Chronic Pain Case Study

Chronic Pain Case Study

In our past blog we defined chronic pain, what is actually happening in a body that is in pain, and discussed what tools we use here to assist recovery. Following on from this, we want to show you how all of that science translate to treatment in the real world – and how it may be of benefit to you!

Here is a case to illustrate the point.

Patient X came to see me in practice with chronic low back pain. He was 42 years old and said that he had trouble with his lower back on and off for 10 plus years. Tick number 1, this is a chronic pain case with the pain having been around for WAY MORE than 6 months.

As well as the back pain he also gets a burning/achey type numb pain down the right side of the body. Tick number 2, he finds it hard to localise where the pain is now and it appears to be vaguely described across a large area of the back.

What did we do?

An EMG assessment of the control and timing of her lower back muscles showed a significant asymmetry from right to left. Along with a weak core muscles and multiple spinal fixations we have tick number 3, a loss of control of the muscles that protect the back.

Patient X showed significant loss of mobility to varying degrees in all three spinal regions but most notably in thoracic (mid-back) extension and rotation and lumbar (low-back) flexion.

Computerised assessment of his balance systems showed a severely depressed balance score. This can be cause or effect but for the purposes of keeping this simple we just acknowledge that this will further affect the control of the muscles that protect the back and needs to change if we are going to get a long-term result that lasts.

Digital posture assessment showed obvious problems with forehead head posture and consequent low back hyper-extension. This was largely driven by an excessive rounding of the mid back and shoulders.

X-rays showed early changes of osteoarthritis at the L4/5 and L5/S1 segments of the low back.

He related that he had been seeing another therapist for treatment at a frequency of once per month and that this therapist didn’t know what else to do as they couldn’t figure out why he wasn’t responding to the treatment. This would be like taking antibiotics for pneumonia once per week instead of three time per day. Adjustments just like medication need to be delivered at the therapeutic dose required to resolve the problem at hand. As discussed previously, chronic pain is a brain-based problem and adjustments are delivered to effects neuroplastic changes neural pathways and areas of the brain we are trying to target.

So, here was the treatment plan:

  • 3 x Chiropractic corrective sessions per week for 6 weeks involving manipulation of dysfunctional spinal segments and soft tissue releases
  • 1 x shockwave session per week to target the chronic tissue changes that had occurred in spinal erector muscles
  • Home exercises to improve posture, mobility and control

Review

Patient X reported a significant reduction in the lower back pain by as much as 50%. The pain was now better localised (what we call “pain centralisation” and described as a dull ache around the base of the spine rather than the whole side of the right body. He could also relate the pain to spending too much time at a desk and could relieve it by having more breaks. In the past there was nothing he could do to relieve the pain. While he had not always been consistent with the exercises, he did also feel that the more he did them the better he felt.

Objective testing showed

  • Balance had improved from severely depressed to moderately reduced.
  • EMG no longer showed the problems with muscle imbalance by way to timing
  • Digital Posture review showed a 30% reduction in forward head posture and a 50% reduction in low back hyper-extension
  • Thoracic extension had improved 25% and rotation 30%

Discussion

So how patient X feels and what our testing says is that we are on the right path, albeit not there yet. While we have obviously not regenerated the degeneration that has occurred in his lower back, we have improved the way his brain perceives space and the body map that it creates. Through a combination of all the things we have done and most importantly the frequency with which it was delivered we are now seeing the signs of neuroplastic brain changes we are after to keep moving forwards.

From here on in we will now work to slowly decrease the treatment frequency and increase the exercise challenges given. Our long term prognosis would be that with proper execution of phases 2 and 3 of this program and continued exercise and lifestyle modifications related to sedentary work practices that we should continue to see further changes hopefully to the point that he is pain free and able to fall back to a monthly maintenance strategy over the longer term.

 

 

By Andrew Richards
Chiropractor
B.Med.Sc M.Chiro

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