Most pain is related to injury or tissue damage and the treatment is relatively straightforward in theory: the tissue at fault is searched for and investigated, a cause is found and the treatment is aimed at improving the underlying abnormality. This is the medical model of disease and injury and it works exceptionally well, diagnosing our fractured leg, pneumonia, arthritic joint or heart attack and then treating it so the problem is solved. The difficulty starts with the many pain conditions which dont fit into this model and which are not well diagnosed or treated by medical doctors.
In normal pain, such as from a sprained ankle, the pain messages pass up to the spinal cord in the back, exciting the nerves there which take the pain on towards the brain. These incoming messages cause the spinal cord nerves to become highly excitable, amplifying the messages as they are sent on, making us feel a lot of pain. This excitation settles down as the inflammation and pain reduces and the spinal cord nerves return towards normal. However, this amplification process can be very powerful and create a pain problem without incoming pain signals. When this happens a person has a pain condition but no underlying physical tissue damage or injury.
Complex regional pain syndrome (CRPS), fibromyalgia syndrome (FMS) and chronic widespread pain (CWP) are typical pain syndromes. CRPS can develop in a wrist or ankle after a moderate or minor injury such as a small fracture or a sprain, with the joint rapidly becoming painful, stiff and swollen. A wrist and hand like this has very limited function and needs to be free of immobilisation as soon as possible to start rehabilitation. Early Osteopathy intervention is vital to get the passive and active ranges of movement as soon as possible and educate the patient in what they have to do.
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.
A clinical psychologist is vital if successful management of people with pain syndromes is to be accomplished as they will tend to produce anxiety, anger, low mood and depression. Patients exhibit poor coping, non-assertive behaviour, aggression, negative thinking and difficulties sticking to a therapy plan. A history of abuse, both in adult relationships or as a child, is common especially in FMS and can have a dominant effect on the patients approach and their relationships with others. Helping these patients through this time needs a clinical psychologist and treatment solely from a Osteo is unlikely to be helpful.
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. - 14130
In normal pain, such as from a sprained ankle, the pain messages pass up to the spinal cord in the back, exciting the nerves there which take the pain on towards the brain. These incoming messages cause the spinal cord nerves to become highly excitable, amplifying the messages as they are sent on, making us feel a lot of pain. This excitation settles down as the inflammation and pain reduces and the spinal cord nerves return towards normal. However, this amplification process can be very powerful and create a pain problem without incoming pain signals. When this happens a person has a pain condition but no underlying physical tissue damage or injury.
Complex regional pain syndrome (CRPS), fibromyalgia syndrome (FMS) and chronic widespread pain (CWP) are typical pain syndromes. CRPS can develop in a wrist or ankle after a moderate or minor injury such as a small fracture or a sprain, with the joint rapidly becoming painful, stiff and swollen. A wrist and hand like this has very limited function and needs to be free of immobilisation as soon as possible to start rehabilitation. Early Osteopathy intervention is vital to get the passive and active ranges of movement as soon as possible and educate the patient in what they have to do.
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.
A clinical psychologist is vital if successful management of people with pain syndromes is to be accomplished as they will tend to produce anxiety, anger, low mood and depression. Patients exhibit poor coping, non-assertive behaviour, aggression, negative thinking and difficulties sticking to a therapy plan. A history of abuse, both in adult relationships or as a child, is common especially in FMS and can have a dominant effect on the patients approach and their relationships with others. Helping these patients through this time needs a clinical psychologist and treatment solely from a Osteo is unlikely to be helpful.
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. - 14130
About the Author:
Andrew Mitchell, clinical editor at the Osteopath Network, writes papers about musculo-skeletal conditions, drug-free treatment, pain management and how to find a physiotherapists in Rugby. He is interested in the treatment of back pain, neck pain and injury and pain management.
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