According to Institute of Medicine of The National Academies, 100 million Americans suffer from chronic pain. The research is very clear about chronic pain. It really is all in your head – your brain that is. But that doesn’t make it any less real. The purpose of pain is to alert the body of an issue that is present. But why then, years after an injury, will people still have pain?
The Purpose of Pain
The root purpose of pain is to avoid future pain. That may seem like an oxymoron, but it can make some real sense if you look at how effective pain can be at doing this. How likely are you to put your full weight on an ankle you just rolled?
Because of this, it reduces the likely hood of you rolling the ankle again. Of course, this drastically changes the way you walk leading to wear on tissues and muscle imbalances. Muscles will get tight to protect and splint injured areas, as well as reduced ability to contract the muscle (arthrogenic muscle inhibition) in order to avoid further injury to the area.
Over time these compensations should resolve as the injury itself heals. When the compensations do not resolve, then chronic pain sets in.
Birth of Chronic Pain
The brain is exceptionally adaptive. It can sort out by priority of importance through the stimulation it receives or doesn’t. For example, a powerlifter is adapted to maximally contract muscles to squat heavy weights. However, the lifter that stops training will start to drastically lose those adaptations. In chronic pain, we lose our awareness of certain areas of the body after pain goes unchecked. This process is called “cortical smudging.”
The key to reducing or eliminating this “smudging” effect is to stimulate the sites of sensitization. Another big word? Ok, last one. Sensitization is the process that instigates the chronic pain loop. (See below) The two have opposite effects but work together to perpetuate the problem. One greatly improves a neurocircuit and the other dampen its ability. In other words, we dampen sensitization and stimulate parts of the brain to bring definition or clarity to remove smudging.
Tools for Desensitizing Pain
A strong driver of reducing lingering pain is through movement. As tissues heal, movement reassures the brain that we can start to depend on the tissue to do it’s job again.
Activation of proprioception through movement or soft tissue work dampens the continuous drive of inflammation to the area.
If this reassurance is never established, then a chronic pain loop will continue to persist.
In more complicated cases you need to assess surrounding tissues to make sure they aren’t complicating the tissues ability to contract and move freely.
Example: Fixing a problem in the hip or low back might restore full motion to a frozen shoulder.
Taking a Systemic Look
Even under the most comprehensive manual treatment from a therapist some issues will require a more aggressive and thorough look outside of the area of complaint.
The problem isn’t always that the tissue is too sensitive, but the that there is too much inflammation for the injury to overcome.
Inﬂammation is generated by the immune system. Inflammation is a natural part of regeneration, but left uncontrolled will drive degeneration. This will deplete vitamins, minerals, and macronutrients over time causing deficiencies.
Reducing Inflammatory Triggers
While clinically, I like to take a more systematic approach and rarely take people off more than 1 food – you might try to go on an anti-inflammatory diet.
- Trying an anti-inﬂammatory or elimination diet can be helpful. Many times just cutting the biggest offenders can have a drastic impact (sugar, dairy, gluten).
- Use caution as you reduce problem foods! You must increase the foods that you can eat, in order to avoid worsening a potential blood sugar issue. Eat plenty of good protein and fat with each meal.
- Reduce inﬂammatory “accelerators.” Things that further drive inﬂammation include stress hormones like cortisol, insulin, and excessive NSAID use.
- Consider adding in supplements that help reduce inﬂammation like Turmeric, Resveratrol, and Fish Oil, Magnesium, Vitamin B6 (P5P), and Zinc also help your body make more ﬁsh oil from omega 3’s.
Whether you’re diabetic and have trouble with high blood glucose (over 100) or low blood glucose (under 85) then this can be a common offender to your ability to get past chronic pain.
Generally, cut sugar out completely and focus on eating either 3 meals – 5 hours apart with around 30g of protein and a third of your calories for the day. If you’re on the low blood sugar side of things, then I’d avoid intermittent fasting in the morning. You need to shift away from your dependency on stress hormones to stable your blood sugar. You can do 6 small meals, but timing is much more difficult to hit every 2-3 hours.
Insulin resistance occurs when the cell becomes sick of being bombarded with insulin constantly. Like the little boy who cried wolf and the town’s people stop listening to him over time. You need to silence the boy long enough for the town people to trust him again.
Stop filling the cell up with glucose
Easy – stop eating sugar! Eat low glycemic carbs and focus on proper fat and protein intake.
Empty the cell of glucose
To improve insulin sensitivity exercise. Start with half of something you think you can do. If you can walk 3 miles, then start with 1.5 everyday. High intensity exercises are even better if you are physically able to.
Supplements like berberine, lipoic acid, and chromium are also helpful to improve insulin issues.
Digestive Driver of Inflammation
If you’re having obvious digestive symptoms like diarrhea, constipation, heartburn, bloating, indigestion, or gas (burping or flatulence), then you may have an inflammation factory in your gut. Typically, this is either from an imbalance in the microbiome, a specific food sensitivity, or a problem in it’s ability to digest certain things. Avoid using a probiotic and look for antimicrobials to reduce potential over growths first.
Autoinflammatory Disease: Autoimmunity
Even with the perfect diet, some people will have an immune system that will continue to drive excess amounts of inflammation.
Very generally, these patients need help balancing an overactive immune system. Many people have these issues without a formal diagnosis of “autoimmunity.” Focus should be on dampening production of inflammation with things like Tumeric or Resveratrol, potentially removing foods, heavy metals, infections, and balancing T Cells with supplements like Vitamin A and D.
I strongly recommend these complicated patients see a holistic practitioner as even experienced practitioners struggle to balance these presentations.
Chronic Pain Infographic for you’re viewing pleasure.
If you or someone you know is experiencing chronic pain, then please seek out a qualified professional. Many times it can be reversed with proper treatment and attention. While sensitization and smudging are huge players in chronic pain, they aren’t the only ones. Pain is not normal and it’s not you just “getting old.”
Stay tuned for follow up articles on specific chronic pain related injuries where I’ll include common sites of sensitization! Leave a comment below for any specific recommendations!
Dr. Todd Anderson DC, MS