Osteopathy Management of Pain Syndromes
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.
If we sprain an ankle the pain signals rush up the nerve towards the spinal cord and cross over onto the next relay of nerves up to the brain. This next relay of nerves is made highly sensitive by the incoming pain and they start to react more and more strongly to the incoming barrage, amplifying the pain we experience in our mind. This will settle down as the injury heals and the system resets to normal, however this does not always occur or a pain can start without any incoming tissue pain at all. This is a pain syndrome, a collection of painful and other symptoms which do not appear to have an underlying pathology.
Typical pain syndromes are complex regional pain syndrome (CRPS), chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). CRPS occurs after minor or moderate injury to a limb such as the ankle or wrist and the underlying reasons are not well understood. In the wrist the person may be in plaster for a few weeks for a minor fracture or sprain but complains of high levels of pain and has difficulty keeping the fingers moving. The fingers are stiff and swollen and moving them elicits significant pain, at which stage immobilisation is removed if possible to allow rehabilitation.
Chronic widespread pain occurs, as the title implies, all over the body, with multiple trigger points in muscle bellies. Trigger points are areas of acute sensitivity to pressure which occur in specific places in muscles and can refer pain away from those sites causing a persistent pain condition. Osteopaths treat trigger point pain with acupuncture, acupressure, stretches and positional advice. Fibromyalgia syndrome occurs mostly in women, and consists of widespread pain, fatigue, hypersensitivity to pressure, poor sleep, feeling unrestored in the morning, brain fog, IBS, reduced physical ability and pain unpredictability.
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.
It is vital that the clinical psychologist teaches FMS sufferers psychological strategies to help them manage the condition and make their wishes clear. Pain management programmes address developing realistic thinking, positive coping strategies, assertive communication, acceptance of the condition, mindfulness, pacing activity and meeting others in the same boat to reduce the feeling of isolation. Sufferers typically communicate with their relatives and others in very passive ways, leading to conflict, anger and resentment as they do not make their needs clear. Realistic thinking addresses the understandable bias towards thinking negatively due to a longstanding pain condition.
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.
If we sprain an ankle the pain signals rush up the nerve towards the spinal cord and cross over onto the next relay of nerves up to the brain. This next relay of nerves is made highly sensitive by the incoming pain and they start to react more and more strongly to the incoming barrage, amplifying the pain we experience in our mind. This will settle down as the injury heals and the system resets to normal, however this does not always occur or a pain can start without any incoming tissue pain at all. This is a pain syndrome, a collection of painful and other symptoms which do not appear to have an underlying pathology.
Typical pain syndromes are complex regional pain syndrome (CRPS), chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). CRPS occurs after minor or moderate injury to a limb such as the ankle or wrist and the underlying reasons are not well understood. In the wrist the person may be in plaster for a few weeks for a minor fracture or sprain but complains of high levels of pain and has difficulty keeping the fingers moving. The fingers are stiff and swollen and moving them elicits significant pain, at which stage immobilisation is removed if possible to allow rehabilitation.
Chronic widespread pain occurs, as the title implies, all over the body, with multiple trigger points in muscle bellies. Trigger points are areas of acute sensitivity to pressure which occur in specific places in muscles and can refer pain away from those sites causing a persistent pain condition. Osteopaths treat trigger point pain with acupuncture, acupressure, stretches and positional advice. Fibromyalgia syndrome occurs mostly in women, and consists of widespread pain, fatigue, hypersensitivity to pressure, poor sleep, feeling unrestored in the morning, brain fog, IBS, reduced physical ability and pain unpredictability.
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.
It is vital that the clinical psychologist teaches FMS sufferers psychological strategies to help them manage the condition and make their wishes clear. Pain management programmes address developing realistic thinking, positive coping strategies, assertive communication, acceptance of the condition, mindfulness, pacing activity and meeting others in the same boat to reduce the feeling of isolation. Sufferers typically communicate with their relatives and others in very passive ways, leading to conflict, anger and resentment as they do not make their needs clear. Realistic thinking addresses the understandable bias towards thinking negatively due to a longstanding pain condition.
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.
About the Author:
Andrew Mitchell, editor of the Osteopath Network, writes articles about physiotherapists in Harpenden, back pain, neck pain, injury management. Andrew is interested in many aspects of alternative medicine.