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-   -   good article on nervous system changes from chronic musculoskeletal pain (https://www.adrsupport.org/forums/showthread.php?t=8526)

lisa 05-02-2005 06:19 PM

This paradigm is very helpful in understanding some kinds of refractory low back or neck/shoulder pain. (You can order it from the canadian pain society website)


Central hyperexcitability in chronic musculoskeletal pain: A conceptual breakthrough with multiple clinical implications

J Lidbeck

Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes � including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others � may essentially be explained by abnormalities in central pain modulation.

The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

Key Words: Central sensitization; Chronic musculoskeletal pain; Mechanism-based pain classification; Pain modulation

Harrison 05-02-2005 07:28 PM

Thanks Lisa! (Where have you been hiding....)

lisa 05-08-2005 02:02 PM

I got a good question in e-mail as to how this chronic pain research helps treatmentwise. I've been reading about this, plus the pain clinic I go to knows a lot about this. The good thing about these central nervous system changes is that in some cases they can be at least partially reversed. I had pretty severe hypersensitivity bordering on reflex sympathetic dystrophy and it's gotten a lot better (although not completely normal). The pain clinic approach involves several things:

a) It's really important to get your pain under control to not reinforce this problem. So they're really aggressive about pain meds (and blocks if needed) and also making sure you don't do exercises in PT that aggravate your symptoms.

b) Conversely pain free movement is really important in reeducating your nervous system. According to the pain clinic, this will actually make changes in your brain. Most good pain clinics include a program of graded aerobic exercise. I found it difficult to figure out how to move towards being aerobic and correcting muscle imbalances/weaknesses without increasing pain but their physical therapist really helped me figure this out.

c) For some people, cognitive behavioral therapy really helps. It's interesting that they have shown through functional MRIs that this kind of therapy can actually induced changes in the brain.
There are also some interesting research where they look at physiologic changes trained yogis have to pain, so it seems like some of this mind/body stuff has a real physical basis, which I suppose is not surprising to anyone that practices it.

The paper below makes the point that many of the symptoms that are traditionally labeled nonorganic, psychosomatic (including the well known Waddells signs that are supposed to show you don't have a real back problem) are likely signs of this central nervous system changes due to chronic pain. Some people can have these changes persist after the original injury has healed.

It's interesting that some pain clinics and infamous Dr. Sarno method often include a) b) and c) for supposedly psychosomatic back problems and get good results. It makes me wonder how many of those people have this central hypersensitivity as the underlying problem. I was always baffled as to how Sarno could get good results in some patients given what totally unscientific his �research� is. Conversely, it would seem his treatment failures are not people �who don't believe the theory� as he claims but people for whom this central hypersensitivity is not the main problem.

In my case, the underlying organic problem is still present, however this central hypersensitivity was amplifying the pain, so their treatment was helpful in reducing my pain even though it didn't remove it.

A book written for patients about this research and how to use it in your treatment by some of the people who trained people at my pain clinic is described in the following link if you are interested.

www.noigroup.com/ep/index.html

Harrison 05-08-2005 07:00 PM

Good stuff, Lisa! Thanks for sharing...hope you're better these days.

biffnoble 05-09-2005 01:10 AM

Lisa:

Your input is immensely appreciated!

About pain: I wonder what the beneficial role of pain/chronic pain, is in cases of insidious disease like central spinal cord stenosis.

What role is pain playing in preventing further damage to the spinal cord itself by limiting activities, movements? Since the cord doesn't have the capacity to express pain is pain sensitization playing a useful role in this situation?

In my experience: if activities involving the neck are engaeged in and c-spine disease pain is masked with palliatives I experience delayed negative effects which include pain but also may include negative affect, "effects". I wonder if these are subtle manifestations of central cord disease and the micro trauma/permanent injury that neck movements may cause. I�ve had little luck in getting substantive information on this.

Is pain free movement, "consequence" free movement?

biffnoble 05-09-2005 01:59 AM

P.S. Lisa:

Followed your link above to this.

http://www.the-scientist.com/2005/03/28/S28/1

Very interesting!

natasha 05-11-2005 04:17 PM

Kisa,
It is interesting that you mentioned Dr.Sarno
4years ago while fighting my lower back and neck pain, numerous MRIs a myalogram, and several doctors giving a fusion %66 of success in my case,
I attacked Dr,Sarno's books. I calle his clinic, was reffered to his student in Chicago area(he was not accepting any patients outside of New York and new Jersey. I had a consultation, bought his tape, woke up the next morning completely pain free and flew back home. His theory about treating TMS(tension myosytis syndrome) works!
By digging out your phychological problems, going into subconscious mind and figuring out the cause
you can target that pain! BUT ONLY if the cause of it is psychosometic. My paradise lasted for almost 2 years. I also have fybromyalgia. I had my dark days. Overall it was an interesting experience. eventully it went downhill, and it took a lot of convincing on my phychiatrist part for me to go back to conventional surgeon.
Anyway, if anyone is interested in Dr.SArno's program I will be gald to share( there is a lot to it). Thanks for listening
Natasha

natasha 05-11-2005 04:19 PM

Sorry, Lisa for mispelling your name!

lisa 05-14-2005 01:31 PM

I read the book �Explain Pain� this week and I have a better understanding of these theories. To answer biffnoble's question, part of what these theories say is that not all pain is caused by tissue damage. Once the nervous system becomes dysfunctional, you can do things that are not aggravating the underlying organic pathology but still cause real physical pain because your nervous system is not processing information correctly.

I've asked my physical therapist about this issue of pain free movement versus consequence free movement because I also was doing home exercises while using significant painkillers. The answer I got from one of them was that a small increase in pain later that quickly resolves is not a problem but if I was doing my exercises in such a way that I had significant pain afterwards that I was doing too much.

There was one exception to this rule, which is muscle soreness from strengthening weakened muscles. That was to be expected and isn't a problem. But I think you can easily distinguish that kind of pain from other kinds.

Re natasha remarks, I'm all for people trying Sarno's approach since for some people they get great results. However he puts off a lot of people and it doesn't work for everyone.

The point of my remarks about Sarno is that you may be able to get an improvement in your pain by doing the things Sarno suggests i.e. adequate pain medication, graded aerobic activity, and learning about pain that is not protective, without necessarily believing in his theories about unconscious rage causing pain or the idea that back pain has no organic cause most of the time.

Beliefs about pain do affect your pain levels in a objective physical way. I saw a functional MRI study by one of the authors of this �Explain Pain� book where they found simply explaining the neurophysiology of the pain (including these theories of nervous system senstation) to a patient with back pain reduced activity in the areas of the brain related to pain during back exercises. There are similar studies showing the effect of anticipation of pain and belief that you have some control over your pain affecting your pain levels. Obviously if you have a severe organic problem, changing your beliefs won't eliminate your pain, but I find it interesting that it can at least modulate your pain.


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