During a routine history exam last week, a client asked; “Why so many questions about pain…it seems pretty simple. I hit my thumb with a hammer – it hurts. I stub my toe – it hurts, I sleep wrong, get a crick – it hurts…what’s all the fuss?”
Wish pain management were that simple. Each day the fascinating world of neuroscience uncovers another layer of truth about pain, but, as yet, we have few complete answers. For instance, what about the soldier wounded in battle who experiences no pain as he drags his buddy from a blown-up hummer…or the guy who loses a limb in a roadside bombing and continues experiencing phantom pain long after the injury has healed? The flip side of that coin is the fibromyalgic or depressed person with a weakened (slow-firing) brain that’s unable to suppress pain responses at higher levels.
A properly firing healthy brain should,
within limits, be able to suppress pain perception.
Having said that, I’d still rather not hit my thumb with a hammer, even though I may have a good brain (debatable). If I hit my thumb with the proverbial hammer–aside from some very bad words flowing from my mouth– I’ll probably just impulsively shake my fingers and wrist back and forth (movement inhibits pain) and perhaps rub it and kiss it to make it feel good (don’t knock it until you try it). The mechanical stimulation from massaging the finger calms the cutaneous (skin/fascial) receptors and shaking the finger (movement) co-activates the joint’s articular receptors. Both help inhibit pain at the spinal cord level.
Intuitively, we know that people are not alike, yet we often use the same treatment methods to deliver pain management. To determine which type of treatment works best, a couple of questions need to be answered during your assessment:
Is my client’s pain a result of a slow-firing brain? If so, what hands-on strategies will facilitate neuronal firing to inhibit their pain?
Does my client’s pain result from increased firing (hyperexcitable brain) and, if so, what can I do to inhibit or down-regulate their pain?
Treatment for slow and fast firing brains will, of course, be opposite. Irritable, highly sensitive brains do not respond well to aggressive deep tissue therapy. In the early sessions, these clients benefit best from slow-paced relaxation modalities such as myofascial mobilization and low-force articular stretching. Conversely, a hemispheric (hypoactive) brain may require a more aggressive faster-paced approach.
Chronic pain triggered by a micro or macro-traumatic event soon permeates the entire nervous system creating central sensitization and neuroplasticity (relearning aberrant movement or pain patterns as normal). Pain/spasm/pain cycles develop as tension, trauma and poor posture compromise proper nervous system functioning and retard the body’s innate healing abilities.