A Patient's Guide to Chronic Pain
At Kleefeld Chiropractic patients often present with chronic pain. Chronic pain is a pain complaint that lasts for longer than 3 months. Unfortunately, tens of millions of Americans suffer from chronic pain each day and chronic pain is not a symptom that stands alone. Other problems associated with chronic pain include:
- Changes in mood including depression, irritability, and anxiety
A Familiar Story at Kleefeld Chiropractic
Chronic pain can start out from a simple injury, such as might occur while lifting shopping bags out of the trunk of the car, or violent sneezing while bending forward.
The sprained tissue becomes inflamed, causing pain signals to be sent to the spinal cord. Healing begins almost immediately. Unfortunately, if the incoming signals are strong enough and go on for long enough, processing centers (dorsal horn) in the spinal cord become sensitized sending signals to the muscles in the vicinity of the sprain to contract and produce muscle spasm. This is initially a protective reflex designed to prevent further injury to the sprained tissue.
However, when the muscles in the injured area contract too much, the tension receptors in the local muscles and joints are activated. These strong signals from the tension receptors can be interpreted in the spinal cord as pain, multiplying the pain signals from the inflamed tissue. This combination of magnified pain keeps the spinal cord dorsal horn in a sensitized state. This vicious cycle is maintained between the injured area and spinal cord by means of a "feedback loop."
Over time, the "cramping" associated with persistent muscle spasm causes restricted joint movement. This is true whether the area of injury is the neck, the back or any extremity joint. Without proper movement and slow normalization of activities of daily living there is no balance between scar tissue formation and normal healing. As a result, faulty scar tissue forms, which can be easily disrupted with minimal strain. This restarts the inflammatory process and another vicious cycle begins. Over time muscles and ligaments become shortened, weakened and of course susceptible to reinjury.
Dr. Kleefeld is of the opinion that the best treatment for chronic pain is "preventing it." However, when chronic pain is a reality, the best treatment is a combination of both long and short-term therapies which typically include the following:
- Short-term strategies focus on initial pain control and typically include medication management, stretching tight muscles and manipulating restricted joints. This has the effect of resetting the abnormal tension receptors in the muscles and joints, reducing spinal cord sensitization and consequently a reduction in pain. When combined with physical therapy modalities such as ultrasound, interferential current and instrumented myofascial therapies, scar tissue and adhesion formation softens and is oftentimes replaced by normal tissue.
- Long-term strategies include slowly normalizing activities of daily living and work tasks in combination with a progressive exercise program to improve and maintain strength and flexibility.
- Referral for multidisciplinary care is indicated, when in spite of well directed treatment utilizing both long and short-term strategies, pain and disability nonetheless persists. The focus of care then becomes referral for specialty consultation, imaging such as MRI scan and potentially surgery and/or interventional injections.