Chronic Pain - The Adhesion/Scar Tissue Connection

davidsmallFrom the desk of David Moffitt B.ap.Sc(PT), M.C.P.A, C.Acup F.C.

A large number of patients that enter our clinic seem to be singing the same tune. "My medication causes stomach pain, I can't sleep, the sleeping medication has caused a massive weight gain, some days I feel my whole body hurts, and every doctor I see thinks I need to see a psychologist".
Recent research by Klein & Sobel suggests that indicate four out of ten patients who regularly consume anti-inflammatory medication will experience serious side effects. A recent study involving sleep deprivation of otherwise healthy military personnel revealed that within 1 week of the experiment the subjects were complaining of diffuse muscle and joint pain. At a recent WCB conference at the University of Alberta, a neurosurgeon pointed out that out of 2,000 x-rays on average only 1 would provide useful information. Considering the cost of a x-ray he suggested the cost effectiveness of medication in Canada poor, it is incumbent on all of us to be more involved in self-management and the return to more natural, less expensive forms of treatment.
One has to ask the question: What is the difference between a "normal" muscle injury and a chronic pain response? We first have to understand when any soft tissue (muscle, tendons, nerves, fascia, ligaments) are damaged, the body produces scar tissue (also referred to as adhesions or collagen). In the majority of the population this response will stabilize within four to eight weeks, depending on the severity of the injury. In many patients, especially those suffering from mixed connective tissue disorders (Raymaud's, Fibromyalgia, Epstein-Barr "mono", Chronic Fatigue, etc.) The scar response is amplified many times resulting in "keloid-type" scarring almost like cobwebs enveloping the muscles, nerves and joints of the affected areas. This myofascial- bramble or cob-web suffocates the normal blood flow and nutrition to the area. Consequently, the tissues start to "dry-out", and the lubrication between the different structures decreases. This results in "rubbing" of the tissues, producing even more scar tissue and adhesions. The patient complains of stiffness, tightness, diffuse-multiple pain and trigger points. Their sleep patterns deteriorate. Consequently the body's ability to produce pain-killing endorphins and cortisoids is decreased. The patients own ability to modulate and control their own pain is further compromised if the "adhesions" or cob-webs" restrict the normal function of the nerve to the muscle. This can lead to occult neuropathy of the segmental nerves that supply the affected muscle. The muscle will then start to degenerate. Cannon's Law of Physiology states that nerve damage to a muscle produces an increase sensitivity to pain - i.e. trigger point tenderness. The Chronic pain cycle has begun. We have been using a treatment protocol that involves a team approach utilizing the use of natural physical medicine and hands-on release of the physical myofascial adhesions and techniques that increase the blood flow to the structures. Herbal remedies to decrease pain and stimulate the auto-immune system (the herb pycnogenal is producing amazing results in stimulating the auto-immune system together with improving energy reserves). Acupuncture to balance the body's response to the damage, pain management to deal with the inappropriate coping mechanisms. A nutritional consultant to advise the patients on how to improve eating habits and thereby increase their metabolism to provide the fuel for muscle repair and energy. Also an active rehabilitation program, using a combination of specially designed equipment. The body must keep moving, otherwise it will degenerate.

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