendency towards joint degeneration and osteoporosis as well.
Although common it is still not widely understood even by many health practitioners.  Indeed like fibromyalgia it will usually go undiagnosed for years. Furthermore the various labels including Benign Joint Hypermobility imply mild, non-progressive conditions (as opposed to the full blown ED syndrome). Coupled with a perceived lack of a definitive diagnosis and specific pharmacological or surgical treatments it is easy to see why this family of disorders can be so common yet so misunderstood.

Fibromyalgia can also present as diffuse musculoskeletal pain which is why it is so important to ask questions regarding family members (siblings and children).  It is this line of enquiry that often yields valuable information in making the correct diagnosis and as a result being able to appropriately treat and advise.  After all this is a characteristic of the person as a whole, not simply a collection of unrelated injuries as it so often appears to be.

Douglas Scown