STRUGGLING WITH CHRONIC PAIN OR CHRONIC ILLNESS?
When looking at a lateral view of the spine, the first thing we notice is the curves. The (normal) forward curve in the neck and low back is known as "lordosis" or "lordotic," while the mid-back curve runs the opposite way and is known as "kyphotic" or "kyphosis". What do these curves do? For starters they allow normal movement, both segmentally and sectionally (HERE). Proper curves also create a spring-like function that allows the spine to act as a sort of shock absorber; particularly important if you work on CONCRETE or other hard surfaces.
Without proper curves your spine would take a pounding of epic proportions. The curves work to distribute weight and force as well as transferring muscle energy to where it's needed. As you might imagine from looking at the picture; when spinal mechanics are off, the end result is that there is abnormal distribution of forces to spinal discs --- or maybe more accurately, to parts of the disc where said force should not be. Allow me to give you an example.
While discs will often herniate some degree laterally, they virtually always herniate backwards (posterior), meaning that herniated discs --- mostly from the low back or neck --- have the potential to be pushed or squeezed into the spinal cord or spinal nerve roots that come from the cord. What does this have to do with maintaining normal lordotic curves?
These normal curves put an axial pressure on the backs of the discs (as opposed to the fronts of the discs). As you can see from the picture above, this squeezes down on the posterior aspect of the disc, while opening up the anterior or front of the disc and pushing it forward. This natural "wedging" of these discs makes it extremely difficult for the disc's jelly center (the nucleus pulposis) to herniate (because without a horrific trauma the disc will not herniate forward), and explains why you will sometimes see this spinal position referred to as "closed-packed". However......
Imagine what would happen to the low back or neck if there were either no curves, or even worse, a REVERSE CURVE. Now, instead of the discs having the "open" portion of their wedge to the front, the open part of the disc faces the back. This is what happens to your lumbar spine if you bend forward and touch your toes. No big deal. That is, no big deal until you start loading the spine. Imagine, however, bending forward and lifting something, while not consciously maintaining the normal curve in your back.
Not only are you opening the disc in the back, but the heavier the object you are lifting (or the more overweight you are), the more pressure you are exerting on the front of the spinal column and discs, as opposed to them carrying this force on the posterior parts of the spinal column (the facet joints). This pressure literally squeezes the disc backwards like squeezing a tube of toothpaste. When there is too much force, or more likely, too many years of poor lifting mechanics, the ligamentous fibers of the disc (the annulus fibroses) that hold the jelly-like nucleus in place begin to separate and tear. The result is that you are now in a position where disc herniations are not only possible, but increasingly probable (HERE is a basic video of what this looks like).
Let's add one more variable to this situation. Let's do some situps. After all, everyone knows that situps are good for your back because strong abdominal muscles promote strong discs ---don't they? Enter Stuart McGill. Decades ago, McGill was the lone voice in the wilderness, warning that situps were not only not good for your back, but were arguably one of the single worst things you could do to your spine. His research has shown why situps are one of the best ways to cause spinal problems, including herniated discs (HERE).
In a recent interview with Dr. William Morgan (A Conversation with the Preeminent Lumbar Spine Researcher: Stuart McGill, PhD); after discussing overuse of spinal imaging, McGill made this statement concerning what's arguably the single most common spinal finding on radiologist's reports DJD or DDD (degenerative joint disease . degenerative disc disease). "When they [radiologists] use the term degenerative disc disease, I put that in the same category as nonspecific back pain. It's a garbage term." Interesting because that is essentially what I said in THIS 2012 POST.
In the PORTION OF THE VIDEO INTERVIEW titled Mechanics of Injury For Lumbar Disk Herniations and Extrusions, those of you suffering low back pain will find some interesting tidbits as far as what put you there, as well as pointing you in the right direction to a solution. The biggest disappointment concerning this video was that two of the chief drivers of chronic back and neck pain were not really addressed; the first being SYSTEMIC INFLAMMATION, the other being micoscopic fibrosis or adhesion of the FASCIA, or more specifically, the thoracolumbar fascia (HERE, HERE, HERE, HERE, HERE, HERE, HERE, HERE, or HERE) --- a factor that increasing numbers of experts are saying is responsible for the majority (as much as 70%) of chronic back pain. I would argue that if you add these two modes of thinking to the knowledge and protocols created by McGill, your results will be better yet. Allow me to explain.
What do we know about back pain?
- We know that back pain is the world's number one leading cause of disability (HERE).
- We know that back pain and disc herniations are both considered "inflammatory" (HERE or HERE).
- We know that back pain is associated with increased potential of developing chronic neurological disorders and diseases (HERE).
- We know that in our sit-too-much society, both LOWER CROSSED SYNDROME and UPPER CROSSED SYNDROME are epidemics that are dramatically increasing in both numbers and severity.
- We know that there is an intimate relationship between chronic pain, chronic illness, adhesed fascia, inflammation, and fibrosis / scar tissue (HERE, HERE, HERE or HERE).
- We know that SCIATICA is often caused by VERY SPECIFIC FASCIAL ADHESIONS as opposed to disc herniations.
- We know that adjustments are helpful for many cases of spine-related pain (HERE). We also know that in many cases, these same adjustments don't hold very well (HERE).
Although I could have taken this list further, it helps explain why even though one cannot ignore the biomechanical aspects of back and neck pain, it's critical to realize there are other factors at play; particularly the chemical factors we refer to as "INFLAMMATION" --- a factor known to put people into a true CONUNDRUM.
If you are interested in shedding systemic inflammation and starting the process of RESOLVING YOUR BACK PAIN, be sure and take a look at THIS POST. It will at least provide a few ideas as far as creating your own personalized EXIT STRATEGY is concerned. Also, be sure to like, share or follow on FACEBOOK if you appreciated this post because it's still a great way to reach the people you love and value most.
MICHIGAN / INDIANA CHRONIC PAIN RELIEF
IN MOUNTAIN VIEW, MISSOURI
Dr. Russ, Good morning!
I came to visit you this past August. I was with my mom and we came from the Indiana / Michigan area. I keep forgetting to give you an update on the treatment you gave me. I found significant relief in my neck and upper back, with my chiropractic adjustments actually holding for longer periods of time now. I started exercising again in December, and my performance and pain levels are a lot better than when I was exercising last spring, before I came for treatment. I remember after the treatment my neck not hurting for the first time in a long time.
I still have some problems with my hip, pelvic, sacrum areas, which were my main concerns. I have a dull ache in my sacroiliac joint (at least I think that's where it is). And I totally can tell I still have some fascial adhesions around my hips and etc. I am working these out with my own fascia tools and Pilates, which seems to be a great choice for my body - a mix of harder work and stretching at the same time. I am also about to start some weight training again. However, if I can't make enough significant progress in the coming 6 months plus, then I will be returning to see you another time to work on these areas, or whatever needs worked on. Stress can really get my back and neck all tight again too. We have some bad winter weather over here and driving makes me tense up real bad.
Overall my entire body is doing much better. I noticed the biggest change when I started exercising again in December and how different it felt this time around post-treatment, versus pre-treatment. I ran on the treadmill the other day for a few minutes and was surprised to see how well I did compared to when I tried last year. Anyways, I had been meaning to write you, but finally got to it! Thank you for what you do! It helps lots of people and is the missing link that my doctors just cannot seem to wrap their brains around!
That's fantastic! Just let me know if you are this way again and we'll try to knock out the rest. BTW, I could not remember you immediately and looked at FB and remembered immediately. That pic with your husband and kids.... amazing! Also, would you mind if I posted this as a testimonial?
Absolutely you can use it! I tell everyone in pain about my journey and the role fascia & scar tissue have played. So shout it to the rooftops! I actually was just helping someone in pain today and told them about mine & sent them links to your blog to read about scar tissue. And yes I thought it might be hard for you to remember me since I came back in August. I actually debated on sending a photo to help! :) My sister is a photographer...that’s why that pic of my family is so good! Anyway, thanks again and maybe see ya in the future!
Allow me to give you a bit of background. The first thing you must realize is that Jenna's case presents a picture-perfect example of what I referred to in my post, "MUZZLED" ---- the all-too-common tale of vaccine damage denial. Bottom line, if reactions to drugs or vaccines are not reported to the proper governmental agencies, they are never counted among the adverse reaction statistics. Thus, whatever drug or vaccine looked at appears much safer than it is. Because the "ANTIVAXXER" rhetoric has been (purposefully) ratcheted up to a scream; whether dealing with topics such as FLU VACCINES, VACCINES in general, or vaccine sequelae such as AUTISM, there is no longer room for a conversation. For the record, numerous meta-analysis have shown that vaccine side effects are reported to VAERS (the government's Vaccine Adverse Event Reporting System) about 1% of the time (HERE). Not a misprint. Now, back to Jenna.
Jenna is a super-fit thirtyish mother of two young children. Always ultra-active, a TDAP SHOT she received while she was pregnant started this nightmare. She entered the world of CHRONIC PAIN, climbed on the MEDICAL MERRY-GO-ROUND, and started spinning. As you might imagine, she had been through all sorts of medical tests and treatments by the time I saw her, but had gotten off all of it except for the ANTIDEPRESSANTS and MUSCLE RELAXERS. The only things that actually helped Jenna were FASCIABLASTING and certain kinds of stretches / yoga. Even though Jenna's issues were "SYSTEMIC," I decided to see her once because I had a hunch I could help (her problems were fairly symmetrical left to right as well as being found both above and below the waist).
What did I determine from the examination and treatment? She had a combination SACROILIAC JOINT PROBLEM and SUPERIOR CLUNEAL NERVE ENTRAPMENT (as well as some HIP FLEXOR ADHESIONS), along with an array of FASCIAL ADHESIONS and connective tissue FIBROSIS, undoubtedly driven by an inflammatory reaction to the shot (remember that inflammation always causes fibrosis --- the medical word for what I refer to in my clinic as "SCAR TISSUE" or "DENSIFIED TISSUE" (HERE). One of the clues that I might be able to help Jenna was that chiropractic adjustments would help her, but the results were extremely short-lived (HERE or HERE) --- something that improved dramatically after her treatment. Speaking of treatment.....
Although I turn down the majority of the people who contact me from around the world because, unfortunately, after providing me with a history, I don't feel I can help them; my pledge to my OUT-OF-STATE & INTERNATIONAL PATIENTS (not to mention most of my local patients) is simple ---- you will know whether my approach will help you after a single treatment. This does not mean that one treatment will be enough to "cure" you (as an old professor of mine used to say, 'the only thing cured is ham'), but you will know whether or not we are on track (HERE or HERE).
For those who want to dig deeper into the root causes of fibrosis-causing inflammation (something I highly recommend, whether you have visible / tangible problems or not), HERE is the post. And if you appreciate what we are doing in tiny MOUNTAIN VIEW, MISSOURI, be sure to show us some love on FACEBOOK since it's still one of the best ways to reach the people you love and value most.
GOT CHRONIC PAIN?
LEARN ABOUT WHAT IT TAKES TO SELF-MANAGE IT!
"There is a shortage of pain specialists with only one for every 21,000 patients. Meanwhile, untreated chronic pain impacts multiple aspects of the patient’s life, leads to depression, anxiety, irritability, emotional frustrations, social avoidance, relationship issues, loss of self esteem and lack of enjoyment of living and, occasionally, leads to suicidal ideation or attempts. Many primary care providers are comfortable treating acute pain due to its short course and usually identifiable cause, however they are much less comfortable treating chronic pain due to the myriad of complexities... such as pain without a clear etiology."
The article went on to talk about various ways of addressing chronic pain, mostly pertaining to medication --- most specifically opioids. Fast-forward six years, and we are in the throes of an OPIOID EPIDEMIC that is costing our nation over 500 billion dollars and killing nearly 50,000 people each and every year.
As I showed you (HERE), the pendulum has swung so far back the other way that many doctors are no longer prescribing opioids for fear of government retribution --- not having their claims paid, losing their licenses, or even being sent to jail. Add this to the medical community's realization that they have no real solutions to most of the chronic health issues they face all day, every day (HERE and HERE), and it's simple to see why there is a shift taking place in what constitutes the best way to deal with patients struggling with chronic pain.
Google 'chronic pain self-management,' and you'll come up with over 130 million hits. Today we are going to talk about just one --- an article from the new issue of Practical Pain Management titled Self-Management of Chronic Pain in Primary Care.
"Despite the complexity of chronic pain, at least half of all patients receive their healthcare from a primary care clinician. This raises a striking conundrum since primary care practitioners have been found to harbor negative attitudes toward patients with chronic pain, driven by a sense of insufficiency in addressing this patient complaint. To effectively address the multidimensional effects of chronic pain, patients need self-management training about behaviors, strategies, and activities that may help to control the destructive effects of pain on their quality of life."
How would you like to have a doctor that harbors "negative attitudes" towards you? The authors went on to talk about "limited options available to manage common cases of chronic pain," as well as that fact that both sides of this equation --- doctors and their patients --- feel "stuck" with their options; both groups typically and unfortunately seeing "increasing medication as the only solution." What this has done --- which, while not perfect for every person or situation --- has forced the medical profession to re-evaluate and abandon many of the practices that got us to this point.
What this really means for you --- the pain patient --- is that with doctors increasingly threatened with treatment audits and their careers being taken from them, the burden is increasingly falling on you to step up to the plate and take care of yourself (after all, today's post is about 'self care'). Since necessity is the mother of invention (or change), let's look at some of the self-management tips being promoted by these authors (an MD and clinical psychologist) for people struggling with chronic pain.
- UNDERSTAND PHYSIOLOGY: Look; if you don't have at least a cursory understanding of PHYSIOLOGY, INFLAMMATION, and CHRONIC PAIN (most people think they understand the latter two, but few actually do), getting better is going to prove tough. Since nothing makes sense, the entire situation, along with everything you try, will seem hopeless. Knowledge really is power! The authors also mentioned 'goal setting' under this bullet point. I would whole-heartedly agree since one of the most important aspects of my protocol is having patients create a PERSONALIZED EXIT STRATEGY for getting out of pain. And even though it was not mentioned, this is a good time to say something about having a support network of some kind. Online is great, but I would argue that in most cases, having someone nearby is better.
- MEDITATION & MINDFULNESS: While I'm a fan (our family watched a COOL VIDEO on meditation last evening), I have argued that "mindfulness" is all too often an intellectual-sounding, all-encompassing cop-out provided to people in chronic pain. A recommendation made by practitioners who aren't really getting to the root of things, or in many cases don't believe it's even possible to do so (HERE).
- BODYWORK: Although the authors mentioned massage, there are an almost unlimited number of forms of bodywork that can provide amazing results (HERE and HERE are two articles on this topic concerning fibromyalgia). Although there are people coping with "intractable" chronic pain (CENTRAL SENSITIZATION), I've shown you how important it is to work with these folks (HERE, HERE and HERE) because in many cases improvement is possible. My goal with my patients is not just to manage, but if possible, help provide solutions (THIS is what I'm talking about).
- STRETCHING, EXERCISE, ADL'S: I'm a huge fan of using various sorts of physical training to help get people back to performing activities of daily living without suffering every step of the way (these authors specifically mentioned stretching and a STRENGTH / CARDIOVASCULAR COMBO). Be aware, however, that in many cases, the cart gets put in front of the horse. Put simply, if people are trying to exercise or stretch areas that are microscopically 'TETHERED' by scar tissue, it has the potential to make things worse (HERE, HERE, or HERE). The more severe the case, the more true this is.
- HEALTHY EATING PLAN: Because I would argue that it's the number one key to solving SYSTEMIC INFLAMMATION (which can greatly help with either local or systemic pain), this bullet should have been number one on the list. Although I'm not quite sure where to begin since this bullet could encompass several volumes of books, THIS SHORT POST provides a starting point. It's important for the chronic pain patient to realize that inflammation always leads to fibrosis (HERE).
- SLEEP HYGIENE: Although I've talked about this in many posts, probably the most important can be found HERE.
- COUNSELING: Several things were mentioned here, including CBT, acceptance therapy, and managing setbacks. While counseling can be valuable (emphasis on "CAN"), it's important to have the right kind of counselor. Many people could benefit from seeing someone who's mostly Florence Nightingale, with a streak of Sgt Lee "Gunny" Ermey.
The most beautiful part of this plan is that much of it can be done on your own. Once your FIBROSIS / SCAR TISSUE has been dealt with, even much of the bodywork can be accomplished without professional assistance (HERE or HERE). For those of you looking to expound on this protocol, HERE it is. And while there are no fool proof methods for dealing with chronically ill or chronic pain patients, my protocol will at least get you thinking outside the box (which research is starting to show is actually inside the box even though far too many practitioners have not yet come to this realization). If you like what you're seeing or feel it deserves to be shared with struggling people, you can reach those you love and value most by liking, sharing, or following on FACEBOOK.
WHICH DIET MIGHT BE BEST FOR YOU?
Firstly, that the average profile of a chronic pain sufferer was female, overweight, and over fifty --- the same profile for developing autoimmunity (HERE). Secondly, and more importantly; we saw that of all the various sorts of diets looked at, the type that seemed to work best (12 of the 16 studies in this category showed significant improvement of pain) simply involved shifting a person's overall pattern of eating away from junk, toward health. Take a look, however, at this statement...
"These limitations add to the disparity between the recognition of nutrition-related issues as key treatment goals and the availability of good-quality, dietetic-led, nutrition-related treatment options for people who experience chronic pain."
In other words, the numerous limitations listed by the study's authors (there were many) created a "disparity," a word whose definition means "discrepancy, inconsistency, imbalance, inequality, incongruity, unevenness, disproportion; variance, variation, divergence, polarity, gap, gulf, breach; difference, dissimilarity, contrast, distinction, differential, contrary, etc."
In other words, we have a situation here in America where not only is dietary advice rarely given in a clinical setting (HERE); when it is, it's frequently wrong (HERE are recommendations from the American Heart Association and the American College of Cardiology). This is a shame considering these authors noted that dietary changes / interventions can improve the quality of life for suffering patients. Even if the advice is good, is the patient necessarily going to follow through? Unfortunately, doubtful. But those who do will see results, and it's about as simple as your doctor providing APPROPRIATE PATIENT HANDOUTS (whether online as mine are, or an old fashioned piece of paper).
Although not all of these points were in the study, allow me to highlight a few generic dietary recommendations of my own for the average person struggling to cope with their chronic pain.
- CUT SUGAR & JUNK CARBS: Sugar and high-glycemic foods --- foods that break down to glucose rapidly (flour, pasta, white potatoes, bread, etc, etc) --- are inflammatory; particularly if GRAIN-BASED (HFCS is a great example). Over the past two decades I've noticed a common theme when people go LOW CARB (almost always for the purpose of WEIGHT LOSS). They frequently see an array of health or pain-related benefits not directly associated with their weight loss. Oh; I better also mention in this bullet point that if you are using DIET PRODUCTS, be sure to click the link.
- INCREASE THE AMOUNT OF GOOD FATS: The fats you are eating are either driving or squelching inflammation (HERE or HERE). When people clean up their fats and do a PALEO / KETO combination, the results are often off the chart.
- EAT QUALITY PROTEIN: If your protein sources consist of processed or commercially-raised meats, or commercially-grown poultry or eggs, it's important to realize that you could be doing much better. You can read about those differences HERE or HERE. For those of you struggling with chronic illness or chronic pain, while trying to get your protein from plant sources; realize that while not necessarily impossible, it can present a significant challenge.
- SPICE THINGS UP: If you spend some time studying the myriad of anti-inflammatory spices (HERE is a post I wrote about yellow spices), you'll quickly see that not only can can you add a huge amount of anti-inflammatory firepower to your diet, you can add a great deal of flavor in the process.
- BEWARE OF FRUITSANDVEGETABLES: Fruits and vegetables were purposely run together in the bullet's title to provide an example of what most people believe and how they behave regarding fruits and vegetables. Tell a person to eat more fruits and vegetables and most --- particularly your hardcore SUGAR ADDICTS --- will add fruit. YESTERDAY'S POST dealt with this briefly via a story explaining what's happening to fruit-eating zoo animals. The point of this bullet is simply that fruits and vegetables are different (HERE), and your diet should be top-heavy in the latter.
Just remember that despite the problems with this study; the final sentence stated, "This review highlights the importance and effectiveness of nutrition interventions for people who experience chronic pain." For those of you looking for other diet-related ideas, or maybe even some ideas that don't necessarily have anything to do with diet, but are all about reducing inflammation, HERE is a short post to browse. And if you appreciate what you are finding on our site, be sure to like, share or follow on FACEBOOK since it's a great way to reach the people you love and value most.
AN EXPERT REVIEW AND SYNOPSIS OF MYOFASCIAL PAIN SYNDROMES
What's just as interesting as calling trigger points a source of pain is that he referred to them a "source of functional limitation". In other words, these creatures (TP's) are not only painful, they have the potential to alter the way you go about your normal day-to-day life. Bordoni went on to talk about the various theories on why people get Trigger Points. Here are some of the takeaways (trying to simplify some of this for my readers).
- Trigger points are more prone to be found in red muscle (aerobic, slow twitch, postural) that white muscle (anaerobic, fast twitch, explosive movements).
- Constant (repeated) microtrauma is a problem --- probably one of the reasons that the consensus is that REPETITIVE INJURIES are usually harder to deal with than acute trauma.
- This constant microtrauma to red fibers causes an increased need for cellular OXYGEN, which depletes cellular energy (ATP) and causes increased sensitivity to pain.
- In this environment, numerous chemicals, compounds, and elements (including the biomarkers we refer to collectively as "INFLAMMATION,") causes both tissue STIFFNESS AND DENSITY, as well as the heightened pain sensitivity and low threshold to meet said sensitivity we saw in the previous bullet. When this process happens in the central nervous system it's known as CENTRAL SENSITIZATION. As the famed neurologist and acupuncturist (he's considered the father of modern dry needling techniques) Chan Gunn said, this can make fibrotic tissue over 1,000 times more sensitive to pain than normal tissue (HERE).
- Thanks to the above-mentioned CS, as well as similar phenomenon occurring in the peripheral nervous system, areas of the nervous system begin firing on their own, sometimes almost perpetually, with an end result that there is "a constant local contraction of the muscle fibers". Mind you, I am not saying that the entire muscle is contracting, but instead, due to the fact that when an individual muscle fiber contracts it contracts at 100%, the individual fibers under the control of a specific nerve can be hyper-stimulated and contract until they finally run out of ATP. The end result is that once this occurs, many people will get a short period of TP relief until the body replenishes it's stores of cellular energy to start contracting again.
- As the vicious cycle spins faster and faster, not only is there an increase in pain, but the FIBROBLASTS actually start converting to myofibroblasts, which dramatically changes the dynamics of the fascia. In fact, Bordoni theorizes that the fascia, which acts as A SECOND NERVOUS SYSTEM, has the potential to itself start sending "looped" messages that play over and over again, causing further "spontaneous presence of local muscle contraction."
- There is also an alteration of the hyaluronan or hyaluronic acid (HA) that, like most everything else seen in fascia, also thickens, becoming more viscous, creating a scenario where the various layers of fascia do not slide on each other (IT LOOKS LIKE THIS). This seems to cause stretching of the nerve tissue in the fascia, creating still another reason for it "becoming constantly activated".
- If you throw altered BLOOD PRESSURE into this whole mess, the smallest blood vessels (the capillaries) become ischemic, starving their corresponding muscles for O2. In a nation where we learned just last week that our COLLECTIVE BMI (body mass index) went up yet again, it's just another nail in the proverbial coffin.
- Because the internal environment of a trigger point is hypoxic (low oxygen), it's also acidic. For those of you who suffer from any sort of digestive issue, I suggest you read about the inverse relationship between the stomach and the body as far as acidity / alkalinity is concerned (HERE).
- The end result is that there are several positive feedback loops (viscous cycles) that set themselves up, causing a release of neurotransmitters that stimulate contraction, based largely on inflammation, hypoxia, acidity, and the muscle contraction itself, "surging the sending of painful information to the nervous system."
- Trigger points, if biopsied, contain cells, tissues, and biochemical markers that are different than normal surrounding tissues. Not surprisingly, the tissues are themselves thickened (sometimes researchers refer to this as "DENSIFICATION").
One of the theories that Bordoni specifically mentioned has to do with altered neurological function of the nervous system as it relates to the SKIN. "The concept of altered electrical activity of the skin and the afferents [sensory nerves] coming from the TPs could explain the altered emotional state in patients with the myofascial syndrome (anxiety and depression)." Interesting, considering ANXIETY and DEPRESSION are both considered to be "inflammatory" diseases (HERE).
Furthermore, we saw confirmation of previous studies that various parts of the brains of people in chronic pain, and especially chronic myofascial pain, actually shrink and atrophy. In fact, I've seen studies showing that this phenomenon can be so severe that over time, brain scans of those who have lived with chronic pain become almost indistinguishable from people with neurodegenerative diseases such as ALZHEIMER'S (HERE).
Although the books by TRAVELL & SIMONS were mentioned (Janet Travell was JFK'S PERSONAL PHYSICIAN), what I found most interesting was the lack of consensus as to what can be used to effectively image and / or destroy these creatures ("Currently, the causes of the presence of TPs are only speculative, as well as the correct evaluative and therapeutic approach."). As far as treatment, Bordoni mentioned every single one of my 'BIG FIVE,' as well as "lidocaine patches, BOTOX, POSTURE-CONTROL EXERCISES, NUTRITION, THERAPY, CHIROPRACTIC ADJUSTMENTS [actually, he mentioned "Osteopathic Manipulation"], ultrasound, STRETCHING, DRY NEEDLING, YOGA, ACUPUNCTURE" and a number of others. What wasn't mentioned was, at least in my mind, even more interesting than what was. Namely, any sort of bodywork, massage therapy, rolfing, TISSUE REMODELING, etc.
The paper's theme was that the drugs are not going to be very helpful and can actually cause a myriad of SIDE EFFECTS. It seems that Bordoni would agree that A SYSTEMIC APPROACH to trigger points has the potential to be much more effective than simply attacking these beasts in a purely local fashion. If you appreciated today's post, be sure to share it with others. FACEBOOK is still an effective way to reach the people you love and care about most!
IS YOURS PATHOLOGICAL OR FUNCTIONAL?
The authors started by stating the obvious; "The current approach to musculoskeletal pain is failing, a new approach is needed." How did they describe the "old approach" ---- the approach largely used today? Mostly, they described it as a myriad of tests for making diagnosis that are typically unhelpful in solving people's problems; particularly their chronic problems. They mentioned the phenomenon of ASYMPTOMATIC DISC HERNIATIONS as well as the fact that most of what is seen on x-rays or musculoskeletal MRI's is not useful as far as determining where a person's pain is coming from (see the following link). "The majority of persistent non-traumatic musculoskeletal pain disorders do not have a pathoanatomical diagnosis that adequately explains the individual’s pain experience and disability." In other words, most of these problems are functional as opposed to being based on visible pathology. What does this mean?
"First, structural changes observed on imaging that are highly prevalent in pain free populations, such as rotator cuff tears, intervertebral disc degeneration, labral tears and cartilage changes, are ascribed to individuals as a diagnosis for their condition. Second, it is arguable that musculoskeletal clinicians have invented treatments for conditions that may not exist or be readily detected."
While the first statement is AS TRUE AS TRUE CAN BE, the second sentence is much more open to debate; especially in light of the first. The first sentence (as explained by the provided link) shows what we have known for decades; that just because 'something' shows up on an MRI does not mean it needs to be surgically dealt with. The famous sports surgeon, James Andrews, showed us this with shoulders (HERE), but it's true with any number of other issues as well, including ever-common KNEE PROBLEMS and subsequent surgeries done for them. There are many others (HERE). The second sentence above, however, is even more problematic because it insinuates that because something is not "readily detected" it doesn't exist.
The examples these authors used were MYOFASCIAL TRIGGER POINTS, postural distortions / muscle imbalances (UPPER CROSSED & LOWER CROSSED syndromes as well as FORWARD HEAD POSTURE always come to mind first) and sacral torsions (chiros call these "SUBLUXATION" and they can be associated with everything from SI ISSUES, SCIATICA, CUTANEOUS NERVE ENTRAPMENTS as well as PIRIFORMIS ISSUES). And that's just for starters. If you have ever dealt with these or similar issues you quickly realize that such problems are not merely 'JUST IN YOUR HEAD' (thanks to an anatomical short leg and numerous roached ankles --- grade III sprains and several avulsions from my basketball days, on varrying levels I have at times dealt with of all of these, including occasionally fighting the dreaded LEVATOR / PEC MINOR SUPER-TRIGGER).
The unifying factor that I believe helps explain the majority of these and other problems (we could easily throw WHIPLASH into this category as well because there are no good tests that detect it or truly describe what's going on) is the FASCIA SYSTEM. When people end up with injuries or systemic issues related to INFLAMMATION, they have to realize that the consequence is always some sort of fibrotic change (HERE). And while practitioners may refer to said changes by numerous names (DENSIFICATION, SCAR TISSUE, FASCIAL ADHESIONS, etc, etc, etc), the bottom line is that just because FASCIA DOES NOT IMAGE WELL with traditional, insurance-covered technologies doesn't mean these problems don't exist.
And while I completely agree with the author's assessment that most non-traumatic musculoskeletal problems revolve around "lifestyle," they discussed numerous management ideas (better sleep, quitting smoking, etc) without as much as mentioning diet and its relationship to systemic inflammation. Honestly, how can struggling patients successfully address the problems they are having ("the individual’s self-efficacy to take control and ultimately be responsible for their health") without a strong emphasis on the quality of food they are consuming on a daily basis (HERE, HERE, HERE, HERE, or HERE)? But then again, it's not news that most doctors fail to discuss diet with their patients in any meaningful way (HERE) ---- an issue that strikes at the very heart of the moot debate over who should be paying for American healthcare; individuals, employers, or the government (HERE).
"We need to reframe what is currently doable and achievable in the management of many non-traumatic musculoskeletal presentations, and honest and open conversations regarding the outcome evidence for these disorders needs to be sensitively communicated. Interventions such as manual therapy, pharmacology and injections, when provided, should be seen as an adjunct, and their risks and benefits must be considered and honestly communicated. To achieve this, the efforts of many institutions, including educational, healthcare, political and professional organizations, health funding bodies and the media, need to be involved."
Ahhhh; utopia. It's lovely isn't it? To bad IT'S NOT REAL. There are some hard facts underlying all of this; namely that "management" of your problems and pain may require some real effort on your part. If, as the authors of this paper argue (I totally agree with them on this point), your doctor / clinician can't make someone healthy via the things they do for you such as drugs or surgery, what would make one think that government or media (or for that matter, education) can play a significant role? That's just it folks, they can't. While this paper seems inclined to agree that Westernized populations are receiving far too much of at least certain types of health care (HERE), it's unfortunate that it didn't acknowledge the deeper truth --- that both EDUCATIONAL EFFORTS and PREVENTATIVE HEALTHCARE do not work as touted. What does work if a person is willing to actually get off the couch and make some lifestyle changes?
Firstly, if you have chronic musculoskeletal pain (HOPEFULLY IT'S NOT CENTRALIZED), it might be beneficial to see if I can help you. What's cool is that like the people HERE and HERE, you will know if my approach is helpful in a single visit (just click the links to see what I mean). Secondly, while I may be able to help get you out of pain, if you are looking to stay that way and get healthier in the process, you might find a few good ideas for reducing your inflammatory load in THIS POST. And since the holiday season is upon us, why not commit to giving yourself the best Christmas present ever this year (HERE)? Also, if you like what you are seeing on our site, be sure and like, share, or follow on FACEBOOK as it's a great way to reach the people you love and care about most.
THE OPIOID CRISIS AND SURGERY FOR CHRONIC PAIN: BRAND NEW RESEARCH REVEALS WHAT YOU MAY HAVE ALREADY SUSPECTEDRead Now
OPIOIDS OR SURGERY AS A PRIMARY WEAPON AGAINST CHRONIC PAIN?
NOT ACCORDING THE THE LATEST RESEARCH
"The U.S. drug overdose epidemic has been inexorably tracking along an exponential growth curve since at least 1979. Although there have been transient periods of minor acceleration or deceleration, the overall drug overdose mortality rate has regularly returned to the exponential growth curve. This historical pattern of predictable growth for at least 38 years suggests that the current opioid epidemic may be a more recent manifestation of an ongoing longer-term process. This process may continue along this path for several more years into the future. Paradoxically, there has been substantial variability with which specific drugs have become dominant in varying populations and geographic locales. This variability all but negates the possibility of confident predictions about the future role of specific drugs. Indeed, it is possible that a future overdose epidemic may be driven by a new or obscure drug that is not among the leading causes of drug overdose death today."
Dr. John Lary, an internist from Huntsville Alabama, commented on an article about this study that was published in MedpageToday (The Opioid Crisis Actually Began 40 Years Ago), stating, "I don't know the solution to the problem. I do know what is NOT the solution -- more government programs, policies, guidelines, and/or regulations." Although he is correct, this leads us to ask the question; how big is the problem? The National Academies of Science, Engineering, and Medicine, published a book back in the summer of 2011 saying that almost 1 in 3 Americans is dealing with CHRONIC PAIN, at an annual cost of (gulp) $635 billion. Believe me when I tell you that these numbers have not gotten better in the seven years since.
Earlier this month, Pain Medicine carried a meta-analysis of 25 studies (Are Invasive Procedures Effective for Chronic Pain? A Systematic Review) trying to ascertain whether or not surgery was a good choice for various chronic pain syndromes (some of those mentioned included BACK PAIN, NECK PAIN, ABDOMINAL PAIN, KNEE PAIN, MIGRAINE, as well as a number of others. "There is little evidence for the specific efficacy beyond sham [placebo] for invasive procedures in chronic pain." As you might expect, ADVERSE EVENTS were exceedingly high in studies where they were reported. One more fun fact from this study was that 87% of the improvement could be attributed to the PLACEBO EFFECT. In article for Medpage (Surgery for Chronic Pain: Risky and Costly), Christopher Cheney wrote....
"The lead author of the research, Wayne Jonas, MD, executive director of Samueli Integrative Health Programs at H&S Ventures in Alexandria, Va., said that physicians and chronic pain patients should consider surgery carefully. Surgery for chronic pain is a prime example of over-utilization of healthcare services and poor care coordination. There are several options for treating chronic pain that do not involve invasive procedures or addictive medications such as opioids. "The American College of Physicians, the Centers for Disease Control and Prevention, the National Institutes of Health, and many other national bodies have recommended non-pharmacological approaches for the treatment of chronic pain," he said. "These include acupuncture, yoga, massage, and other such approaches. In addition, behavioral medicine has been demonstrated for many decades to be effective for chronic pain.""
What's my takeaway from studies like this? Easy. Do whatever it takes to diminish SYSTEMIC INFLAMMATORY PROCESSES in your body. Although it's far from a "cure all" (some of you may need to see a SPECIALIST IN FUNCTIONAL MEDICINE), I've created a post with a generic protocol that has enough "juice" in it to help many of you, arguably most of you, improve your inflammation levels and subsequently improve your health and energy levels (HERE IT IS). If you like what you're seeing, be sure to like, share or follow on FACEBOOK as it's a fantastic way to reach the people you love and care about most.
YOURS MAY NOT BE "CENTRAL SENSITIZATION" AFTER ALL
"Pain may be prevalent in 39 to 55% of post-stroke patients but not all cases involve central pain. The types of pain that may occur after a stroke include shoulder pain (the most common), headaches, spasticity, and lastly, central post-stroke pain (CPSP). CPSP represents about 25% of post-stroke pain cases."
After mentioning the usual array of drugs used to deal with CPSP (ANTIDEPRESSANTS, STEROIDS, OPIOIDS, anticonvulsants, and others), and likewise suggesting that none work well and all have problems associated with their use, Bottros made this statement. "CPSP is a result of misinterpretation of afferent sensory input by the sensitized neurons within the brain, rather than generated spontaneously by the damaged central nervous system (CNS) neurons." In other words, in at least some cases, sensory nerves are "misinterpeting" what they are sensing, not necessarily that CPSP is always generated by the brain itself.
In a study from the July issue of Pain (How Central is Central Poststroke Pain? The Role of Afferent Input in Poststroke Neuropathic Pain), Bottros' team found that by performing a nerve block in the affected extremity, they totally shut down the pain in 7 of 8 subjects within half an hour --- something that would be impossible if the pain were "autonomously generated within the CNS. Rather, this pain is dependent on afferent [sensory] input from the painful region in the periphery."
In English, this means that people's CHRONIC PAIN might not be, in many cases, as "centralized" as they've led to believe. And while I don't make any sort of claims about being able to help people with CPSP (that's a job for a qualified FUNCTIONAL NEUROLOGIST), I have been saying this very thing for a long time --- that a significant amount of pain that's been diagnosed as "centralized" is not. This is why I have suggested that people who are not really sure whether their pain is due to Central Sensitization or might be arising from FASCIAL ADHESIONS, should have A TREATMENT (yes, just one) and see. If they are in fact, "centralized," the only harm will be that they fired up their pain for a few days (HERE).
To carry the process one step further, in the PPM article, Dr. Bottros talked about "altering cytokines". Why is altering cytokines a big deal if you hope to improve your situation and your pain? Because CYTOKINES are the chemical messengers made by your immune system so that cells can signal and communicate with each other. And while integral for the healing process locally, when there are too many or too much of these chemicals coursing through your body systemically, bad things happen, including pain, fibrosis (SCAR TISSUE) and DISEASE. Listen to these cherry-picked findings from the journal International Anesthesiology Clinics (Cytokines, Inflammation and Pain).
"Cytokines are small secreted proteins released by cells have a specific effect on the interactions and communications between cells. Inflammatory responses in the peripheral and central nervous systems play key roles in the development and persistence of many pathological pain states. Certain inflammatory cytokines in spinal cord, dorsal root ganglion, injured nerve or skin [fascia] are known to be associated with pain behaviors and with the generation of abnormal spontaneous activity from injured nerve fibers. There is abundant evidence that certain pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α are involved in the process of pathological pain. In the CNS, there are two types of glial cells, microglia and astrocytes, which can be activated by excitatory neurotransmitters released from nearby neurons. It has been well demonstrated that spinal glial activation is necessary for induction of the neuropathic pain state. In summary, proinflammatory cytokines are involved in the development of inflammatory and neuropathic pain."
I've talked extensively on my site about TNF-ALPHA and INTERLEUKIN 6, showing that inflammation will always lead to FIBROSIS that in my clinic I refer to simply as scar tissue. Furthermore, we see that these cytokines have the propensity to activate Central Sensitization by hyper-activating microglia (HERE). This is why whether your pain is centralized or not, reducing the amount of systemic inflammation in your body is a good thing. And when you consider that virtually every disease process (including many that you've been led to believe are purely genetic --- HERE) is based on systemic inflammation, addressing said inflammation starts making even more sense. Sometimes, however, you will need treatments that actually create inflammation. Huh?
Just remember that local inflammation is needed to heal injured tissues, whether the injury is acute or chronic. TISSUE DEFORMATION (breaking scar tissue and lengthening shortened, THICKENED or "TETHERED" connective tissues) requires activation of the local inflammatory response (HERE) as well as activation of the cells that make COLLAGEN (these are known as FIBROBLASTS). It's why the longer you study the simple protocol I created for helping people reduce systemic inflammation (HERE), hopefully reducing their pain levels in the process, the more sense it makes. If you like what you're seeing be sure and like, share, or follow on FACEBOOK as it's a great way to reach the people you love and care about most.
A NEW GOVERNMENT STUDY SHOWS YOU'RE NOT ALONE
- Linked to restrictions in mobility and daily activities
- Linked to dependence on opioids
- Linked to anxiety and depression
- Linked to poor perceived health or reduced quality of life
- 50 million of U.S. adults have chronic pain
- 20 million U.S. adults have high-impact chronic pain (chronic pain that limited life or work activities on most days or every day during the past 6 months)
I could go on but the real question we need to answer is why? Easy. With sedentary people living on skittles, mountain dew, and fast food, it isn't tough to start realizing why Westernized nations are becoming increasingly SICK AND INFLAMED. What are you going to do about it? The first thing you need to realize is that despite having greater access to hi-tech healthcare than any point in our nation's history, national health continues its rapid decline. Just last week the new government stats on OBESITY showed that there are now 7 states with obesity rates over 35% and 30 with obesity rates of over 30%. I don't care who you are or what your political persuasion is, this trajectory is beyond unsustainable no matter who you think should pay for it (HERE). Unfortunately, our government doesn't understand this. Case in point....
"Chronic pain contributes to an estimated $560 billion each year in direct medical costs, lost productivity, and disability programs. The National Pain Strategy, which is the first national effort to transform how the population burden of pain is perceived, assessed, and treated, recognizes the need for better data to inform action and calls for estimates of chronic pain and high-impact chronic pain in the general population. This report helps fulfill this objective and provides data to inform policymakers, clinicians, and researchers focused on pain care and prevention."
Firstly, the over half a million dollars a year is grossly underestimated, and let me show you why. This year's Gross Domestic Product is going to be in the 20 trillion neighborhood. Writing for the Financial Times last November, Sam Flemming (White House Economists Warn of $500 Billion Cost of US Opioid Crisis) showed us that the OPIOID EPIDEMIC alone is costing that much ---- almost 3% of GDP. What's even whackier is that if you follow the link, you'll see that just like any number of other governmental health-related fiascos (the fat-phobic food pyramid comes immediately to mind), the government is directly responsible for this one as well.
Look folks, collecting more data, informing policy makers, having meetings, and creating reports is nothing more than busywork. And while it keeps the bureaucracy churning, unfortunately it doesn't really help anyone find relief. It doesn't really help people find solutions. It doesn't really help people break the chains of powerlessness that keep them anxious, depressed, humiliated, and lonely. The CDC talks about "PREVENTION," seemingly not realizing that study after study after study has shown it to be all but worthless in terms of the medical model. It's time you realize that if you truly want your life back, don't expect your doctor, your insurance company, YOUR EMPLOYER, OR ANYONE ELSE to help you out. It's on you --- you are going to have to do it yourself. While this might sound scary on the surface, let me show you why it's actually "EMPOWERING".
THIS SIMPLE PROTOCOL has something for everyone. And while it's not going to "cure" everyone (remember that ham is the only thing that's cured), reducing systemic inflammation is never a bad thing when it comes to addressing the factors related to chronic pain and chronic illness. Don't grow old regretting what your life could have been if you had done things differently. Sit down today and create a written blueprint for taking your life back --- an EXIT STRATEGY if you will. HERE are examples of what these look like. And if you know someone who desperately needs this information, a great way to reach them is by liking, sharing, or following on FACEBOOK --- excellent for reaching those you love and care about most.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration