In a recent article, Chronic Pain Fuels Boom in Opioids, the issue of opioid use for pain has sky-rocketed. It’s an interesting and VERY relevant topic; and it’s not just about people taking these medication illegally. Addiction to opioid pain medication is just as much an issue in those who get their medications legally as in those who get them on the black market. Feel free to read the article, it really is a great read on the topic; I am not going to write about these issues. What I want to write about is, what happens when we over-treat pain and how could it potentially create a reward system in which we are conditioning ourselves to be in pain.
Let me explain, I’ll use opioid medication as an example. Most opioids work by connecting with receptors in the brain to simulate or release chemicals that reduce pain, often, these chemicals “reward” s for their efforts. What does this mean?
This reward system produces a scenario where we tend to be attracted to the stimulus (cause) of the reward; in this case, a squirt of dopamine. This means that we are literally rewarding ourselves for being in pain. Does this occur naturally….. yes, but not to the extent that opioids do it.
How does this translate to everything else we do for pain? Possibly the same way! I know, you’re reading this thinking, “…are you saying that I shouldn’t get chiropractic care, massage therapy, myofascial work, dry needling, acupuncture, and other treatments for pain? Are you telling me that taking anti-inflammatory medications and natural products, stretching, soaking in a hot tub and other things I can do to relieve pain are bad?”
Well, no, that’s not what I am saying. What I am saying is that maybe we have created a scenario where, by paying attention to every ache and pain and giving ourselves rewards (in the form of nice and/or therapeutic treatments) for that ache and/or pain, we have created MORE pain. We may be literally producing pain in our nervous systems at a level that’s higher than needed. This is pure clinical speculation but here’s an interesting observation; the incidence of painful conditions has risen site a bit over the last 20 years, especially in the last 10. Is this because there is a lack or deficiency in treatments to alleviate pain? No, on the contrary, there are more.
How Much Pain is OK? How much is too much?
- Is below an intensity of about 4 on a 0-10 scale
- Disappears shortly after beginning activity
- This would imply that movement is good for it, this is great.
- The morning pain should be mild, if it’s more, you need to see a doctor about it
What is pain?
Pain is an interpretation of a signal by our brain. Under normal conditions, it often tells us that there is the potential for damage of a tissue or tissues. This is not ALWAYS the case though; our brains can interpret non-damaging signals as pain and it often does. This is one of the most promising theories about the cause of chronic pain…. that our central nervous systems are creating pain when it shouldn’t.
In conclusion, pain, like any other signal in the body is just that, a signal, but that signal may be going off for the wrong reason. It is my heart-felt opinion that we need to connect to our bodies better so that we can know when a certain pain is normal and not a signal that we are damaging anything versus when a certain pain is a signal that we need help.
I will be addressing this topic in future posts and will be talking about movements and movement patterns you can do to determine if pain you are feeling is a normal part of being active or if it is a sign that it’s going to cause long-term issues with movement and possibly be a sign that certain tissues are being damaged.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Well, just a short post about an article by Leon Chaitow entitled: Breathing Pattern Disorders and Lumbopelvic pain and Dysfunction: An Update.
Those of you who have seen me in my Portland Oregon Chiropractic and Functional Movement Clinic, Optimum Function, or at my NCNM teaching clinic shift, may have wondered why I recommended breathing exercises as the first line of low back pain treatments; well, Dr. Chaitow will help explain it in his article.
Enjoy….. and take a few deep, belly-breaths today to honor your core and exercise your diaphragm.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
As a Chiropractor and educator in Portland, Oregon, I see patients with pain of all types and intensities; I also lecture on myofascial pain and mechanical pain (low back, shoulder, neck, etc.). A subject that recently came up with both my students, interns and colleagues is, how much pain is OK?
Can you answer this? How about your medical doctor, naturopath, chiropractor, physical therapist? I was playing devil’s advocate with some interns in my teaching shift at NCNM and I asked them,
“Should we be treating every little ache and pain our patients have and if so, is this teaching them to be hypersensitive?”
In addition, what impact does this have on their pain coping mechanisms, both internal and external? I believe it gives the message that any and all pain is bad and makes patients much more likely to overuse pain medications. There has been some speculation amongst researchers and clinicians (doctors and therapists) alike that we are conditioning ourselves to be in pain. By taking pain medication and other remedies every time we feel, even the slightest pain, we may be conditioning our nervous system to SENSE PAIN ALL THE TIME.
Now most know that in my Portland chiropractic, nutrition, myofascial therapies and functional movement clinic, Optimum Function, I often treat patients to improve function instead of treating pain. The simple fact is, we have to help patients with their pain because often, that is why they are coming in; the unanswered question is, how much is OK?
I have been training in Brazilian Jiu Jitsu (BJJ) in Portland at Straight Blast Gym for almost a year now and recently, been training harder . We have some fighters going to the worlds at the end of this month and our competition team has been going at it in practice. This past Friday, my back just couldn’t take the pace and today, it’s hard for me to move around, in fact, writing this is painful as sitting seems to be the offending position. Is this OK? Well, in my opinion, it is…. let me explain.
I overdid it, I kept playing in people’s guards and they kept trying to break down my posture, the is the game of BJJ. I should have known better, my back has been feeling tired after practices for 2 weeks, I should have modified my game. Now I am in pain, I didn’t damage anything, just some minor strains and sprains but in an area that is fairly crucial to functional movement and one that is affected by just about any position I put myself in. I have no doubt, that in 2-3 days, I will be back to 100%
Why am I writing this? Because I am planning on doing a more in-depth article series on the topic and will use this information to help educate my patients and students on this topic so we don’t over focus on normal, physiologically-beneficial pain.
Stay Tuned…. feel free to leave a comment, maybe I’ll use it in the articles to come on this topic.Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
OK, many of you know that I have been involved in the efforts to allow chiropractors to perform dry needling (especially if you are a patient). This spring, the Oregon Board of Chiropractic Examiners (OBCE) ruled in our favor, allowing chiropractors to use this technique in the treatment of myofascial trigger points. What is dry needling? I’ll get to that in a bit….
Chiropractors in Oregon and the rest of the world, have been treating myofascial trigger points and myofascial pain since we became a profession. The big issue here is that many of us want as many tools to treat these issues as possible; this is where using small gauge, solid filament needles comes into play. Currently, there are a number of states that allow chiropractors to use this tool in the treatment of their patients with myofascial problems; I have chiropractic colleagues in Colorado who use dry needling to treat their patients and have communicated with chiropractors in other states that allow dry needling about how effective it is in treating myofascial trigger and tender points. I was first introduced to dry needling while I was working as a massage therapist in an osteopath’s office in Colorado. I observed hundreds of patients receive this treatment and the osteopath I worked with was great with regards to teaching me what and why he was performing it.
Dry needling involves placing a very thin, single use, disposable, sterile, solid filament needle (not hollow) with clean needle technique into a myofascial trigger point and/or tender point. The number of needles used during any individual visit and the number of visits you are given this treatment depends on many factors that differ from patient to patient. These points are detected an number of different ways. As chiropractors, we have been assessing myofascial dysfunction and treating it with various techniques, like:
- Chiropractic adjusting
- Manual trigger point therapy
- Pin and stretch techniques
- Physiotherapy modalities like electric stim and cold laser
- Active rehab and myofascial release
- Instrument-assisted soft tissue therapies
We fully understand why and how myofascial problems arise; aberrant biomechanical processes, joint dysfunction, injury and repetitive stress are all avenues to developing myofascial pathologies and chiropractors are aptly trained and qualified to both detect, diagnose and treat these pathologies. Using dry needling is yet another tool with which we treat these issues; in my experience observing, performing and having dry needling performed on me, I can say that it is often more efficient, just as effective and less painful than the other therapies listed. This is why I have been fighting for the inclusion of this technique into my scope of practice since I was still a chiropractic student.
What’s the problem? Well, the acupuncture community in Oregon have been duped into thinking that this ruling means chiropractors will be stealing patients from them and it would hurt the profession. This is just not the case, in most of the states where chiropractors are allowed to perform dry needling, acupuncture, as a profession, is doing just fine and has been growing at rates that are as good, if not better than in those states where chiropractors can’t perform dry needling. Having a chiropractic clinic in SE Portland and a teaching shift at the NCNM clinic in SW Portland, I refer patients for acupuncture all the time when it is appropriate; I have even referred my patients for acupuncture for myofascial issues. When I give these types of referrals, I have often been very disappointed in that the acupuncturist sometimes ignores needling the injured tissue and treats the patient more constitutionally, needling distant acupuncture points. This is the beauty of acupuncture, it is a healing modality at the foundation of Oriental medicine that works wonders with patients on many levels. Dry needling is an incredibly superficial technique compared to the broad scope of acupuncture and is only used to treat myofascial pathologies.
Last week, the OBCE approved me to utilize dry needling in my practice and I did, on many patient suffering from myofascial pathologies, the results were profound and now this week, because the Oregon Association of Acupuncture and Oriental Medicine filed an injunction, I cannot continue to use this technique to benefit my patients. Will I send these patients to an acupuncturist? No, there’s no need, I have other treatments that will work just as well as dry needling but may take longer and cause a bit more discomfort. Would these patient have gone to see an acupuncturist for their problem to begin with? No, they came to see me because it is more appropriate for them to do so, for this specific issue.
It’s really quite silly, as a chiropractor, I often perform high velocity, low amplitude thrusts to joints that need to have movement restored. The reason chiropractors do this is to help restore balance in the body so our innate healing properties can flourish. Does this mean chiropractors “own” this technique? No, there are other providers that use the same high velocity, low amplitude thrusts to joints; usually, these other providers are using this tool for slightly different reasons and what they are doing is not inherently chiropractic. Acupuncturists use solid filament needles to perform their craft; as a chiropractor, I would use the same needles to treat myofascial trigger and tender points; does this mean I would be performing acupuncture? Absolutely not, in fact, to imply this is a slap in the face to acupuncturists and Oriental medical practitioners just as saying a physical therapist who performs joint mobilizations is performing chiropractic. Both are using similar s tools for VERY different reasons!
What Oregon has is an opportunity to create dry needling verbiage in the Oregon rules and regulations that actually protects the scope and right of acupuncturists. there are states (I am not going to name them), who allow chiropractors to perform “chiropractic acupuncture” and “biomedical acupuncture”; these are unprofessional, inappropriate terms that disrespect the ancient art that is acupuncture. Oregon can be the first state to clearly define dry needling as completely separate from acupuncture just as joint mobilizations and manipulations performed by non-chiropractic providers are completely separate from the art of chiropractic.
I needed to replace the memory in a laptop computer today and getting to it with traditional tools seemed impossible without damaging the computer. I was able to use a couple of bicycle-specific tools to do the job effectively, efficiently, and without undue damage to the computer. Was I performing bicycle mechanics to my computer? No, that’s obvious, I was just using another tool for the job, a tool that performed better than the more traditional tools in my toolbox.
The acupuncture association in Oregon is now going to spend $30,000 to fight this and, in the end, chiropractors will likely be able to perform dry needling in Oregon; what a waste of money! In addition, I am also concerned that this move may create a false sense of extreme competition between chiropractor and acupuncturists and erode any collaborative efforts our two professions may put forth to bring more complementary medical treatments to Oregonians.
OK, rant over, I needed to get that off my chest. I hope this is over soon so I can use whatever tool necessary toYours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health