Disclaimer Acute & chronic pain may be a sign of a serious underlying disease or condition. It is imperative that you see your physician or health care provider to determine the cause of your pain. This lecture is not intended to diagnose or treat any condition.
The Silent Epidemic Estimates are that 50 million Americans live with chronic pain caused by disease, disorder or accident 25 million people suffer from acute pain from surgery or accident 2/3 of these people have had their pain for more than five years
The Silent Epidemic The most common types of pain are arthritic, lower back, bone/joint pain, muscle pain and fibromyalgia. Estimates are that 20% of adult Americans experienced chronic pain in 1994 and approximately 4.9 million individuals saw their physician for chronic pain treatment in 1999.1
Pain perception Pain receptors in the body send signals through nerves to the spinal cord and then up to the brain where pain is “perceived”. In the brain there are areas that bring awareness to the pain and areas (limbic system) that determine our “experience” of pain.
The Gate Control Theory Melzack & Wall’s theory from the 1960’s states that in the spinal cord there is a neuronal “gate” that signals must pass through and the gate can be open or closed. The gate is controlled by movement and other sensory information that over-rides pain signals and is specific to the area of pain
The Brain Controls Pain The brain has pathways that inhibit or modulate pain signals These pathways rely on neurotransmitters such as serotonin, endorphins and enkephalins to transmits signals that block pain signals to the brain
Underlying Causes Chronic low grade inflammation – Prostaglandin imbalance causes systemic inflammation which chemically stimulates pain receptors2 Injured pain receptors give off substance P which causes the release of histamine which leads to inflammatory prostaglandin production and sustained activation of the pain receptors. Metabolic Syndrome is linked to inflammation – 2/3 of the Adult US population are overweight or obese – 25% of Americans have Metabolic Syndrome (insulin resistance) – Chronic subclinical inflammation is part of this syndrome
Underlying Causes Lack of proper motion – ↓ frequency of firing of mechanoreceptors – ↓ input into the cerebellum & cortex allows increased pain signals to be perceived. – Pain fibers grow into scar tissue and lead to increased or chronic pain Neurotransmitter deficiency or imbalance – Deficiencies in Serotonin, Endorphins, Enkephalins
Nutritional Solutions Anti-inflammatory diet – Low Glycemic Diet, high blood sugar leads to increased inflammation – High Omega 3 diet, fish and flax, decrease fatty meats and poultry (2.7 g of EPA/DHA 2:1 daily) Adequate protein intake – Your body needs adequate protein over 60 grams per day to synthesize neurotransmitters and repair muscles and tissues – Protein with each meal keeps your blood sugar levels normal Adequate water intake – Most all metabolism in your body takes place in water – You need to drink half your body weight in ounces of water per day – Adequate water turns off histamine which reduces inflammation and pain
Neurological Solutions Better Brain Chemistry – Increase your body’s reserves of Endorphins and Enkephalins with DLPA – DLPA 500 mg (50:50) 1-2 tabs 3x daily before 3 PM or – DPA 500 mg 1 tab 3x daily before 3 PM – B complex vitamin daily B6 is required for neurotransmitter synthesis (serotonin and dopamine)3 – Magnesium 200 mg to 400mg daily, helps prevent over-excitation of neurons – Vitamin D 1,000 IU daily (or as recommended from blood test)4 Chiropractic Care – Improve frequency of firing of mechanoreceptors to the brain – Improve your function so you can be more active which uses the Gate Control Theory to reduce pain signals – Improved posture reduces chronic pain
Manual Therapy Solutions Specialized myofascial therapies – Active Release Techniques® effectively restores motion and removes interference to normal tissue function which contributes to pain – Adhesions trap nerves that travel through muscle and fascia and can cause chronic pain and disability – Movement therapies such as this retrain the body to move and function correctly to make everyday activities and exercise easier and more enjoyable
Functional improvements Exercises – Studies indicate that exercise may be the only reliable approach to resolving the disability of chronic back pain – Motion is Life and increased motion reduces pain, stabilizes blood sugar, elevates mood and keeps your weight normal Postural awareness and improvement – Chronic postural distortions result in chronic pain patterns – Muscles become too tight and short and pull on the body causing the antagonist muscles to become too long and tight and lead to chronic pain – Learn how to correct your posture using specialized exercises to change a chronic pattern Cerebellar training – Cerebellar exercises improve coordination and increase frequency of firing to the brain which then inhibits excessive pain signals
REFERENCES 1http://www.aapainmanage.org/literat ure/Articles/PainAnEpidemic.pdf 2 http://www.jci.org/articles/view/6749 3 http://ods.od.nih.gov/factsheets/vita minb6.asp 4 Ross, J. The Mood Cure (New York: Penguin Books, 2002) pp. 106-117.