Chronic Pain

Before you start treatment there is one very important distinction to make. There is big difference between the treatment of acute pain (short term, first time and one off) vs. chronic pain (long term and recurrent).

Given that your pain has now been present for more than 6 months and there may have been acute relapses during this time means that you fall into the chronic pain category. With that must come a different approach so that you get the best results possible.

Here are the facts:

  • People with chronic back pain (CBP) show structural brain changes. Studies have shown measurable losses of brain tissue in areas associated with body awareness, higher cognition and emotional decision making.
  • People with CBP also show functional brain changes making it difficult for them to actually localise where the pain is. We commonly here something like, “It just feels like a dull ache across my low back and into the top of my legs.”
  • Body control is also distorted. Studies have shown chronic back pain sufferers to lose control of the muscles that protect the back, making them even more susceptible to injury.
  • Studies have shown that CBP sufferers also feel pain to a range of normally non-painful stimuli such as touch, sound, smell and taste. This occurs through a process of sensitisation at multiple brain sites whereby neural circuits that process information such as pain become overactive.
  • People with CBP have altered brain chemistry. Given this, it is not surprising that with chronic pain one can have a feeling of simply “being down” or as severe as being clinically depressed. The levels of key neurotransmitters such as serotonin, noradrenaline and dopamine all have been shown to be affected in chronic pain sufferers. Even more interesting is that the evidence seems to suggest that CBP is what comes first and causes the chemical changes in the brain rather than the other way around.

So, what does this all mean for you as a chiropractic patient looking for a solution to your problem?

Firstly, chronic pain is not just a posture, joint or muscle problem, it is also a brain problem.

This means that the priority for the successful treatment of your injury lies in our ability stimulate better brain function. Our focus must be upon the re-organisation of the way your brain perceives where your body is in space, as well as where your brain perceives the pain to be. This takes a global approach not just a focus on where you think the pain is. Chronic spinal injury no matter where, is the result of a global positioning problem and this means all your joints need to be working properly. Unfortunately, this is why many people fail to respond to treatments that are focused solely upon the injured area.

Secondly, because we are dealing with neuroplastic changes that have occurred in the brain, as well as the original stress to the tissues concerned your persistence is the key. In many cases it can take many months of work both in the clinic and at home for the brain based changes to take place and the benefits to become obvious. Short term expectations only lead to frustration and disappointment.

Finally, frequency is everything. When the focus is upon normalising brain function, chiropractic adjustments along with supportive exercises need to be repeated at very specific time frames. Corrective adjustments that stimulate neural pathways of joint positioning and pain perception may need to be performed as often as 3-4 times per week in the early months. Failure to get this right is going to give you the same result as taking the right medicine at the wrong dose – no change.

So, now more than ever as we embark on this process together you will need to stay focused and committed to the goals you have set. It will take time and commitment but the result is always worth it.

By Andrew Richards
B.Med.Sc M.Chiro

  1. Apkarian AV, Sosa Y, Sonty S, Levy RM, Harden RN, Parrish TB, Gitelman DR. Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density. J Neurosci 2004. 24 (46) 10410-5
  2. Wand et al. Cortical changes in chronic low back pain: Current state of the art and implications for clinical practice. Manual Therapy (2010)
  3. Frederick R. Carrick Changes in brain function after manipulation of the cervical spine: Journal of Manipulative & Physiological Therapeutics 1997; 20(8) 529-545