Saturday, 20 February 2016

The Pain Management Prism

Let’s take a look at the goal of pain management. It’s a pretty good goal. We’re betting that this goal would resonate with a lot of readers, either for yourself, for a loved one or for a client. But how is it achieved? The more we learn, the more we see that pain management really can be divided into a few inter-wound, but different paths.


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Let’s use the image of a prism to explain how the different aspects of pain management work together. As you see in the image above, when a beam of light hits a prism, the light is separated into a rainbow of colours. For the purposes of this post, let’s think of pain management as that beam of light. Then we can divide it into several components to examine how they connect with each other to achieve one cohesive goal. 

To begin with, let’s take a brief look at what components go into our experience of pain and how we can impact those components. To greatly oversimplify the process, first your body senses something (pressure, temperature, etc) and creates a message about it. Your nerves then transmit this message up to your brain. Your brain then combines this message with other information to come up with an interpretation of what is happening in the body. If your brain decides this is something you need to be aware of immediately, it lets you know through pain.


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How This Relates to Pain Management

The message creation: One aspect of pain management is to look at what is happening in the tissue. That is, focus on what is causing the sensory neurons to fire. For example, is there a broken bone, too much pressure, or damaged cartilage? Are the muscles tense or stiff? This may be the most common approach to pain management and is particularly beneficial in acute pain situations where there is an immediate problem in the tissue. Treatment involves techniques such as stretching, strengthening, realigning, using ice or heat, massage, and electrical stimulation.

The message transmission: Another aspect of pain management is to look at quieting or blocking the signals that your brain receives from the nerve cells in your body. The theory behind this is that if you can quiet the message, you can reduce or eliminate the pain. The nervous system is more complex than a simple messaging system. It modifies the messages sent to the brain, sometimes amplifying the message. This is problematic for us when it results in chronic pain, so some treatments try to dampen the message or cut it off completely. These treatment methods include nerve blocks and some pharmaceuticals.

When most people think of pain management, they focus on treatments that address these two mechanisms. However, there is a third mechanism that is also essential in addressing the complexity of chronic pain.

The message interpretation: The final aspect of pain management we’ll discuss in this post is how the brain interprets these signals. When your brain gets a signal that something is going on in the body it gathers all the information it can to make a decision about this signal. It looks at past experiences, what you know about that area, and other sensory information. Things like mood, fatigue, and a multitude of other factors impact how these sensations are interpreted.  The brain then makes a decision about the significance of the information. It decides whether an alarm is needed, and how loud the alarm will sound. We then experience this “alarm” as pain. 

Researchers have turned this concept around and speculated that if the threat value of these incoming signals could be lowered, then the volume on the alarm could be decreased. Therefore the pain could also be reduced (Moseley, 2007).  Some examples of treatments based on this concept include relaxation techniques (telling the brain that things are okay), visualization (telling your brain that you can complete the movement pain free), and graded exposure (learning that awful pain doesn’t happen with every movement). This is the aspect of pain management that we’ve focused on the most in our blog so far, because it’s an area that we find really exciting. It’s an area that’s relatively new and full of possibilities.

The entire spectrum works together

Just like white light is made up of a spectrum of colours, we believe that effective pain management is made up of a combination of treatment techniques. There is benefit to looking at tissue based mechanisms as well as brain based mechanisms, and everything in-between. All three components discussed in this post (creation, transmission, and interpretation) have an impact on the pain message and open up possibilities for intervention. This generates a whole range of tools that can be explored and new ways to potentially change and reduce pain. But more than simply reducing pain, this opens the door to improving functioning and quality of life for individuals with chronic pain. For us, this means there is always hope.


Acknowledgements:


Diagrams by Ashley and Colleen. Nervous system graphic and brain drawing from freepik.com


References:

Moseley, G.L. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews, Volume 12, 169-178.

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