How to approach our clients with chronic pain?
We are all clear about what a client with chronic pain is, by definition a client with chronic pain is a localised and subjective perception that can vary in intensity and is felt in one part of the body. It is the result of stimulation of the sensory nerve endings.
Pain is an unpleasant sensation that can manifest itself in different ways, which, depending on its intensity, can prevent the sufferer from carrying out daily activities.
Chronic pain is pain that persists or recurs for > 3 months, persists > 1 month after resolution of an acute tissue injury or accompanies a non-healing injury. Causes include chronic disorders (e.g., cancer, arthritis, diabetes, low back pain, digestive problems, heart problems), injuries (e.g., herniated disc, ligament sprain) and many primary pain disorders (e.g., neuropathic pain, fibromyalgia, chronic headache).
In principle we could think of these as diseases, disorders that have no link, but regardless of whether our client has a chronic problem of the muscular system such as chronic low back pain, fibromyalgia or Krohn’s disease, there is often an overlap, which we will discuss later.
We, as manual therapists, focus on the tissue, for example in case of chronic low back pain, we usually stretch, press, inhibit, relax the muscles, etc…,
But what is the point of this type of work if we want to offer a client with chronic pain to return to an independent and functional level of life?
Because it is not a tissue problem, the tissue, in general, in a few days regenerates, we see that in a sprain, after a few days of inflammation little by little this is removed, and functionality returns.
What happens when it becomes chronic?
I keep saying that it is not a primary problem of tissue, if that e sverdad, that the musculature, joint capsules will suffer, `but I repeat. No, it is not the origin, it is not the tissue that feeds the loop of inflammation or chronicity,
if we go back to the case of a sprain that tends to become chronic, and without going into, excuse me, a biochemistry class, there has been an acute inflammation before, where cytokines have increased, which, at first, is what is expected, because physiologically, inflammation appears as an activation of the immune system to protect the affected structure.
These mediators are small molecules consisting of lipids (prostaglandins, leukotrienes and thromboxane), modified amino acids (histamine, serotonin) and small proteins (cytokines, growth factors, interleukins…) which represent specific information destined to cells able to use this information thanks to the presence of specific receptors in their plasma membrane. Inflammatory mediators are of plasma origin (synthesised by the liver) or cellular origin.
The question is, why don’t these mediators return to normal blood levels?
There is a feeding loop that will irritate the peripheral nervous system, and these will generate a metabolic response that will feed the response and action loop, remember that the immune system is controlled by the sympathetic system, the sympathetic and parasympathetic systems are part of the autonomic nervous system.
And here is the key.
If you change the information coming from afferent pathways to the brain, the brain will give a different response,
Not only the autonomic nervous system pathways may be involved, but also, sometimes the humoral system may be involved in these situations, and here in chronic clients, manual therapy, manipulation, massage, will not help,
We have talked about the information coming up from important plexuses and nerves, like the information coming up from the splenic nerves, vagus nerve, sacral plexus or others, but there is also a system that escapes us, the descending inhibitory system, a system as a response to inhibit pain signals..,
Our professors teach us that from parts of the body, the sensors, nerves send signals of pain, today he has shown that he is false, be an alarm response, so that I spoken before to change the information that move up for these our nervous, also we have the possibility to work about the humoral system, for example estimating the chimiorreceptors of the aortic cayado, and the information that the read to the cerebro via the vagus nerve, the nucleus of the solitary tract or estimating the descending inhibitory system,
For all our work, sea in a fibromyalgia, in a chronic lumbargia, in a chronic strain etc must be focused on the thigh, no muscle, no physiology and the mechanisms that feed the chronic bulge.
Another important thing is that the neuroplastic changes that occur in different brain structures
as a result of chronic diseases were discovered, and with manual therapy it is not possible to
redirect these damages, therefore, if you want to do a professional treatment of chronic
patients and so on, , access a market of 25% of patients in Denmark with guarantees
of effectiveness, you should incorporate these new ideas in your daily work.
Do you want to learn how to treat different types of clients with chronic pain?
Nøglen til behandling af kroniske patienter med lændesmerter, gigt,
fordøjelsesproblemer, fibromyalgi er ikke at behandle muskelsystemet
eller leddet, men snarere nervesystemets mekanismer, der opretholder
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