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