Friday, August 30, 2013

Persistent Pain (Part 1)

Persistent pain is complicated 

New patients usually come to me after everything else failed to help them.  Massage therapy, neuromuscular therapy, manual therapy, basically any of the things that I do, are not chosen as the first line of defense.  This should come as a surprise to no one, human beings want a quick solution to even the most complex problem, and manual/massage therapy is far from simple.  Nothing I do is as easy as taking a pill, popping a joint, or getting poked with a needle, therefore at least one of these things will likely precede me.  So I'd like to take some time to talk about everything else; the stuff people do to address their pain other than massage therapy.

Is it dangerous? Does it mean something?

When a pain starts, let's say you wake up with a sore ankle, what is the first thing you do?  Attempt to ignore it, walk it off, maybe do some stretching, and if any of these things work, the problem ceases to get any attention.  This is important because it illustrates the usefulness of pain.  Your body says to your brain, "Hey, there is something going on in the ankle, you may want to check on it."  Your brain responds by directing conscious attention to the problem and applying basic solutions:

False Alarm? "Ignore it, if it's legitimate this won't help."
Positional or Muscle Energy Issue? "Walk it off, if it's serious or dangerous this won't help."
Tissue Tension Issue? "Stretch it out, if this doesn't help, try something else."

Something Else: You have an acetaminophen deficiency.

Now, you've exhausted your simplest solutions, and for some reason the pain hasn't gone away.  Maybe it has been a day or a week, maybe two, and you are beginning to worry about it,  so you try more complex problem solving.  Over the counter medicines, aspirin and acetaminophen, maybe ibuprofen or naproxen.  With the exception of acetaminophen, if you have an inflammation issue, these medicines will take the edge off.  By altering the chemical milieu in the body you effective turn down the volume on pain.  At this point, you are supposed to heal from whatever damage is causing the discomfort, and with the aid of the meds, that wait should be more tolerable.

Side Note: Tylenol may also help with mental anguish - or with watching David Lynch films.

What about Ice or Heat?  What about Ice and Heat?

The Intolerable Wait: Bargaining with an unreasonable body.

More time passes, countermeasures are becoming less effective as you become more conscious of all things ankle.  The medicine dosage has been increased to keep up with your tolerance level and the pain's persistence.  You start avoiding anything that makes the ankle hurt, including walking like a normal person.  People comment on your hobbling gait and it makes you even more conscious of the ankle.  This ankle has gone from a supporting role to a starring role in your life.  At this point, you want expert advise.

(Heads Up: Mildly explicit language warning on this video)

Standard medical doctors aren't great with mechanical pain.  They have a huge amount of competency and skill with internal medicine, but not-so-much when it comes to chronic or positional or muscular pain.  Here is a very thoughtful post about dealing with chronic pain from a doctor's perspective.  If you don't get referred out to a physical therapist or an orthopedist, you are likely to get more over-the-counter meds or in some cases, prescription pain meds and/or muscle relaxers.

At this point, the pain could become suffering if you don't find some way to cope with it.  In the next blog, I'll talk about the alternative medicine route, and its various advantages and drawbacks.

Tuesday, August 6, 2013

TED Talks For You, Understand Pain Better (Part 2)

For a massage therapist and massage patients, understanding pain is absolutely essential. Reading books and research papers is not for everyone, and that is what makes TED such a great concept. Here are some quick and interesting videos to help you get a better grasp on the often head-scratching reality of pain.

To understand pain, it helps to understand what is going on inside the brain.  Pain is first and foremost a brain state which can be altered by input from visual, psychological cues:

How one perceives their pain, and whether or not one feels in control of it is directly correlated to how much one suffers.  At the PNMT Colloquium, David Flueke spoke about psychosocial aspects of pain, one point he made was that pain feels threatening to quality of life, but when that pain begins to threaten ones identity it becomes suffering:

Past and present pain states are altered by memory and expectation. The amount of happiness and the intensity of pain that one experiences and remembers can change based on how we interpret and define the story around these experiences.

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