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Break the Pain Cycle

Did you know that pain is created in your brain to let you know that something is not OK in your body?1 When this happens, it’s actually a good thing, because it tells you to stop doing some things that are potentially dangerous or harmful. Feeling pain, in this situation, is actually helpful and informative.   If we listen to our bodies, these pain experiences are a good thing.

But for some people, pain can become a real problem, because sometimes pain can persist even after an initial injury has healed.2 When this happens, we call it chronic pain. This is when the pain has become non-informative and non-helpful and the pain itself has become a problem. When you have chronic pain, your brain has learned to be in pain and you have entered a nasty pain cycle.

 

The way your brain does this is very similar to the way your brain learns anything else. It’s called neural plasticity – or brain adaptations. The great thing is that there are lots of ways to break your pain cycle. Staying positive, or eating well, or sleeping well and staying active can all be great places to start.3-5 Even as little as a short walk every day can help.6

If there are movements you cannot do because of your pain, you can still help yourself by just imagining doing those movements. We know from neuroscience research that imagining a movement influences your brain in a very similar way to actually doing the movement. This can help to retrain your brain to understand that these movements are not dangerous – because imagining doing the movement will not hurt. You can basically trick your brain into giving you back pain-free movement.

Brain scientists who have studied the effects of chiropractic spinal adjustments have discovered that adjustments may also change the way your brain gets into a pain cycle.7 This may occur because it’s well known now that chiropractic adjustments have a neuralplastic effect on the brain,8 meaning chiropractic adjustments of your spine change the way your brain adapts and processes sensory and movement information. In particular, chiropractic adjustments change the function in a part of your brain called the pre-frontal cortex.9and the pre-frontal cortex is actually the part of your brain that is very involved in how we end up in this vicious chronic pain cycle.10

To study how chiropractic care may impact on the development of these pain cycles, scientists studied brain activity in people doing what is called a cold-pressor test. This involves measuring brain function, through EEG recordings or electroencephalography, and they recorded this at rest and then when the participant’s hands were immersed in icy cold water. As you might expect, the cold-pressor test isn’t very pleasant and can be quite painful. The participants then either received a single session of chiropractic care or a control intervention and then they did the cold-pressor test again while their brain activity was recorded.

What the scientists found was that after the inactive control intervention the participants brains activity decreased when they repeated the cold pressor test, but there were no changes in the brain activity during the cold pressor test after the chiropractic spinal adjustment session. What this means is that the participants showed pain habituation happening  after the sham intervention, which is expected, and means that they’re getting used to the pain. However, after the adjustments session by the chiropractors, no habituation occurred. The scientists think that this may mean that chiropractic care plays a role in preventing the brain adaptations that occur as pain becomes chronic.  In other words, chiropractic care may ‘reset’ the way the brain processes pain information so that it does not learn to be in chronic pain.

This may be why chiropractic care has been shown, in research studies, to help people who suffer with neck pain,11-13 back pain,14 15 and certain types of headaches.16 It could be that chiropractic care helps their brains to adapt better and break the cycle of pain that they’re in.

So, if you suffer with chronic pain, do your best to stay positive, move often, eat well, sleep well, and go see your family chiropractor. Remember it’s never too late to beak your pain cycle.

References

  1. Swieboda P, Filip R, Prystupa A, et al. Assessment of pain: types, mechanism and treatment. Annals of agricultural and environmental medicine : AAEM 2013;Spec no. 1:2-7. [published Online First: 2014/07/09]
  2. Curatolo M, Arendt-Nielsen L, Petersen-Felix S. Central Hypersensitivity in Chronic Pain: Mechanisms and Clinical Implications. Physical Medicine and Rehabilitation Clinics of North America 2006;17(2):287-302. doi: 10.1016/j.pmr.2005.12.010
  3. Manchikanti L, Singh V, Kaye AD, et al. Lessons for Better Pain Management in the Future: Learning from the Past. Pain and therapy 2020 doi: 10.1007/s40122-020-00170-8 [published Online First: 2020/05/16]
  4. Genova A, Dix O, Thakur M, et al. Chronic Non-cancer Pain Management and Addiction: A Review. Cureus 2020;12(2):e6963-e63. doi: 10.7759/cureus.6963
  5. Elma Ö, Yilmaz ST, Deliens T, et al. Chronic Musculoskeletal Pain and Nutrition: Where Are We and Where Are We Heading? Pm r 2020 doi: 10.1002/pmrj.12346 [published Online First: 2020/02/23]
  6. Suh JH, Kim H, Jung GP, et al. The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine 2019;98(26):e16173. doi: 10.1097/md.0000000000016173 [published Online First: 2019/07/03]
  7. Navid MS, Lelic D, Niazi IK, et al. The effects of chiropractic spinal manipulation on central processing of tonic pain – a pilot study using standardized low-resolution brain electromagnetic tomography (sLORETA). Sci Rep 2019;9(1):6925. doi: 10.1038/s41598-019-42984-3 [published Online First: 2019/05/08]
  8. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyogr Kinesiol 2012;22(5):768-76. doi: 10.1016/j.jelekin.2012.02.012 [published Online First: 2012/04/10]
  9. Lelic D, Niazi IK, Holt K, et al. Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study. Neural plasticity 2016;2016:3704964. doi: 10.1155/2016/3704964
  10. Seminowicz DA, Moayedi M. The Dorsolateral Prefrontal Cortex in Acute and Chronic Pain. The journal of pain : official journal of the American Pain Society 2017;18(9):1027-35. doi: 10.1016/j.jpain.2017.03.008 [published Online First: 2017/04/13]
  11. Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev 2015(9):Cd004249. doi: 10.1002/14651858.CD004249.pub4 [published Online First: 2015/09/24]
  12. Gross A, Miller J, D’Sylva J, et al. Manipulation or mobilisation for neck pain: a Cochrane Review. Man Ther 2010;15(4):315-33. doi: 10.1016/j.math.2010.04.002 [published Online First: 2010/06/01]
  13. Bryans R, Decina P, Descarreaux M, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther 2014;37(1):42-63. doi: 10.1016/j.jmpt.2013.08.010 [published Online First: 2013/11/23]
  14. Goertz CM, Pohlman KA, Vining RD, et al. Patient-centered outcomes of high-velocity, low-amplitude spinal manipulation for low back pain: a systematic review. J Electromyogr Kinesiol 2012;22(5):670-91. doi: 10.1016/j.jelekin.2012.03.006 [published Online First: 2012/04/27]
  15. Ruddock JK, Sallis H, Ness A, et al. Spinal Manipulation Vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-analysis. J Chiropr Med 2016;15(3):165-83. doi: 10.1016/j.jcm.2016.04.014 [published Online First: 2016/09/24]
  16. Bryans R, Descarreaux M, Duranleau M, et al. Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 2011;34(5):274-89. doi: 10.1016/j.jmpt.2011.04.008 [published Online First: 2011/06/07]
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