Pain Syndromes and Osteopathy
Posted on September 15, 2009
Filed Under Back Pain | Leave a Comment
We grow up with the medical model of injury and disease in our heads, its our way of understanding what happens to us. When a pain or other problem occurs, the doctor investigates and pins down the fault to a particular organ or body system, targeting the treatment to improve the malfunctioning of the part. The problem then goes away or is managed such as healing in a fracture, recovery from pneumonia after antibiotics and replacing an arthritic joint. However, there is a group of pain conditions which do not fit well into this system and are not widely recognised or treated.
Normal tissue injury pain occurs when the injured area transmits a volley of pain impulses up towards the spinal cord nerves in the back, which take the signals and carry them on towards the brain. The volleys of incoming pain excite the spinal cord nerves strongly and they react by amplifying their reactions to them, giving us higher levels of pain. We then protect the area, it settles and heals and the system settles down to its normal state. However, some conditions do not fit this picture, do not have a precipitating injury or event and do not settle down with time, fitting poorly into the normal picture. These pain syndromes are not well understood or diagnosed.
Typical pain syndromes are complex regional pain syndrome (CRPS), chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). CRPS occurs after minor or moderate injury to a limb such as the ankle or wrist and the underlying reasons are not well understood. In the wrist the person may be in plaster for a few weeks for a minor fracture or sprain but complains of high levels of pain and has difficulty keeping the fingers moving. The fingers are stiff and swollen and moving them elicits significant pain, at which stage immobilisation is removed if possible to allow rehabilitation.
Widespread pain syndromes are very challenging problems for the patient and are very difficult to treat with any success. CWP shows trigger point hypersensitivity in the bellies of the muscles, specific points which are very painful to palpate and refer pain down to structures nearby. Osteopathy treatment consists of an exercise programme, stretching, acupressure, postural correction advice and acupuncture. Fibromyalgia has the typical symptoms of CWP with the addition of difficulties concentrating, IBS, severe fatigue, unrestored sleep, poor sleep, hypersensitivity to pressure and an over-reaction to activity.
Anger, depression, anxiety or low mood are common accompaniments to a chronic pain syndrome, necessitating the skills of a clinical psychologist if the patients are to be successfully managed. Patients find sticking to a treatment plan very challenging and exhibit anger, irrational thinking, poor coping, non-assertive communication and negativity. FMS patients often disclose an abuse history either as children or in adult relationships and this can be the dominating feature of their presentation. Isolated Osteo treatment is unlikely to work and the psychologists input is vital.
A FMS pain management programme covers several psychological skills and strategies, including pacing activity, realistic and negative thinking, assertiveness and communication skills, mindfulness and acceptance, goal setting and planning, validation of the reality of the condition and reduction of isolation by meeting others with the same condition. Passive communication with families, friends and others is very common and this leads to anger and frustration as they are unable to make their needs clear. The overall very negative nature of the pain experience leads to a negative bias in thinking about the world and their problems.
Pain syndromes are not amenable to normal medical management but medication can be helpful if it does not increase mental confusion or fatigue. Drugs such as amitriptyline, used initially for depression, are given to reduce pain and improve sleep. A graded exercise programme, guided by a Osteopath, can improve strength, fitness and so functional ability. Patients report stretching is helpful and especially so if the pain is severe enough to preclude exercise. Pain syndrome sufferers benefit from a multi-disciplinary approach and a structured strategy.
Andrew Mitchell, clinical director of the Osteopath Network, writes papers about musculo-skeletal conditions and physiotherapists in London. The Osteopath Network has more than 550 clinics located throughout the UK and offers treatment at weekends and after hours.
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