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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 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 it's 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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