Massage for Medically Complex People

How can patients and practitioners treat Chronic Pain?  My approach is to first try to understand what we are dealing with.  Chronic pain, by its very nature, is a slippery phenomenon.  Without a clear cause, there is no clear protocol to fit a client who comes in with pain that doesn’t go away and can even morph into pain in different areas, of different intensities, durations and onset.  Therefore, I am attempting a series of blogs to get clearer about how to deal with a problem that just won’t quit.

Chronic Pain is different from acute pain.  Acute pain has an obvious cause that heals and the pain goes away, while the onset of Chronic Pain usually cannot be traced to a single cause and the pain is not going away.  These two important distinctions set chronic pain apart and can invite anxiety, depression, difficulty sleeping, and a deep sense of seperation from a world that is not allowing the pain and its cause to heal.

First of all, let us distinguish some changes that happen to the nervous system in chronic pain.

• Sensations are more intense.  Nerve receptors are activated at a lower threshold. and more nerve receptors are recruited when a person has Chronic Pain.
• A stimulus that feels like pressure to an average person, feels like pain to someone with Chronic pain.  The nerve receptors called free nerve endings have the capacity to be stimulated by both pressure and pain stimuli. Even a light touch can be noxious to someone who is having a flare of chronic pain.
• A stimulus that feels like heat or cold to an average person, feels like pain to someone with Chronic pain. Nocioceptors (pain receptors) can learn to fire in response to less intense stimuli.. Nocioceptors called free nerve endings react to pain and also respond to temperature changes. But in chronic pain free nerve endings translate both temperature and pain stimuli as Pain.

Now let’s talk about positive feedback loops that speed up and accentuate the devastating effects of Pain.

• Pain -> Stress -> Pain.  When you are in pain, that leads to more stress. Perhaps you are stressed about the effects of the pain on your ability to perform your job, or maintain your relationships.  Increased stress and tension in the body sensitizes you to tighten up and feel more Pain.
• Pain -> Decreased Sleep -> Pain. When you are in pain, it is hard to get comfortable enough to sleep.  Sometimes when you finally get to sleep, the pain wakes you out of it.  Without sleep the body cannot rest and renew and pain gets worse.
• Pain -> Increased Depression and Anxiety -> Pain.  When I hurt and the pain won’t go away, it makes me anxious and depressed about my future.  I don’t see how I can have any control over making the pain go away and I dread or fear the resurgence of pain.  My increased depression and anxiety makes me susceptible to increased tension, which my body now has learned to interpret as Pain.

Why does Chronic pain seem to start out of the blue?
Adults rely on movement patterns that were learned long ago as toddlers.  These old ways of moving through life have gotten us where we are today. However, toddler movement patterns are probably not the most efficient ways to use an older body.  This may not surface as a problem for many years, but unfelt wear and tear accumulates.

Inefficient movement patterns  expend energy that does not translate into movement.  The excess energy that is not being used to move turns into heat and inflammation.  This irritation slowly wears down cushiony tissue, ligaments, and spinal discs in your body.  Eventually bones are left rubbing on bones.  When the tipping point is finally reached, a simple action can cause a nerve ending to be irritated and chronic pain begins.

So what can you do? 
The solutions I have learned to rely on involve re-learning how to move and feel more efficiently and pain-free. Sometimes entraining the body into ease needs to be demonstrated to the body passively, with bodywork, since the nervous system gets so confused that it cannot untangle what increases pain sensations and everything hurts.  At a certain point in a patient’s recovery, active movement can be taught (through mindful movement such as Qigong, yoga, MELT method, Yamuna balls, Feldenkrais, Trager, and other easy movements) to reinforce retraining the nervous system. Awareness of how what I do, think and experience affects my pain can also be incredibly helpful.

The best bodywork to retrain the nervous system involves some back and forth communication with the patient so that they know what makes them feel better, even a little and what makes the pain worse.  I especially like Myofascial bodywork for this reason.  I also like Lymphatic Detox and Craniosacral techniques because they address the inflammation and heightened sensitivity that results from Chronic Pain directly.  I will talk more about bodywork, active and awareness techniques and tackle how to cope with complicating factors of chronic pain in future blogs.  Stay tuned.  Meanwhile check out my services page to learn more about my Myofascial, Lymphatic and Craniosacral bodywork and Qigong active movement classes, introduced in this post.