The source: Three Sources of Chronic Pain

• Possible structural problem
• Inflammation of soft tissues
• Neurophysiological Disorder – “short circuits”

The receptor—your brain

Three additional variables affect your perception of pain:

• Sensitization
• Memorization
• The “Modifiers” –1) anxiety 2) anger 3) sleep

Chronic pain is a complex problem and even more so, as each person is unique. It won’t respond to isolated simplistic treatments. The approach that is successful in solving pain is similar to that of fighting a forest fire.

“I Can Only Fix What I Can See”

These concepts apply to pain in any part of the body regardless of the source. I will discuss low back pain as one example. The exact source of your LBP is usually unclear.  Many assume if you are pursuing a diagnosis with your doctor then there must be an indentifiable problem that is solvable with surgery. Surgery is felt to be the “definitive” solution.

• It is only definitive if you can see the problem.
• Even then the potential benefits must outweigh the risks.
• I often compare spine surgery to dentistry. (Back Pain vs. Mouth Pain)

A high percent of spine surgery should never be performed.

• What many surgeons are defining as “structural” is simply normal aging anatomy.
• Degenerative disc disease is not a disease.
• All intervertebral discs lose water content with age.
• They have been shown not to be the source of your chronic LBP.
• A fusion for a degenerated disc has a success rate of < 30%.

Video: “Get it Right the First Time”

Surgical Results Overly Optimistic

Marsha’s Three Needless Spine Surgeries

The post Understand Chronic Pain first appeared on Back in Control.

The post Understand Chronic Pain appeared first on Back in Control.

Our brain has neurological circuits that can become memorized. In this video I discuss phantom pain, which is more the rule than the exception with amputations. This factor is a significant problem with any chronic pain situation.

The post Video: Memorizing the Circuits: Phantom Pain first appeared on Back in Control.

The post Video: Memorizing the Circuits: Phantom Pain appeared first on Back in Control.

Thoughts are also memorized and can become obsessive circuits. Unfortunately, the brain becomes more focused on negative thoughts because there is natural tendency to suppress them. Although you make think you are successfully conquering them, you are actually giving them more neurological attention.  “The surgeon screwed up my back.” “I can’t get out of bed.” “The pain is ruining my life.” These circuits can take on a life of their own, running on a constant loop. If left unchecked, they turn into a serious obstacle to recovery; one that’s not a psychological issue as much as it is a “programming” issue. You can develop tools to break the cycle of negative thinking, but first you have to conceptualize how the brain works.

The Talent Code

Dan Coyle wrote a book, The Talent Code, where he points out how genius is created. He also makes a nice connection to neuroscience research. There are three factors contributing to high-level learning: 1) Deep learning 2) obsessive repetition 3) Master coaching. The ideas is to engage in repetition of specific moves within a narrow range. I feel the same concepts apply to way the brain processes pain. Reading this book has been helpful for my patients to better conceptualize the formation of pain circuits. Motivated by The Talent Code

Phantom limb pain

Neurological connections associated with pain will often continue to function, even if the offending stimulus is removed. A classic example of this is “phantom limb” pain. It occurs in patients who require an amputation, usually because blood supply to the limb is compromised by vascular disease. Common causes are diabetes or atherosclerosis, when there is not enough blood to sustain viability to the limb. Prior to the amputation, lack of oxygen causes the limb to become very painful. After the limb is removed, up to 60% of patients feel the pain as though the limb were still there.  Almost 40% of sufferers characterize the pain as anywhere from distressing to even more severe than before. (4)

There is not a more definitive operation than removing the entire source of the pain by performing an amputation. The nervous system does not even know the leg is gone, and it still feels the same sensations and pain. From those of us who have the visual experience of performing these amputations, this is a dramatic example of the power of the nervous system. It is also a reminder that the brain also is an extremely complex sophisticated computer, which is programmable. To “de-program,” it takes much more than will power.

Body image disorder

Another example of a situation where a stimulus was removed, but the brain couldn’t be “de-programmed,” was a major reconstructive spine surgery that I performed in my third year of practice. Brad, the patient, was a 27 year-old athletic banker who had a moderate “hunchback” deformity called kyphosis. He was experiencing a lot of pain in middle of his back associated with it.  The deformity was about an 80- degree forward curve (the highest normal value is around 55 degrees).  I was hesitant to perform surgery, as it is a major five to six hour procedure with significant risks.  The surgery went well, however, and his curve was reduced to 50 degrees.  Post-surgery, it became clear that his body image had been his major issue, and it didn’t change at all nor did his pain.

There are many examples of negativity. However, the point is that once the nervous system becomes fixated on one specific negative thought pattern, it is not going to stop on its own. It’s possible to break the circuit but it takes very specific techniques.

Video: Standard Stress Skills Inadequate

The post 3 – Memorization of Neurological Circuits first appeared on Back in Control.

The post 3 – Memorization of Neurological Circuits appeared first on Back in Control.