Chronic Pain

We slowly let negative stressful world bombard our protection system causing an imbalance in our anxiety system. Over years, we make bad health choices reducing our ability heal. We incur trauma upon trauma that does not completely heal due poor sleep and lack cardiovascular conditioning. We set stage for chronic pain.

When allowing deterioration health habits, we also accumulate years of damage without proper healing. As we over contract our muscle groups in neck and jaw areas, we get to enjoy the frequent muscle joint pain and gradual overstimulation and damage the pain reporting system. At some point the pain escalates in intensity, frequency, and duration to overload the strong woman of today or great dragon slayer.

Chronic pain sounds so final, so hopeless, so out control. And yes, if you don’t take back control, as soon as possible, you will become a “victim” of chronic pain. In fact, the only chance of reducing chronic pain is to make a passionate attempt to remove all sources of the pain, reverse poor health habits, implement tools to countermove the anxiety system, and promote healing from any traumas-events-falls-blows-MVA’s.

The true danger of long term chronic pain is the anxiety system coupling with the pain system to escalate the pain unbearable level. The many different pains manipulate your physiological, biochemical, and mechanical changes to pain reporting system, that become harder to reverse over time.

Set aside the confusion, 1) acute verses chronic pain, 2) world’s brain washing "fast-quick-cheap", 3) distractions of career-social-family-children- wants; so that you can focus on getting better-out pain-healthier-happier. You are destined to keep your pain for rest of your life unless you get passionate-focused-determined.

Differences acute vs chronic

Chronic pain is frequent-continuous-daily pain. The pain may vary or flare, but it is relentless. The chronic pain is moderate to severe and is described with descriptive adjectives (throb, deep, sharp, intense). Chronic pain spreads to larger areas of body in the highly innervated areas such as head and neck are more distracting. Chronic pain is aggravated by stress and anxiety, not caused.

There are many classic locations of body that can develop chronic pain: headaches, jaw pain, back pain, neck pain, knee pain, shoulder pain, sinus pain, and ear pain. There are many forms of chronic pain: atypical toothache, diabetes, lupus, fibromyalgia, neuropathic pain, GERD, burning mouth, jaw pain, atypical earache, trigeminal neuralgia, Hypermobility, Hyoid syndrome.

TypeLevels painEpisodesTreatmentHealth HabitsAnxiety
AcuteMild to modInfrequentSingleGoodNo effect
ChronicMod to severeFrequent-dailyComplexPoorIncreases

How do get chronic pain

Chronic pain requires an ongoing/frequent pain, high level anxiety, poor health habits, and usually a trauma or two. ANALOGY: Fertile soil (poor health habits) and a seed (trauma). The pain teaser is our friend the muscle joint pains (headache, neckache, jaw ache, or any pain) frequently bombarding pain reporting system. DO not forget the daily inflammation sources of sinus, ears, mouth, eyes, allergies, food sensitivities, pollen, etc. Now that the stress/anxiety system slowly couples with pain system to aggravate pain, we are on roller coaster of chronic pain. The world negativity causes a moderate level of up-regulation sympathetic system most of the time.  The poor health habits (PHH) involve sleep, conditioning, diet, negative thinking keep us from our healing abilities until one day we fall off Clift of Chronic PAIN.  The sudden abrupt injury-accident-trauma-damage to body causes a sudden demand for significant healing at a time when healing is at all-time low. The perfect formula for chronic pain is made up of many health care choices we make every day.

Pain + Anxiety + PHH + Trauma = Chronic Pain

(Tribute: Paul Durham is research scientist Missouri and his work on chronic pain and all chronic pain literature I have read & studied in last 30 years is the basis of this formula)

Pain Teaser:

Inflammation: Headache-Neckache-Backache-Jawache

Inflammation: Sinus-Ears-Mouth-Allergies-Pollen-Mold

There is a daily nagging pain that plaques us in most of our early adult life. In some cases, there can be two nagging pains, such as headache and sinusitis, head and neck, jaw and neck.  Unfortunately, the nagging pain are creeping into the childhood and teen years due a significant deterioration of health habits, the break up of family, increasing child abuse, war's PTSD, and hostile/violent world. Since these single, mild, infrequent pains, the causes are probably known, but ignored.  You can provide the reason that your nagging pain was not managed in timely manner. Many times, the blame has been placed on our bias of medicines or public's bias to fast-quick-cheap, but in reality, it can be a lack time-energy-focus-desire-passion on part patient. In today’s medical climate, medicine is spending so little time to diagnose that the management of the causes will be forgotten art.

Let’s go back to your teen years, your parents were proud owner of a gene that makes you susceptible to frequent sinusitis. The inflammation in your upper respiratory system frequently bombard the pain system with warnings of the inflammation. Let’s add to our story, frequent tension headaches from stress of being early adult life with emotional-school-social-relationship-sexual demands. These two pains bombard the pain system with no demand to manage problems. The medical solution to tension headache has been pain medications to cover up pain and not treat cause. The treatment for sinusitis is nasal sprays-decongestants-antihistamines which does target the symptoms, but the virus-pollen-allergies are not controlled. The treatment for tension headache is Ibuprofen taken like candy until we kill our gut and little attention is paid to managed stress/anxiety in our early adult life; thus, less bombardment to sympathetic system and the less stimulation pain system.

As child and teen, let’s throw in some miscellaneous trauma’s into mix and evaluate our healing abilities at that time. We can see poor sleep invading childhood and teen years causing poor healing to our damaged structures that we will need to work correctly in our adult life. The lack sleep from a child gaming all night and the occasional trauma is not healing properly; thus, we begin our chronic pain growth and development. 

The world in which are genes function can manipulate genes into expressing themselves negatively. The complex world of gene and gene expression is too large for our purposes, but understand this: you and your world can change the way a gene expresses itself, especially in the discussion of chronic pain development.

Here the learning curve will be how all the inflammation chemicals and pain signals set us up for pain conditions.

Anxiety:

It not hard to see how hard the world works to deteriorate your habits . With the worlds attempt at making you socially acceptable and acceptably unhealth, we add to development of chronic pain by our thinking choices of negativity-worry-fretting-perfectionism-social pressures. The bread winner takes passion for success and turns it into perfectionism. The loving mother turns love into worry. The fretting teenage over hair, make up, and designer clothes. The world is quite gifted at manipulating our sympathetic system and unfortunately we are gifted at up regulating our protection system by our inner negative voice. We upregulate our sympathetic system, fight or flight system, or our protection system regularly and consistently. This persistent sympathetic system dominance resets rheostat for normal operations into state of alert all time. Many in today’s world can passionately manage normal concerns into OCD, panic attacks, PTSD, and Emotional Hijacking. These spikes in sympathetic system to an already high-level activity are relentless. Reset the high idle of car to a racing level and see/hear/feel the damage. As with car, we are using up alot of resources we need for healing and causing a lot damage to pain reporting system.

The damage protection system is constantly ramping up it warn signals to get our attention, especially when we’ve been too busy to pay attention to reoccurring pains or stressors. The protection wiring tries to warn us by increasing  the size painful area, increases the pain from same stimulus, reporting pain from nonpainful source, and prolonging the pain duration.  The protection system tries get your attention; so that, you get motivated to seek healing for the damage, but we continue ignore it or we simple treat symptom not causes.  When the protection system adds new wiring from the stress-anxiety system to pain system, it was in effort to really get you motivated. As the acute pain episodes increase frequency-severity-duration, the prolonged heighten anxiety stimulates the sympathetic system to attach to pain system; thus, anxiety can now stimulate more pain. The body is trying to tell us to look for ways to reduce old pain-new pain-anxiety-poor health habits that has set you up for continuous pain. All we hear is the doctor needs to give us pain pill; so, we are getting mad at doctor for not treating our symptoms, when we should be mad at him or her for not treating our high levels of anxiety with Integrative tools. Now, there is mind twister. We only like medicine when it acts like drug pusher.

Poor Health Habits

Chronic pain develops after many years of deterioration of your health habits  (Sleeping-Exercise-Nutrition-Anxiety). In my day (yes, I am ole fart), I began my deterioration of our health habits came when I went off college, but many of my classmates went off recruiting more responsibilities (work-marriage-children-house-social-church). We allowed the world to gradually deteriorate of our health habits; therefore, decreasing our ability heal from the daily damage of living. The world’s brain washing for fast-quick-cheap, the world’s demand on our time, and world’s influence on what we want, pushes us toward poor health habits. The gradual onslaught of demand of time, the constant distractions to demands, the social pressures, school-work demands, our own virtues turn into vices cause stealing of energy from our ability heal, and constantly bombard sympathetic system and pain system.

ANALOGY: Story of Frog

Like the frog in pot of water, it begins with having fun in its natural environment. As the heat increases, the frog is lulled to its demise by slow but steady increase in temperature. At some point, the frog is cooked. Oh yes, even frog got hints of the deterioration in his or her condition, but it choose to ignore them.

Occasionally we see a dramatic deterioration in health habits during certain periods of life: 1) Like the college kid with their fast food eating, late night parties, and drug consumption; 2) Domestic goddess w/ 2 kids-husband-job-community-beauty ignoring their health habits: poor sleep, high anxiety, cleaning after locust hit refrigerator after school;  3) Working moms w/ their 36 hr day demands, eating no breakfast, make up in car, work projects, worrying about family while at work, 4) Working dads: trying get promoted for more money, keeping family happy w/ “wants”, losing sleep for work project, not exercising by getting home 7 pm.  We do not see underlying problem of not recovering our good health habits in middle of living. The many years of no exercise, poor sleep, unhealth nutrition, and worrying-fretting-perfectionism-negative thinking kills our defense system and our healing ability.

The four health habits are cardiovascular conditioning, sleep, nutrition, and thought habits:

  1. The cardiovascular “conditioning” is increasing our activity to a level that strengthens heart and increase tidal volume of lungs. The cardiovascular conditioning improves tone of your muscles which is important for resistance to trauma damage. Cardio increases energy structures of muscles (mitochrondra) and sewer system capabilities (lymphatics) which improves efficiency and removes toxins from muscles better. Cardio balances and increases efficiency in all our organ systems.
  2. Sleep includes quality breathing-depth sleep-sleep architecture-production of physiological chemicals-healing -pain system. Deep sleep produces more growth hormone. Better breathing oxygenates body for better processing. Proper coordination of all cycles sleep is important for our bodies physiology-biochemistry because the majority of healing occurs here.
  3. The diet-nutrition provides resources use to build the proteins-cell membranes-hormones-neurotransmitters-immunity (defenses)-run body processes, and nourish fona-flora of gut. The diet is made up of positive chemicals (nutrients-vitamins-trace elements-fiber) use to off set the negative chemicals (over use of antibiotics-sugar-salt-caffeine-nicotine-toxins) that our body sustains damage from repetitive insults.
  4. The pain reporting system is increasingly-changing-adapting due repetitive healing difficulties, increasing pain reports, high anxiety-stress stimulating sympathetic system to interconnect to pain system. Increasing pain signals and poor healing causes rewiring-recoding-reproduction of neurotransmitters-widen field pain in pain reporting system. The pain system is being overwhelmed by increasing pain inputs from episodic pains (Head-neck-jaw-sinus-allergies), poor healing causing changes in way pain nerves behave, and increasing interconnect to anxiety-stress sympathetic system overwhelms the pain reporting system from multiple sources, ie chronic pain.

SUMMARY PHH

The protection system is constantly ramping up it warn signals to get our attention, especially when we’ve been too busy to pay attention. The protection wiring tries to warn us by increasing  size painful area, increases pain from same stimulus, pain from nonpainful source, and prolonging the pain.  The protection system tries get your attention; so that, you get motivated to seek healing for the damage, but we continue ignore it. The nervous system connects stress-anxiety system to pain system, it was in effort to really get you motivated. The body is trying to tell us to look for ways to reduce old pain-new pain-anxiety-poor health habits that has set you up for continuous pain.

Trauma:

In our early life, what happens when an unforeseen trauma forces us into a healing state and our healing ability is impaired. In our middle ages, what happens when a Fall-Blow-Injury forces into chronic pain state. We walk the edge of chronic pain cliff for years and wind finally blows us off cliff (chronic pain analogy). We desperately look for a path out of ravine of chronic pain, but the path is not easily determined, easy to take, or easy to manage, easy to afford. World’s brain washing does not prepare us for our task ahead; so, we search for acute pain solution (pulled muscle back) for chronic pain problem (chronic back pain).

First, we look to our front-line professionals (MD, DDS, some specialist) who are well trained at acute pain. They treat the pain that they have been trained to manage, acute pain: 1) trauma (broken leg, sprained back, toothache, elbow pain, hand pain, scratch cornea); 2) Infections (cold, sinusitis, cut, intestinal, ear);         3) Muscle joint pains (neck-head-jaw-back); 4) Allergies-food sensitivities; 5) Miscellaneous (rash, splinter, puncture wound, mild asthma, episodic arthritis, etc.). 

There are pathologies like lupus, fibromyalgia, diabetes, asthma, arthritis, frequent muscle/joint pains, that do not respond to acute pain therapies. They require more healing-energy-focus-passion-effort-economics. There is plenty of confusion acute verses chronic pain. For example, a trauma presents itself and usually heals w/ simple therapies. A second trauma pain is not responding to simple-single-acute pain therapies.  We have to rethink in our attempts to manage the second trauma, disease, pathology. We may have to reclaim our good health habits. We may have to manage anxiety-stress-up/regulation sympathetic systems. The trauma-insult-invasion that throws us over the edge into chronic pain ravine must be managed differently to be successful.

Tale Twin Sisters:

Two females 18-year-old twins riding back seat of grandpa car when another car ran off the other side road overcorrected and flipped across the median into front of grandpa car. One twin who gamed late night-ate junk food-stress out about school had neck pain for lifetime and the other twin active runner for school, good sleep and eating habits, great in school had neck pain for week.

Summary Chronic Pain Formula:

There is a high price for bad health habits, and it called pain. It has no respect for money, privilege, age, gender, personality style, hair color, or shoe size. You cannot ask for help.

Formula:   Pain Teaser + Anxiety + PHH + Trauma = Chronic Pain

Patient 1:  Freq HA + Daycare/mom + Sleep/Condition + Blow jaw = Chronic Pain

Patient 2: Freq Neck + CEO/Perfect + Sleep Apnea + Bike Fall = Chronic pain

Patient 3: Freq Jaw + PTSD/OCD + Gaming Late/Posture + MVA = Chronic Pain

Changes Pain System

Biochemical-Physiological-Anatomical CHANGES

The pain systems wiring changes to increase size painful area, more pain from same stimulus, pain from nonpainful source, stress increases ongoing pain, and prolonging pain.  The bodies neurological adaptive changes acts as a warning signal of damage that is not healing properly. We ignore pain or cover up pain; so, the patient is not forced into making changes in health habits or anxiety-stress-up/regulation sympathetic system. As pain system adds new wiring from the stress-anxiety system to pain system, it causes a confusing phenomena of increase stress increases pain. The pain from same stimulus causes a greater pain response. The pain spreads to neighboring structures. For science buffs, these are exciting discoveries over past 30-50 years, but for the pain patient reading one or two of the discoveries may suffice. You need relieve for your chronic pain, but it comes with a price of taking responsibility for your poor health habits and poor controls over your emotional brain. You decide how much science is necessary to prove to you that tools are necessary to manage the chronic pain formula.

Chronic pain for prolonged periods of time causes nerves from sympathetic system (stress-anxiety system) to attach to pain system. Take two twin sisters one with acute pain and the other with chronic pain. If you stress the sister w/ acute pain, there is no pain increase. If you stress the sister with chronic pain, you get a pain increase. As you have noticed with your own pain, over time, the more anxious you get the more the pain increases; so, you are not crazy. Most patient do not understand this concept, therefore, feel they lost it.  Their friends with acute pain do not see this connection; so, we feel misunderstood. It would not surprise you to know many acute pain doctors know very little about chronic pain parameters; therefore, do not treatment plan for poor health habits-anxiety management-structural damage from past-pain systems adaptive changes. Many of professionals get their learning about chronic pain failures by utilizing single acute pain therapies. The learning institutions due not have adequate training-knowledge-maturation programs for chronic pain. The insurance industry has discriminated against chronic pain facilities over last 50 years, running them out business. Be careful on blaming others for chronic pain problem, many patient’s resist treatment plans that include health habit transformation, anxiety tools implementation (biofeedback, counseling) because they have no clue that nerve of pain connects to nerve of sympathetic system and many other chronic pain causes-aggravators-initiators. 

HORMONAL EFFECTS

At Raleigh Facial Pain Center, the ratio of females-to-males requesting examinations was 84% in 2001, and 80% in 2002.  The chronic pain literature also points out female to male rations in most all chronic pain pathologies. Unfortunately, the exact reasons for this are difficult to research due to multiple factors – hormonal influences, central sensitization (rewiring), and sympathetic system changes.  Increasingly, research is linking chronic pain to gender.  The study of chronic muscle syndromes, such as myofascial pain jaw joint pathologies, dysfunction, atypical odontalgia, Meniere’s disease, Lupus, burning mouth, and cervical dysfunction, all reveal a strong pre-disposition towards women.  Some 86% of female chronic pain sufferers in a Swedish study were found to clench or grind their teeth. 

Many of chronic pain pathologies have a female to male dominance. For example, nearly all the chronic pain syndromes, such as chronic fatigue syndromes- fibromyalgia-osteoarthritis-IBS/Reflux/GERD, Ehlers Danlos Syndrome, Migraines and certain malignancies, have a female predominance.  Migraines affect 18% of females and 6% of males. Tension headache have a female predominance with 46% of females to 38% males.  Arthritis is 1 in 4 ratio of female to males w/ females have more pain. Fibromyalgia is 90% women to men.
 
 

One of the most fascinating research findings in recent years is the estrogen receptor on the female’s mast cell.  This receptor, genetically coded to provide the female sets up inflammation enhancement, is absent in men.  When the estrogen levels flux and blood levels of estrogen increase, it couples with the mast cell, making it more susceptible to breakdown.  The mast cell is a storage tanker for many neurogenic chemicals and is the predominant cell in the inflammation process.  Estrogen couples with the mast cell receptor making it more sensitive to an inflammation stimulus and dumping its load of neurogenic chemicals.  As it does so, it releases neurogenic chemicals more quickly, and with greater numbers of mast cells responding. One of the substances released by the mast cell is NGF (nerve growth factor).  NGF stimulates production of substance P and VIP [vasoactive intestinal polypeptide] that are the main messenger molecules (neurotransmitters) of the pain system.  As a result, a female will get more chemicals, more inflammation, more pain signals, and more swelling from the same stimulus than a male.  This monthly bombardment of neurogenic chemicals takes its toll on the female body and it is the female species that has an over stimulation of muscle and joint structures and pain.

The migraine headache is neurogenic-inflammation chemical overload that reaches toxic levels in the blood stream going to the brain.  The neurogenic chemicals come from a variety of head and neck structures such as chewing system muscle/joint, neck muscle/joint, sinus infections, ear infections, eye contact with environment, orifices head bacterial invasion, and allergies.  The two major arteries (vertebral and carotid) going to the brain pass most of these structures picking up the inflammatory chemicals.  The body produces inflammation from normal function, but abnormal function creates an excessive inflammation chemicals. 

Some of the abnormal activities are: clenching, grinding, chewing gum, jaw posturing, bad bite, neck posture, arthritic joints, gum disease, allergens, muscle-bracing-posturing, and disc displacement in neck and jaw.  When neurogenic chemicals reached toxic level, it threatens brain safety stimulating vasodilation of blood vessels.  This flushes the toxins away from the brain.  The receptors in the blood vessels are angry about the stretching caused by neurogenic chemicals.  Each person’s threshold in the migraine generator is set at different levels by genetics.  It is believed that certain females have a lower setting than others.  So, you see it Migraines are result of genetic setting of the migraine receptor, various neurogenic sources, and the estrogen mast cell receptor activation.
 

The pain system neurotransmitter, serotonin, which has long been associated with the migraine headache, varies with the plasma levels of estrogen.  The number of serotonin receptors available, it’s binding capacities, and its functional status is all associated with estrogen levels.  In other words, when estrogen is high, the serotonin levels are also elevated.  Imitrex is a serotonin-mimicking drug used to abort (stop) migraines once they are in full swing.

Females exhibit greater sensitivity to laboratory pain as compared to males.  Gender differences in pain sensitivity are not site specific, and they seem more noticeable in deep sustained pain sensations similar to the pain of neck and head.

Estrogen and progesterone induce increased secretions of prostaglandin, which inhibit central norepinephrine release (a nerve messenger in pain inhibitory system), antagonize morphine analgesia (make pain pills not work as good), sensitize pain receptors (more pain receptors react to same stimulus), and increase neurogenic inflammation.

ReCoding Nervous System

Chronic pain has lasting effects on the pain sensing systems.  Constant or recurrent pain induces a lowering of the threshold for pain by the pain receptors.  The pain system also activates the silent nociceptor.  One of the mechanisms of wind-up is by A-beta fiber glutamate, binding to the AMPA receptor, activating protein kinase, removing magnesium plug, allowing the C-fiber glutamate to bind to the NMDA receptors, allowing inflow of calcium, and turning on dorsal horn cells for activity.  These receptors do not normally react to the environment but when activated by pain, are brought into action.  The pain system reacts to smaller and less intense stimuli.

Turning on silent nerves to transport more pain signals in presence of ongoing pain

It has been known for years that any increase in stress has no effect on acute pain, but stress does increase levels of discomfort for those with chronic pain.  One may stress a patient that has a toothache or a broken leg and there is no increase in pain levels.  If one stresses a patient that has an episodic head-neck pain, high anxiety, & poor health habits, then there is a sharp increase in pain levels. 

Ongoing pain creates new alpha-1 receptors which react to stress molecule, adrenalin.

Normal pain fibers (C-fibers) do not react to stress molecules (adrenalin).  Pain causes alpha-1receptors to be produced and transported to C-fiber terminals.  These receptors are sensitive to adrenalin produced by the sympathetic system when the body is under stress.  Now the pain fibers that usually respond only to pain stimulus will respond to stress stimulus. 

Painful stimulus such as damaged joints, over used muscles, or ear-tooth infection induces mast cells to release their load of chemicals.  Included in this inflammation soup is Nerve Growth Factor (NGF).  NGF stimulates new growth of nerve fibers that is necessary for healing.  The problem is it also stimulates nerve growth in pain reporting system or C-fibers. 

The sprouting of sympathetic fibers in the dorsal horn to connect to pain system nerves (C-fibers).  The stress system gets a direct wiring to the pain system.  NGF stimulates the growth of a-Beta fibers to C-fibers in the dorsal horn.  Likely this is the mechanism that explains why touch and pressure can create pain in chronic pain patients.

Normal connection in dorsal horn

Ongoing pain creates new connection from the touch and pressure layer to pain layer.

Sympathetic Reasons for Pain

Muscle pathologies such as neck aches, backaches, and headaches are definitely more predominant in females.  Each of these muscle-based pathologies shows a relationship between pain and increases in stress. 

Consider when a driver cuts in front of your car.  The stress (perceived danger) activates the sympathetic system that causes a nerve impulse to travel down the sympathetic pathway to the muscles called the gamma efferent nerve fiber.  These nerve fibers activate muscle spindles to prepare the muscle to move due to the perceived danger.  In this case, your body doesn’t move, only your gamma efferent fiber does. Over prolonged and frequent stimulation of the muscle spindle without movement, it becomes damaged-enlarged-swollen causing a sustained contraction of the smooth muscle of the muscle spindle.  The toxin build-up from the over-stimulation of the sympathetic system (protection system) creates the onus for these damaged smooth muscle spindles to become what is called a trigger point. 

Trigger Point forming in Muscle Spindle

Recent research reveals evidence that damaged muscle tissues (trigger points) is muscle spindles under the control of the sympathetic system.  In one study, sympathetic blocking agents injected into the trigger point blocked the pain, but the skeletal blocking agents (curare or Botox) did not block the pain. The amount of neurogenic chemicals in the muscle and the extra workload due to painful muscle splinting creates the environment for damaged muscle fibers.  Muscle pathology is set off by increased inflammation in muscles during estrogen fluxes.  The pain itself can create more muscle contraction and an increase in muscle tone.  Trigger points develop, which are sources of neurogenic stimulation of the pain system.  The inflammation, swelling, and pain gradually induce less exercise, poor sleep, and additional pain.

Chronic muscle pathologies such as fibromyalgia, chronic fatigue syndrome, myofascial pain syndrome, and tension headache all have trigger points associated with them.  The muscle-based pathologies are confusing because they can hurt where they are located or refer to distant areas. 

Trigger Points in the Neck Muscles

A good example of referral pattern of trigger points is a heart attack that feels like indigestion:

  1. trigger point in Masseter refers pain lower 2nd molar
  2. Trigger point in Temporalis refers pain upper 2nd molar
  3. Trigger points in suboccipital muscles refer to around ear
  4. Trigger points in SCM refer to frontal & ear

These referral patterns are now used in chronic pain diagnosis as a way to identify the correct site of the pain source.  The critical point is that deep muscle pain is not location-specific in the brain; thus, allowing the site of the pain to be different from the source of the pain.  As book on trigger points by Travell and Simon outlines the distinct patterns of referral.  For example, the atypical earache may have referred pain from other locations and the atypical toothache may be referred pain from muscles.

Muscle-based pathologies are more prominent and prevalent in women.  The over-stimulation of muscles in females means that the sympathetic system is enhanced, more reactive, and more sustained.  The female sympathetic system is enlarged and more responsive to stimuli.

The lower highway that is the primitive protective system is enhanced in females that have had verbal, physical, or sexual abuse.  The book Emotional Intelligence by Daniel Goldman uses the term emotional hijacking for this.  The female species seems more prone to taking on the cares of the world, family, society, church, community, and world, especially after they become mothers.  This over-stimulation of the sympathetic system begins to set the stage for autonomic system imbalance (parasympathetic verses sympathetic).  When one side of the system is dominant, the other is recessive.  The parasympathetic system is in charge of life support systems and the sympathetic is in charge of protection.  Conservation of resources allows for use of one system more than another. When we over-stimulate the sympathetic system, we suppress the parasympathetic system.  The longer the perceived danger or stress – the less the life support systems work correctly.  So, eventually our sleep and digestive systems begin to malfunction to impair our healing.  Slowly, progressively, and insidiously, the sleep quality goes down with increased awakening, slower sleep onset, and awakening unrefreshed.  We get to a point where we become food sensitive and aspirin products hurt our stomach.  The autonomic system imbalance is another way the great circle of pain gets to be a viscous merry go round. 

Summary Adaptive Changes Pain System

The longer pain continues, the worse health habits, and the more upregulated sympathetic system, the more adaptation of the nervous system such as sympathetic sprouting, a-beta fiber connect C-fiber, activation silent pain receptors, Apha-1 receptor production, trigger point development, and increase inflammatory chemicals.  In other words, the biochemistry-physiology of body has changed, and you have to accept the challenge to reverse these changes as much as possible and soon the better.  

SUMMARY CHRONIC PAIN MANAGEMENT

The damage protection system is constantly ramping up it warn signals to get our attention, especially when we’ve been too busy to pay attention to reoccurring pain and the slow deterioration of our health habits. The pain system tries to warn us by increasing  the size painful area, increases the pain level from same stimulus, reporting pain from nonpainful source, and prolonging the pain duration.  The protection system tries get your attention; so that, you get motivated to seek healing for the damage, but we ignore it, or we cover it up with pain pills.  When the protection system adds new wiring from the stress-anxiety system to pain system, it was in effort to really get you motivated. As the acute pain episodes increase frequency-severity-duration, the prolonged heighten anxiety stimulates the sympathetic system to attach to pain system; thus, anxiety can now stimulate more pain. The body is trying to tell us to look for ways to reduce old pain-manage new pain-decrease anxiety-change our poor health habits that has set you up for continuous pain.

Chronic Pain Formula

Pain + Anxiety + PHH + Trauma = Chronic Pain

TypeLevels painEpisodesTreatmentFab Four
AcuteMild to modInfrequentSingle txGood health habit
ChronicMod to severeFrequent-dailyComplex txPoor health habit

ANALOGY CHRONIC PAIN

Chronic pains (multiple pain areas) requires fertile soil (poor health habits) plus a potent seed (trauma) w/ plenty of water (anxiety).

Chronic Pain Formula: why do I have chronic pain ?

  1. Pains
  2. Anxiety
  3. Poor Health Habits
  4. Trauma

ACUTE PAIN:

3 TOOL BOXES MEDICAL CARE

  1. Medications
  2. Surgery
  3. Integrative tools

Autonomic system: 1) sympathetic system: fight or flight, protections system 2) parasympathetic system: rest & replenish,

Stress/Anxiety causes upregulation sympathetic system, adrenalin production, stress hormone, tense muscles

Anxiety increases pain levels in chronic pain

  1. Emotional hijacking or PTSD
  2. Negative emotional brain
  3. World’s manipulation-outer, news-politics-negativity-violence-hatred
  4. Talent turned negative-inner, love turn worry
  5. Science of pain escalation
  6. Sympathetic fibers connect to pain fibers in dorsal horn
  7. Turning on silent nerves to transport more pain signals
  8. Ongoing pain creates new alpha-1 receptors which react to stress molecule, adrenalin

REWIRING

Over prolong periods to time, chronic pain causes nerves from sympathetic system (stress-anxiety system) to attach to pain system. So, in chronic pain,  stress and anxiety can increase pain levels. Many women with high pain thresholds have met their match w/ relentless chronic pain constantly aggravated by stress and anxiety. Many women think that 1) they lost it, 2) making it up, 3) hypochondractic, 4) wimps, due fact that they are not managing pain as well as they use to be able to handle. This feeling is misguided, they are fighting an new foe.

Tale Of  Twin sisters: one with acute pain and the other with chronic pain.

  1. If you stress the sister w/ acute pain, there is no pain increase.
  2. If you stress the sister with chronic pain, you get a pain increase.

As you have noticed with your own pain, over time, the more anxious you get the more the pain increases; so, you are not crazy. Many women who have managed childbirth, feel they lost their minds, when this chronic pain resist all pills and shots fail to relieve pain and pain keeps increasing with stress. Pain has always caused stress, but now stress is causing pain. it because their friends with acute pain do not see this connection. They feel their friends who have only had acute pain do not understand what they are going through. Beware, most of our physicians or dentist are trained in acute pain and throw acute pain tools at a chronic pain,  making woman feel like hypochondriac.

WARNING OF DANGER

The coupling of the protection system to pain system is a way the body is ramping up its warning signals to get our attention, especially when we’ve been too busy to pay attention to pain. The protection wiring tries to warn us by increasing  the size painful area, increases the pain level from small stimulus, reporting pain from nonpainful sources, and prolongs the pain duration.  The protection system tries get your attention; so that, you get motivated to seek healing for the damage, but we continue ignore it.  When the sympathetic system (protection) causes rewiring from the stress-anxiety system to pain system, it was in effort to get you motivated. As the pain episodes increase frequency-severity-duration, the prolonged heighten anxiety stimulates the sympathetic system to attach to pain system; thus, anxiety can now stimulate more pain. The body is trying to tell us to look for ways to reduce old pain-new pain-anxiety-poor health habits that has set you up for continuous pain. After the stress system wires to pain system, it takes a lot of team effort to facilitate the dewiring of painful connection. So when pain team keeps working to reduce even low levels pain, it is disconnect all the wires to pain system from anxiety system.

Health habits

  1. Exercise
  2. Sleep
  3. Negative thinking
  4. Nutrition

Exercise:  

  1.  Strength heart & lungs
  2. Burns up excessive adrenalin
  3.  Calms emotional brain
  4. Removes irritating toxins
  5. Improves efficiency muscle joint systems 

Negative thinking:

  1. stress or anxiety fires up emotional brain
  2. overrides cognitive brain
  3. pumps adrenalin into blood
  4. powerful control over emotional brain
  5. negative thinking loops feed fire
  6. worry, fretting, rumination, anger are manipulators

Sleep:

  1. Proper Oxygenation of body
  2. Biochemical construction molecules
  3. Repair and healing
  4. Proper Sleep cycles
  5. Re-establish balance-harmony-efficiency

Nutrition:

  1. Energy
  2. Nutrients
  3. Flora health
  4. Trace elements
  5. Addictions
  6. Stimulants
  7. Slow poisons  

Trauma: 1) Falls, 2) MVA, 3) Blows, 4) Lacerations. 5) Repetitive impacts

Overload: Too much input

Now, let me get this straight, the pain doctor tells me I have to work on all health habits to enhance my healing abilities at same time I am working on the pain. I don’t have time to even go to the bathroom and he wants me to manage time, money, habits, wants, distractions, barriers, negative thoughts, and health habits. I just want a magic pill, shot, or some sort of quick fix; so, I can get back to my busy and hectic life. The family would fall apart if mommy goes into a pain management. So, what does a strong woman like me do in case like this. It takes time and passion for real healing to occur, but you and family will be glad you did. In reality, I am trying to give you hope, but it takes a lot passion over prolonged period to get healing you need. The world did not build an easy road for you and I to follow in chronic pain

We have help thousands of patients just like you to control their pain and get back their health. Ask around, someone in you neighborhood has chosen to control their pain and get their life back.

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