MUSCULOSKELETAL PAIN
Movement
of our skeletal system of
bones requires muscles and
their attachments, ligaments
and tendons. Injury to some
of the 696 muscles of our body (mostly
in pairs) is a commonly occurring
event. Most often pain occurs
in the muscles of the low
back, neck, shoulder and hip regions.
Sprain is the most common
injury.
Dr. Janet Travell has described
in great detail the disorders
and treatments of the musculoskeletal
system including myofascial/fibromylagic
conditions. When muscles
are strained and then sprained
usually a small rupture of
muscle cells occurs which
then leads to a protective
inflammatory response which
is interpreted as pain. If
not severe this often heals
in one to two weeks on average.
During the healing process
a taut band of muscle tissue
forms in the injured area.
This taut band is known as
an "active trigger
point". When severe it may
lead to activation or "sensitization" of
the dorsal horn of the spinal
cord which in turn overly "interprets" incoming
signals (magnifies) from
the muscle creating more
muscle tension with resulting
pain. In a normal healing
process, the sprained muscle
heals, the active trigger
point goes away and there
are no residual problems
or chronic muscle pain. If,
following the injury and
healing a taut band of muscle
tissue remains (reasons as
yet unknown) then a "latent
trigger point" is believed
to form leaving that muscle
more subject to future injury
and pain.
A critical area
of pain and pain management
research is in the region
of the dorsal horn because
muscle pain and all other
pain signals outside the
brain and spinal cord converge
on this region. Melzack and
Wall (1965) proposed a mechanism
in the dorsal horn which
gates (magnifies or shrinks)
all incoming signals. This "gate
control theory" explains
that incoming signals from
a muscle can sensitize and
open the gate to more pain
while the brain can send
downward signals to do the
same thing thus creating
a massive pain response often
viewed by the doctor as far
beyond the scope of the injury.
Equally, the brain can "desensitize" or
reduce the inflow of pain
signals at the level of the
dorsal horn thus reducing
the overall pain experience.
It is believed that the state
of thinking and feeling within
the brain exerts a downward
effect on the dorsal horn
to increase or decrease its
sensitization. This suggests
that our positive and negative
thought patterns and our
positive and negative emotional
patterns can play a significant
role in the severity of our
pain experience not to mention
our tendency to suffer in
pain. Reducing stress and
learning that "hurt is not
harm" when
it comes to chronic pain
are useful techniques.
Most musculoskeletal pain
problems benefit from a combination
of treatments which are aimed
at both physical rehabilitation
and healing of the acute
sprain. When muscle pain
is chronic it may benefit
from a combination of physical
as well as cognitive-emotional
treatments aimed at reducing
dorsal horn sensitization.
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