Back Clinic Chronic Pain Chiropractic Physical Therapy Team. Everyone feels pain from time to time. Cutting your finger or pulling a muscle, pain is your body’s way of telling you something is wrong. The injury heals, you stop hurting.
Chronic pain works differently. The body keeps hurting weeks, months, or even years after the injury. Doctors define chronic pain as any pain that lasts for 3 to 6 months or more. Chronic pain can affect your day-to-day life and mental health. Pain comes from a series of messages that run through the nervous system. When hurt, the injury turns on pain sensors in that area. They send a message in the form of an electrical signal, which travels from nerve to nerve until it reaches the brain. The brain processes the signal and sends out the message that the body is hurt.
Under normal circumstances, the signal stops when the cause of pain is resolved, the body repairs the wound on the finger or a torn muscle. But with chronic pain, the nerve signals keep firing even after the injury is healed.
Conditions that cause chronic pain can begin without any obvious cause. But for many, it starts after an injury or because of a health condition. Some of the leading causes:
Arthritis
Back problems
Fibromyalgia, a condition in which people feel muscle pain throughout their bodies
Infections
Migraines and other headaches
Nerve damage
Past injuries or surgeries
Symptoms
The pain can range from mild to severe and can continue day after day or come and go. It can feel like:
A dull ache
Burning
Shooting
Soreness
Squeezing
Stiffness
Stinging
Throbbing
For answers to any questions you may have please call Dr. Jimenez at 915-850-0900
Why does localized damage or injury caused by trauma lead to chronic, intractable pain in certain patients? What’s in charge of the translation of local injury with acute pain into a chronic pain condition? Why does some pain respond to anti-inflammatory drugs and/or medications, whereas other forms of pain require opiates?
Pain is an intricate process involving both the peripheral nervous system (PNS) and the central nervous system (CNS). Tissue injury triggers the PNS, which transmits signals via the spinal cord into the brain, in which pain perception occurs. However, what causes the intense experience of pain to develop into an unremitting phenomenon? Can anything be done to prevent it? Evidence indicates that chronic pain results from a combination of mechanisms, such as neurological “memories” of preceding pain.
Nociception: The Simplest Pathway
Acute or nociceptive pain is characterized as the regular experience of discomfort which occurs in response to very basic damage or injury. It is protective, warning us to move away from the origin of the insult and take care of the trauma. The mechanisms that create nociceptive pain include transduction, which extends the external traumatic stimulation into electrical activity in specialized nociceptive primary afferent nerves. The afferent nerves then conduct the sensory information from the PNS to the CNS.
In the CNS, the pain data is transmitted by the primary sensory neurons into central projection cells. After the information is transferred to all those areas of the brain which are responsible for our perception, the actual sensory experience happens. Nociceptive pain is a relatively simple reaction to a particularly simple, acute stimulus. But the mechanics in charge of nociceptive pain cannot identify phenomena, such as pain that persists despite removal or healing of the stimulation, such as in the instance of phantom limb pain.
Pain and the Inflammatory Response
In circumstances of more severe injury, such as surgical wounds, tissue damage may stimulate an inflammatory reaction. However, other conditions, especially arthritis, can also be characterized by continuing cases of inflammation associated with intense pain symptoms. The mechanisms for this type of pain related to tissue damage and an inflammatory response are different from early-warning nociceptive pain.
Observing the incision or site of other damage or injury, a cascade of hyperexcitable events occur in the nervous system. This bodily “wind-up” phenomenon begins at the skin, where it is potentiated along the peripheral nerves, and culminates at a hypersensitivity response along the spinal cord (dorsal horn) and the brain. Inflammatory cells then surround the regions of tissue damage and also produce cytokines and chemokines, substances which are intended to mediate the process of healing and tissue regeneration. But, these agents may also be considered irritants and adjust the properties of the primary sensory neurons surrounding the area of trauma.
Thus, the major factors which trigger inflammatory pain include damage to the high-threshold nociceptors, known as peripheral sensitization, changes and alterations of the neurons in the nervous system, and the amplification of the excitability of neurons within the CNS. This represents central sensitization and is accountable for hypersensitivity, where areas adjacent to those of the true injury will experience pain as if these were injured. These tissues can also react to stimulation which normally doesn’t create pain, such as a touch, wearing clothing, light pressure, or even brushing your own hair, as if they were truly painful, referred to as allodynia.
Neuropathic pain results from damage or injury to the nervous system, such as carpal tunnel syndrome, postherpetic neuralgia and diabetic neuropathy. Although some of the mechanisms which seem to cause neuropathic pain overlap with those responsible for inflammatory pain, many of them are different, and thus will need a different approach towards their management.
The process of peripheral and central sensitization is maintained, at least theoretically and experimentally, during the excitatory neurotransmitter, glutamate, which is believed to be released when the N-methyl-D-aspartate (NMDA) receptor is activated.
The nervous system is made up of either inhibitory or excitatory neurotransmitters. Most of what permits our nervous system to respond appropriately to damage or injury is the fine-tuning or inhibition of a variety of processes. The overexcitation of the nervous system is seen to be an issue in a number of different disorders. For instance, overactivation of an NMDA receptor can also be related to affective disorders, sympathetic abnormalities, and even opiate tolerance.
Even ordinary nociceptive pain, to some degree, activates the NMDA receptor and is believed to lead to glutamate release. Nonetheless, in neuropathic pain, oversensitivity to the NMDA receptor is key.
With other types of chronic pain, such as fibromyalgia and tension-type headaches, some of the mechanisms active in inflammatory and neuropathic pain may also create similar abnormalities in the pain system, including central sensitization, higher excitability of the somatosensory pathways, and reductions in central nervous system inhibitory mechanisms.
Peripheral Sensitization
Cyclo-oxygenase (COX) also plays an essential function in both peripheral and central sensitizations. COX-2 is one of the enzymes which are induced during the inflammatory process; COX-2 converts arachidonic acid into prostaglandins, which increase the sensitivity of peripheral nociceptor terminals. Virtually, peripheral inflammation also causes COX-2 to be produced from the CNS. Signals from peripheral nociceptors are partially responsible for this upregulation, but there also seems to be a humoral component to the transduction of the pain signals across the blood-brain barrier.
For instance, in experimental models, COX-2 is generated from the CNS even if animals receive a sensory nerve block prior to peripheral inflammatory stimulation. The COX-2 that is expressed over the dorsal horn neurons of the spinal cord releases prostaglandins, which act on the central terminals, or the presynaptic terminals of nociceptive sensory fibers, to increase transmitter release. Additionally, they act postsynaptically on the dorsal horn neurons to produce direct depolarization. And finally, they inhibit the activity of glycine receptor, and this is an inhibitory transmitter. Therefore, the prostaglandins create an increase in excitability of central neurons.
Brain Plasticity and Central Sensitization
Central sensitization describes changes which happen in the brain in reaction to repeated nerve stimulation. After repeated stimuli, amounts of hormones and brain electric signals change as neurons develop a “memory’ for reacting to those signs. Constant stimulation creates a more powerful brain memory, so the brain will respond more rapidly and effectively when undergoing the identical stimulation in the future. The consequent modifications in brain wiring and reaction are referred to as neural plasticity, which describe the capability of the brain to alter itself readily, or central sensitization. Therefore, the brain is activated or sensitized by previous or repeated stimuli to become more excitable.
The fluctuations of central sensitization occur after repeated encounters with pain. Research in animals indicates that repeated exposure to a painful stimulation will change the animal’s pain threshold and lead to a stronger pain response. Researchers think that these modifications can explain the persistent pain that could occur even after successful back surgery. Although a herniated disc may be removed from a pinched nerve, pain may continue as a memory of the nerve compression. Newborns undergoing circumcision without anesthesia will react more profoundly to future painful stimulation, such as routine injections, vaccinations, and other painful processes. These children haven’t only a higher hemodynamic reaction, known as tachycardia and tachypnea, but they will also develop enhanced crying too.
This neurological memory of pain was studied extensively. In a report on his previous research studies, Woolf noted that the improved reflex excitability following peripheral tissue damage or injury doesn’t rely on continuing peripheral input signals; rather, hours after a peripheral trauma, spinal dorsal horn neuron receptive fields continued to enlarge. Researchers also have documented the significance of the spinal NMDA receptor to the induction and maintenance of central sensitization.
Significance for Pain Management
Once central sensitization is established, bigger doses of analgesics are often required to suppress it. Preemptive analgesia, or therapy before pain progresses, may lower the effects of all of these stimulation on the CNS. Woolf demonstrated that the morphine dose required to stop central hyperexcitability, given before short noxious electrical stimulation in rats, was one tenth the dose required to abolish activity after it had grown. This translates to clinical practice.
In a clinical trial of 60 patients undergoing abdominal hysterectomy, individuals who received 10 mg of morphine intravenously at the time of induction of anesthesia required significantly less morphine for postoperative pain control. Furthermore, pain sensitivity around the wound, referred to as secondary hyperalgesia, was also reduced in the morphine pretreated group. Preemptive analgesia was used with comparable success in an assortment of surgical settings, including prespinal operation and postorthopaedic operation.
A single dose of 40 or 60 mg/kg of rectal acetaminophen has a clear morphine-sparing effect in day-case surgery in children, if administered in the induction of anesthesia. Furthermore, children with sufficient analgesia with acetaminophen experienced significantly less postoperative nausea and vomiting.
NMDA receptor antagonists have imparted postoperative analgesia when administered preoperatively. Various reports exist in the literature supporting the use of ketamine and dextromethorphan in the preoperative period. In patients undergoing anterior cruciate ligament reconstruction, 24-hour patient-controlled analgesia opioid consumption was significantly less in the preoperative dextromethorphan category versus the placebo group.
In double-blind, placebo-controlled research studies, gabapentin was indicated as a premedicant analgesic for patients undergoing mastectomy and hysterectomy. Preoperative oral gabapentin reduced pain scores and postoperative analgesic consumption without gap in side effects as compared with placebo.
Preoperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has demonstrated a significant decrease in opioid use postoperatively. COX-2s are preferable due to their relative lack of platelet effects and significant gastrointestinal safety profile when compared with conventional NSAIDs. Celecoxib, rofecoxib, valdecoxib, and parecoxib, outside the United States, administered preoperatively reduce postoperative narcotic use by more than 40 percent, with many patients using less than half of the opioids compared with placebo.
Blocking nerve conduction in the preoperative period appears to prevent the development of central sensitization. Phantom limb syndrome (PLS) has been attributed to a spinal wind-up phenomenon.�Patients with amputation
often have burning or tingling pain in the body part removed. One possible cause is that nerve fibers at the stump are stimulated and the brain interprets the signals as originating in the amputated portion. The other is the rearrangement within the cortical areas so that area say for the hand now responds to signals from other parts of the body but still interprets them as coming for the amputated hand.
However, for patients undergoing lower-extremity amputation under epidural anesthesia, not one of the 11 patients who received lumbar epidural blockade with bupivacaine and morphine for 72 hours before operation developed PLS. For people who underwent general anesthesia without prior lumbar epidural blockade, 5 of 14 patients had PLS at 6 weeks and 3 continued to experience PLS at 1 year.
Woolf and Chong have noted that perfect preoperative, intraoperative, and postoperative treatment comprises of “NSAIDs to reduce the activation/centralization of nociceptors, local anesthetics to block sensory inflow, and centrally acting drugs such as opiates.” Decreasing perioperative pain with preemptive techniques enhances satisfaction, hastens discharge, spares opioid use, along with diminished constipation, sedation, nausea, and urinary retention, and may even stop the development of chronic pain. Anesthesiologists and surgeons should consider integrating these techniques in their everyday practices.
When pain occurs as a result of damage or injury in consequence of surgery, the spinal cord can attain a hyperexcitable state wherein excessive pain reactions occur that may persist for days, weeks or even years.
Why does localized injury resulting from trauma result in chronic, intractable pain in some patients? Tissue injury leads to a constellation of changes in spinal excitability, including elevated spontaneous firing, greater response amplitude and length, decreased threshold, enhanced discharge to repeated stimulation, and expanded receptive fields. The persistence of these changes, which are collectively termed central sensitization, appears to be fundamental to the prolonged enhancement of pain sensitivity which defines chronic pain. Numerous drugs and/or medications as well as local anesthetic neural blockade may limit the magnitude of the central nervous system (CNS) windup, as evidenced by diminished pain and diminished opioid consumption in the preemptive analgesic models.
Dr. Alex Jimenez’s Insight
Chiropractic care is an alternate treatment option which utilizes spinal adjustments and manual manipulations to safely and effectively restore as well as maintain the proper alignment of the spine. Research studies have determined that spinal misalignments, or subluxations, can lead to chronic pain. Chiropractic care is commonly utilized for pain management, even if the symptoms are not associated to an injury and/or condition in the musculoskeletal and nervous system. By carefully re-aligning the spine, a chiropractor can help reduce stress and pressure from the structures surrounding the main component of out body’s foundation, ultimately providing pain relief.
Enteric Nervous System Function and Pain
When it comes to the diminished use of drugs and/or medications, including opioids, in order to prevent side-effects like gastrointestinal health issues, the proper function of the enteric nervous system may be at play.
The enteric nervous system (ENS) or intrinsic nervous system is one of the key branches of the autonomic nervous system (ANS) and consists of a mesh-like system of nerves which modulates the role of the gastrointestinal tract. It’s capable of acting independently of the sympathetic and parasympathetic nervous systems, even though it might be affected by them. The ENS can also be called the second brain.�It is derived from neural crest cells.
The enteric nervous system in humans is made up of some 500 million neurons, including the numerous types of Dogiel cells, approximately one two-hundredth of the amount of neurons in the brain. The enteric nervous system is inserted into the lining of the gastrointestinal system, beginning at the esophagus and extending down to the anus. Dogiel cells, also known as cells of Dogiel, refers to some kind of multipolar adrenal tissues within the prevertebral sympathetic ganglia.
The ENS is capable of autonomous functions, such as the coordination of reflexes; even though it receives considerable innervation in the autonomic nervous system, it does and can operate independently of the brain and the spinal cord.�The enteric nervous system has been described as the “second brain” for a number of reasons. The enteric nervous system may operate autonomously. It normally communicates with the central nervous system (CNS) via the parasympathetic, or via the vagus nerve, and the sympathetic, that is through the prevertebral ganglia, nervous systems. However, vertebrate studies reveal that when the vagus nerve is severed, the enteric nervous system continues to function.
In vertebrates, the enteric nervous system includes efferent neurons, afferent neurons, and interneurons, all of which make the enteric nervous system capable of carrying reflexes and acting as an integrating center in the absence of CNS input. The sensory neurons report on mechanical and chemical conditions. The enteric nervous system has the ability to change its response based on such factors as nutrient and bulk composition. In addition, ENS contains support cells that are much like astroglia of the brain and a diffusion barrier around the capillaries surrounding ganglia that’s like the blood-brain barrier of blood vessels.
The enteric nervous system (ENS) plays a pivotal role in inflammatory and nociceptive processes. Drugs and/or medications that interact with the ENS have recently raised considerable interest because of their capacity to regulate numerous aspects of the gut physiology and pathophysiology. In particular, experiments in animals have demonstrated that�proteinase-activated receptors (PARs) may be essential to neurogenic inflammation in the intestine. Moreover, PAR2 agonists seem to induce intestinal hypersensitivity and hyperalgesic states, suggesting a role for this receptor in visceral pain perception.
Furthermore, PARs, together with the proteinases that activate them, represent exciting new targets for therapeutic intervention on the ENS. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Most, if not all, ailments of the body trigger pain. Pain is interpreted and sensed in the brain. Pain is modulated by two key types of drugs which operate on the brain: analgesics and anesthetics. The term analgesic refers to a medication that relieves pain without loss of consciousness. The expression central anesthesia refers to a medication that depresses the CNS. It’s distinguished by the lack of all perception of sensory modalities, for instance, loss of consciousness without loss of critical functions.
Opiate Analgesia (OA)
The most successful clinically used drugs for producing temporary analgesia and relief from pain are the opioid family, which includes morphine, and heroin. There are currently no additional powerful pain therapeutic options to opiates. Several side effects caused by opiate use include tolerance and drug dependence or addiction. In general, these drugs modulate the incoming pain information in the spine and central nervous system, in addition to relieve pain temporarily, and can also be called opiate producing analgesia (OA). Opiate antagonist is a drug that antagonizes the opioid effects, such as naloxone or maltroxone, etc.. They are competitive antagonists of opiate receptors. However, the brain has a neuronal circuit and endogenous substances which modulate pain.
Endogenous Opioids
Opioidergic neurotransmission is located throughout the brain and spinal cord and is believed to influence many functions of the central nervous system, or CNS, such as nociception, cardiovascular functions, thermoregulation, respiration, neuroendocrine functions, neuroimmune functions, food consumption, sexual activity, competitive locomotor behaviour as well as memory and learning. Opioids exert marked effects on mood and motivation and produce a sense of euphoria.
Three classes of opioid receptors are identified: ?-mu, ?-delta and ?-kappa. All 3 classes are widely dispersed in the brain. The genes encoding each one of these have been cloned and found to function as members of the G protein receptors. Moreover, three major types of endogenous opioid peptides that interact with the above opiate receptors have been recognized in the central nervous system, including, ?-endorphins, enkephalins and the dynorphins. These 3 opioid peptides are derived from a large protein receptor by three different genes, such as the proopiomelanocortin, or POMC, gene, the proenkephalin gene and the prodynorphin gene.�The opioid peptides modulate nociceptive input in two ways: first, they block neurotransmitter release by inhibiting Ca2+ influx into the presynaptic terminal, or second, they open potassium channels, which hyperpolarizes neurons and inhibits spike activity. They act on various receptors within the brain and spinal cord.
Enkephalins are considered the putative ligands for the ? receptors, ? endorphins for its ?-receptors, and dynorphins for the ? receptors. The various types of opioid receptors are distributed differently within the peripheral and central nervous system, or CNS. There’s evidence for functional differences in these receptors in various structures. This explains why many undesirable side effects occur after opiate treatments. For instance, mu (?) receptors are widespread in the brain stem parabrachial nuclei, where a respiratory center and inhibition of these neurons may cause what’s known as respiratory depression.
Central or peripheral terminals of nociceptive afferent fibers feature opiate receptors in which exogenous and endogenous opioids could act to modulate the capability to transmit nociceptive information. Additionally, high densities of opiate receptors are found in periaqueductal gray, or PAG, nucleus raphe magnus, or NRM, and dorsal raphe, or DR, from the rostral ventral medulla, in the spinal cord, caudate nucleus, or CN, septal nucleus, hypothalamus, habenula and hippocampus.�Systemically administered opioids at analgesic dosages activate spinal and supraspinal mechanisms via ?, ?, and ? type opioid receptors and regulate pain signals to modulate symptoms.
Neuronal Circuits and Pain Modulation
For many decades it was suggested that somewhere in the central nervous system there is a circuit which can modulate incoming pain details. The gate control theory and the ascending/descending pain transmission system are two suggestions of such a circuit. Below, we will discuss both in further detail.
Gate Control Theory
The initial pain modulatory mechanism known as the gate control theory, has been proposed by Melzack and Wall in the mid 1960’s. The notion of the gate control theory is that non-painful input closes the gates to painful input, which results in avoidance of the pain sensation from travel into the CNS, for example, non-noxious input, or stimulation, suppresses pain.
The theory implies that collaterals of the large sensory fibers carrying cutaneous sensory input activate inhibitory interneurons, which inhibit and regulate pain transmission data carried from the pain fibers. Non-noxious input inhibits pain, or sensory input, and closes the gate to noxious input. The gate control theory demonstrates that in the spinal cord level, non-noxious stimulation will create presynaptic inhibition on dorsal root nociceptor fibers that synapse on nociceptors spinal neurons (T). This presynaptic inhibition will also prevent incoming noxious information from reaching the CNS, for example, it will shut the gate to incoming toxic information.
The gate control theory was the rationale for the idea behind the production and utilization of the transcutaneous electrical nerve stimulation, or TENS, for pain relief. In order to be effective, the TENS unit generates two different present frequencies below the pain threshold that can be taken by the patient. This process has found a degree of achievement in chronic pain treatment.
Evidence for an inherent analgesia system was found by intracranial electrical stimulation of certain discrete brain regions. These areas would be the periaqueductal gray, or PAG, and nucleus raphe magnus, or NRM, dorsal raphe, or DR, caudate nucleus, or CN, septal nucleus, or Spt, along with other nuclei. Such stimulation or sensory signals, inhibits pain, making analgesia without behavioral suppression, while the touch, temperature and pressure sensation stays intact. According to research studies, SPA, or stimulation produced analgesia, is more pronounced and continues for a longer period of time after stimulation in humans than in experimental animals. Additionally, during SPA, the subjects, however, still respond to nonpainful stimulation like temperature and touch within the circumscribed region of analgesia. The most effective CNS, or central nervous system regions for SPA to occur, would be in the PAG and the raphe nuclei, or RN.
Electrical stimulation of PAG or NRM inhibits spinal thalamic cells, or spinal neurons that project monosynaptically to the thalamus, in laminae I, II and V to ensure the noxious information from the nociceptors which are ultimately modulated in the level of the spinal cord. Furthermore, PAG has neuronal connections to the nucleus raphe magnus, or NRM.
The activity of the PAG most likely occurs by activation of the descending pathway from NRM and likely also by activation of ascending connections acting on greater subcortical levels of the CNS. In addition, electric stimulation of PAG or NRM produces behavioral analgesia, or stimulation produced analgesia. Stimulation produced analgesia, or SPA causes the release of endorphins which can be blocked by the opiate antagonist naloxone.
During PAG and/or RN stimulation, serotonin, also medically referred to as 5-HT, can also be discharged from ascending and descending axons from subcortical nuclei, in spinal trigeminal nuclei and in the spinal cord. This release of 5-HT modulates and regulates pain transmission by inhibiting or blocking incoming neural action. Depletion of 5-HT by electrical lesion of the raphe nuclei or with a neurotoxic lesion made by local injection of a chemical agent such as parachlorophenylalanine, or PCPA, results in blocking the power of opiate, both intracranial and systemic, as well as that of electrical stimulation in order to produce analgesia.
To confirm if the electric stimulation produced analgesia via the release of opiate and dopamine, then the region is locally microinjected with morphine or 5-HT. All these microinjections ultimately create analgesia. These processes also provide a way of identifying brain areas related to pain suppression and assist to produce a map of pain centers. The most effective way of producing opiate analgesia, or OA, is by intracerebral injection of morphine into the PAG.
The PAG and RN as well as other brain structures in which analgesia is produced, are also rich in opiate receptors. Intracerebral opioid administration produced analgesia and SPA can be blocked by systemic or from local microinjections of naloxone, the morphine antagonist, into the PAG or RN. For that reason, it’s been suggested that the two, both OA and SPA, operate by a frequent mechanism.
If OA and SPA behave through the same intrinsic system, then the hypothesis that opiates activate a pain-suppression mechanism is much more likely. As a matter of fact, current evidence suggests that microinjections of an opiate into the PAG activate an efferent brainstem system which inhibits pain transmission at segmental spinal cord levels. These observations imply that analgesia elicited from the periaqueductal gray, or PAG, demands a descending pathway into the spinal cord.
Dr. Alex Jimenez’s Insight
Pain modulation occurs through the process of electrical brain stimulation which occurs due to the activation of descending inhibitory fibers, which regulate or inhibit the input and output of certain neurons. What has been described as opioid and serotonergic antagonists, is believed to reverse both local opiate analgesia and brain-stimuli generated analgesia. The sensory signals or impulses in the central nervous system are ultimately controlled by both ascending and descending inhibitory systems, utilizing endogenous opioids or other endogenous substances, such as serotonin as inhibitory mediators. Pain is a complex perception which can also be influenced by a variety of other factors, including emotional state.
Mechanisms of Pain Modulation
Ascending and Descending Pain Suppression Mechanism
The primary ascending pain fibers, such as the A ? and C fibers, reach the dorsal horn of the spinal cord from peripheral nerve areas in order to innervate the nociceptor neurons in Rexed laminae I & II. Cells from Rexed lamina II make synaptic connections in Rexed layers IV to VII. Cells, particularly within laminae I and VII of the dorsal horn, give rise to ascending spinothalamic tracts. In the spinal level, opiate receptors are located in the presynaptic endings of their nocineurons and in the interneural level layers IV to VII from the dorsal horn.
Activation of opiate receptors at the interneuronal level produces hyperpolarization of the neurons, which lead to the the inhibition of activation as well as the release of substance P, a neurotransmitter involved in pain transmission, thus preventing pain transmission. The circuit which consists of the periaqueductal gray, or PAG, matter in the upper brain stem, the locus coeruleus, or LC, the nucleus raphe magnus, or the NRM, and the nucleus reticularis gigantocellularis, or Rgc,� leads to the descending pain suppression pathway, which inhibits incoming pain data at the spinal cord level.
As stated before, opioids interact with the opiate receptors in distinct central nervous system levels. These opiate receptors are the normal target regions for hormones and endogenous opiates, such as the endorphins and enkephalins. Due to binding at the receptor in subcortical websites, secondary changes which result in some change in the electrophysiological properties of the neurons and regulation of their ascending pain information.
What activates the PAG to exert its consequences? It was discovered that noxious stimulation triggers neurons in the nucleus reticularis gigantocellularis, or RGC. The nucleus Rgc innervates both PAG and NRM. The PAG sends axons into the NRM, and nerves in the NRM send their axons to the spinal cord. Additionally, bilateral dorsolateral funiculus, or DLF, lesions, referred to as DLFX, block the analgesia produced by both electrical stimulation and by microinjection of opiates directly into the PAG and NRM, but they just attenuate the systemic analgesic effects of opiates. These observations support the hypothesis that discrete descending pathways from the DLF are necessary for both OA and SPA.
The DLF is comprised of fibers originating from several brainstem nuclei, which can be serotonergic, or 5-HT, from nerves located inside the nucleus raphe magnus, or NRM; dopaminergic neurons originating from ventral tegmental area, or VTA, and adrenergic neurons originating from the locus coeruleus, or LC. These descending fibers suppress noxious input in the nociceptive spinal cord neurons in laminae I, II, and V.
Opiate receptors have also been discovered in the dorsal horn of the spinal cord, chiefly in Rexed laminae I, II, and V, and such spinal opiate receptors mediate inhibitory effects on dorsal horn neurons transmitting nociceptive information. The action of morphine seems to be exerted equally in the spinal cord and brainstem nuclei, including the PAG and NRM. Systemic morphine acts on both brain stem and spinal cord opiate receptors to produce analgesia. Morphine binds the brainstem opiate receptors, which triggers the brainstem descending serotonergic pathway into the spinal cord as well as the DLF, and these have an opioid-mediated synapse at the level of the spinal cord.
This observation demonstrates that noxious stimuli, instead of non-noxious stimulus, determine the gate control theory, which are critical for the activation of the descending pain modulation circuit where pain inhibits pain via the descending DLF pathway. In addition, there are ascending connections in the PAG and the raphe nuclei into the PF-CM complex. These thalamic regions are a part of the ascending pain modulation at the diencephalon degree.
Stress Induced Analgesia (SIA)
Analgesia may be produced in certain stressful circumstances. Exposure to many different stressful or painful events generates an analgesic response. This phenomenon is known as stress induced analgesia, or SIA. Stress induced analgesia has been believed to give insight into the physiological and psychological factors that trigger endogenous pain control and opiate systems. By way of instance, soldiers injured in battle or athletes hurt in sports sometimes report that they don’t feel pain or discomfort during the battle or game, nevertheless, they will go through the pain afterwards once the specific situation has stopped. It’s been demonstrated in animals that electrical shocks cause stress-induced analgesia. Based on these experiments, it is assumed that the pressure the soldiers and the athletes experienced suppressed the pain which they would later experience.
It’s believed that endogenous opiates are produced in response to stress and inhibit pain by triggering the midbrain descending system. Furthermore, some SIA exhibited cross tolerance with opiate analgesia, which indicates that this SIA is mediated via opiate receptors. Experiments using different parameters of electrical shock stimulation demonstrate such stress induced analgesia and some of those anxieties that produce analgesia could be blocked by the opioid antagonist naloxone, whereas others were not blocked by naloxone. In conclusion, these observations lead to the decision that both opiate and non-opiate forms of SIA exist.
Somatovisceral Reflex
The somatovisceral reflex is a reflex in which visceral functions are activated or inhibited by somatic sensory stimulation. In experimental animals, both noxious and innocuous stimulation of somatic afferents are proven to evoke reflex changes in sympathetic efferent activity and, consequently, effector organ function. These phenomena have been shown in such regions as the gastrointestinal tract, urinary tract, adrenal medulla, lymphatic cells, heart and vessels of the brain and peripheral nerves.
Most frequently, incisions are elicited experimentally by stimulation of cutaneous afferents, even though some work has also been conducted on muscle and articular afferents, including those of spinal cells. The ultimate responses will represent the integration of multiple tonic and reflex influences and might exhibit laterality and segmental trends as well as variable excitability in line with the afferents involved. Given the complexity and multiplicity of mechanisms involved in the last expression of the reflex response, attempts to extrapolate to clinical situations should most likely be conducted in favor of further systematic physiological studies.
The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Pain perception varies across different people based on their mood, psychological condition and previous experience, even when pain is brought on by similar physical stimulation and ends in a similar level of damage. In 1965, Ronald Melzack and Patrick Wall summarized a scientific theory about the psychological influence on pain perception; known as the gate control theory.
If it wasn’t for this theory, pain perception would still be connected to the intensity of the pain stimulation and the degree of damage caused to the affected tissue. But Melzack and Wall made it clear that pain perception is far more complicated than we believe.
Based on the gate control theory, pain signals aren’t free to travel to the brain as soon as they’re generated in the region of the damaged or injured tissues. These first need to encounter specific neural gates found at the level of the spinal cord level, where these gates ascertain whether the pain signals should reach the brain or not. To put it differently, pain is perceived when the gate gives way to the pain signals and it is not as intense or it is not sensed at all when the gate closes for the signs to pass through.
This theory provides the explanation for why people find relief by massaging or rubbing a damage, injured or painful site. Although the gate control theory cannot demonstrate the whole picture of the fundamental system which underlies pain, it’s visualized the mechanism of pain perception and it has created a pathway to various pain management treatment approaches.
Nerve Fibers in Transmission of Sensory Signals
Every organ, or portion of the human body, has its own nerve supply which are in charge of carrying electric impulses generated in reaction to several senses, such as touch, temperature, pressure and pain. These nerves, which make up the peripheral nervous system, transmit these sensory signals, to the central nervous system, or the brain and the spinal cord. These impulses are then translated and perceived as senses. The peripheral nerves send signals to the dorsal horn of the spinal cord and from there, the sensory signals are transmitted into the brain through the spinothalamic tract. Pain is a sensation which alarms a person that a tissue or certain portion of the human body has been damaged or injured.
Due to their axonal diameter and their conduction speed, nerve fibers can be categorized into three different types, nerve fibers A, B and C. The C fibers are considered to be the smallest among the three different types. Moreover, there are four subtypes within the A fibers: A-alpha, A-beta, A-gamma and A-delta. From the A fiber subtypes, the A-alpha fibers are the largest and the A-delta fibers are the smallest.
The A fibers which are larger compared to the A-delta fibers, carry sensations, such as touch, pressure, etc., into the spinal cord. The A-delta fibers as well as the C fibers carry pain signals into the spinal cord. A-delta fibers are faster and carry sharp pain signals while the C fibers are slower and carry diffuse pain signals.
When thinking about that the conduction velocity of nerve fibers, the A-alpha fibers, which are the biggest A nerve fibers, have greater conduction speed compared to A-delta fibers and C fibers, which are considered to be the smallest nerve pathways. When a tissue is damaged or injured, the A-delta fibers are activated first, followed by the activation of the C fibers. These nerve fibers have a tendency to carry the pain signals to the spinal cord and then to the brain. However, the pain signals are transmitted through a much more complex process than what is simply explained above.
The gate control theory implies that the sensory signals or impulses which are transmitted by the nerve fibers encounter neural gates at the level of the spinal cord and these will need to get cleared through those gates to reach the brain. Various factors determine how the pain signals ought to be treated in the neurological gates, including:
The intensity of the pain signals
The degree of another sensory signal, such as touch, temperature and pressure, if produced at the site of damage or injury
The message from the brain itself to deliver the pain signals or not
As previously mentioned, the nerve fibers, both large and small, carrying the sensory signals, end in the dorsal horn of the spinal cord from where the impulses are transmitted into the brain. According to the original postulate of Melzack and Wall, the nerve fibers project to the substantia gelatinosa, or SG, of the dorsal horn and the initial central transmission (T) cells of the spinal cord. The SG consists of inhibitory interneurons that behave as the gate and ascertain which sensory signals should get to the T cells then go further throughout the spinothalamic tract to finally reach the brain.
When the pain signals carried by the small nerve fibers, or the A-delta fibers and the C fibers, are somewhat less intense compared to another non-pain sensory signal like touch, temperature and pressure, the inhibitory neurons stop the transmission of the pain signals through the T cells. The non-pain signals override the pain signals and therefore the pain is not perceived by the brain. When the pain signals are somewhat more intense compared to the non-pain signals, the inhibitory neurons are inactivated and the gate is opened. The T cells transmit the pain signals into the spinothalamic tract which carries those impulses to the brain. As a result, the neurological gate is influenced by the relative amount of activity from the large and the small nerve fibers.
How Emotions and Thoughts Affect Pain
The gate control theory also suggests that the pain signal transmission could be affected by thoughts and emotions. It’s well known that people do not feel that a chronic pain or, more appropriately, the pain does not disturb them if they concentrate on other activities which interest them. Whereas, people who are depressed or anxious may often feel intense pain and can also find it challenging to cope with. This is due to the fact that the brain sends messages through descending nerve fibers which stop, reduce or enhance the transmission of pain signals through the gate, depending on the emotions and thoughts someone may be going through.
Gate Control Theory in Pain Management
The gate control theory has caused a radical revolution within the field of pain management. The theory suggested that pain management can be accomplished by influencing the larger nerve fibers that carry non-pain stimulation. The concept has also paved way for more research on cognitive and behavioral strategies to achieve pain relief.
Among the most tremendous advances in pain management research is the arrival of Transcutaneous Electrical Nerve Stimulation (TENS). The gate control theory forms the cornerstone of TENS. In this procedure, the selective stimulation of the large diameter nerve fibers taking non-pain sensory stimulation from a particular region nullifies or reduces the impact of pain signals from the region. TENS is a non-invasive and affordable pain control strategy that has been widely used for the treatment of chronic and intractable pain by various healthcare professionals, which may otherwise have been non-responsive to analgesics and surgical interventions. TENS is tremendously advantageous over pain drugs from the aspect that it does not have the problem of medication interactions and toxicity.
For instance, many doctors of chiropractic, or chiropractors, utilize TENS and other electrotherapeutic procedures in their practice. These are generally utilized along with spinal adjustments and manual manipulations to increase circulation as well as to aid in the support of chiropractic care. Several other invasive and noninvasive electrical stimulation techniques are discovered to be helpful in several chronic pain conditions such as arthritic pain, diabetic neuropathy, fibromyalgia, etc.. The theory has also been extensively studied in treating chronic back pain and cancer pain. However, favorable results are not attained in some conditions and the long term efficacy of these techniques based on the theory still remains under consideration.
Dr. Alex Jimenez’s Insight
Chiropractic care is widely utilized to benefit patients with chronic pain. Symptoms of persistent pain and discomfort have become a big health issue in the United States where many years of research have found that drugs and/or medications are not necessarily a solution to the problem. The gate control theory, which was first proposed over half a century ago, has offered healthcare professionals new insights on the perception of pain, providing a variety of pain management treatment methods, such as the use of transcutaneous electrical nerve stimulation, or TENS, as well as other electrotherapeutic procedures. Chiropractors can help with pain management through spinal adjustments and manual manipulations, and through the use of TENS.
Nevertheless, the gate control theory has radically revolutionized the area of pain research and it has achieved to get numerous studies which aim at presenting a pain-free lifestyle into the patients who suffer from chronic pain. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Feet are important. When you consider what your feet go through, taking 8,000 steps over the course of a day, according to the Illinois Podiatric Medical Association (IPMA), it�s easy to see how 75 percent of all Americans will have some type of foot pain at some point in their lives. Plantar fasciitis is a common and very painful foot condition that can become chronic if not treated. It is also a condition that responds very well to chiropractic care.
Plantar Fasciitis Explained
Plantar fasciitis is caused when the ligament that connects your toes to your heel (the plantar fascia) becomes inflamed, swollen, and weak. This causes the bottom of your foot or heel to hurt when you walk or stand, especially when you first wake or after sitting for a long time.
The pain tends to be sharp and stabbing. It is the most common cause of heel pain and is more prevalent among middle aged people. However, anyone can get it at any age, especially people who spend a lot of time on their feet.
How Chiropractic Helps Plantar Fasciitis
Chiropractic care is a very effective treatment for plantar fasciitis as well as the pain that is caused by the condition. Chiropractic for plantar fasciitis involves a very precise technique that involves adjustments to the feet and ankles as well as spinal alignment. This provides several benefits.
Reduces Stress in the Plantar Fascia � When a ligament is inflamed or stressed the tissue can develop very small tears that cause the pain of plantar fasciitis. Chiropractic adjustments made to the heel and foot take the pressure off of the plantar fascia, allowing it to relax.
Promotes Healing � When the stress on the plantar fascia is reduced through these chiropractic adjustments, the foot can begin to heal. The chiropractor may also recommend specific exercises that stretch the ligament and help it heal. They may also advise the patient of lifestyle changes as well as nutritional adjustments that can help with the pain and condition.
Provides Effective Pain Management � Chiropractic is a very effective way to manage pain throughout the body. Spinal adjustments allow better communication between the brain and nerves, allowing the central nervous system to function more effectively. Condition specific adjustments speak to the root of the problem, not just the symptoms. This means a more effective form of pain management that is longer lasting.
Reduces the Risk of Further Injury � When a person has a condition like plantar fasciitis, they will often adjust their gait in an effort to avoid the pain. This puts stress on other parts of the body and can lead to back pain, sore joints, strained muscles, and other problems. Chiropractic�s whole body approach helps the person realign their body properly so that they stand and walk properly. This helps them avoid further injury and discomfort.
Chiropractic Complements Other Treatments
While chiropractic care can be an effective treatment for plantar fasciitis on its own, it is also a very good complement to other treatments for the condition. Patients may use chiropractic in conjunction with physical therapy, massage, and even injections to manage the pain and treat the condition. It can also help with speeding healing and helping to provide better mobility.
Plantar fasciitis can take several months to heal, but by adding chiropractic treatments to your recovery plan, you can feel better faster while more effectively managing your pain. Regular chiropractic treatments can also keep the condition from becoming chronic. By working with your chiropractor and following their recommendations you can reduce your pain and shorten your healing time.
Injury Medical Chiropractic Clinic & Chronic Pain & Treatments
Chiropractic care for individuals with cerebral palsy is considered (in most cases) a natural form of treatment that helps with several musculoskeletal and nervous system conditions that normally affect individuals with the disorder. Past results have been so successful that chiropractic care is an extremely sought plan of treatment to assist with numerous health issues.
What is Chiropractic Care?
Chiropractic care, sometimes known as chiropractic intervention, is an alternative treatment option where licensed chiropractors perform various techniques to help decrease pain and discomfort, and also to restore proper musculoskeletal and nervous system functions. According to the American Chiropractic Association, or the ACA, chiropractic care concentrates on musculoskeletal system disorders and nervous system disorders.
The Palmer College of Chiropractic reports that “no portion of your body leaks the dominance of your nervous system.” This usually means that misalignments of the spine, or subluxations, as well as other improper functions of the spinal cord along with different regions of the human body can lead to poor health and improper musculoskeletal and nervous system functioning.
Treatment includes focusing on various areas of the human body, such as the back, neck, shoulders, upper and lower extremities, and joints in the arms and legs. Chiropractic care may also center on rehabilitation and therapeutic exercises as well as individualized diet programs in order to help increase strength, mobility and flexibility. Treatment is normally performed without any drugs, although some chiropractors have the capacity of prescribing specific medications, if needed.
Chiropractic Care and Cerebral Palsy
A range of documented case studies show that kids with cerebral palsy who received chiropractic care were able to sit up (when they formerly couldn’t), walk up stairs without help, and use their arms and hands better.
For example, Dr. Dan Van Roon, of Van Roon Chiropractic in Massachusetts, wrote that an 8-year-old girl with cerebral palsy, who suffered from frequent seizures and tremors, was treated with chiropractic care after previous clinical efforts, such as physical therapy and acupuncture, proved to be ineffective. Within fourteen days of getting chiropractic care, that comprised of 22 chiropractic adjustments, her mother reported that the child was able to walk upright and walk up stairs by herself (two things she had been incapable of performing).
The young girl’s parents also reported that not only were her muscles not as limp, but she gained confidence, walked and also had a large improvement in her emotional and psychological state of being.
In another case, Dr. Van Roon wrote that a 7-year-old boy who didn’t start walking until he was 5, also revealed significant improvement after receiving chiropractic care. Before treatment, he had seizures, pain and numbness in his limbs, tremors, throat pain, nosebleeds, anemia and excruciating foot pain. After his first chiropractic care session, he started showing improvement.
As treatment progressed, so did the boy’s progress. He gained strength, began walking longer distances, and had progress in both sleeping quality and education.
Additional areas of improvement reported after kids with cerebral palsy had chiropractic care included a decrease in:
Pain and muscle stiffness
Breathing problems
Drooling
Muscle contractions
Neck pain
Musculoskeletal conditions
Gait issues
Spine issues
Anxiety and stress
Headaches and chest pain
Leg/arm problems
Speech problems due to respiratory issues
Spasticity
Urinary incontinence
Common Chiropractic Care Treatment Methods
Throughout the initial chiropractic care session, a full medical history should be supplied so that the chiropractor is first familiar with the individual’s medical history. Then, the chiropractor may ask you and/or your child specific questions about pain and any activities which make the symptoms worse, followed by an exam which could include diagnostic tests, such as X-rays or a MRI test, that may include analyzing the individual’s:
Neurological integrity
Range of movement (in the affected region)
Muscle tone and strength
Abnormalities
Misalignment
Flexion Distraction therapy, and much more
Treatment depends upon medical history and physical exam results. However, common chiropractic care treatment methods include:
Spine adjustments, which can include spinal adjustments and manual manipulations, the “Activator” technique, and/or the “Gonstead” method
Adjustment to joint dysfunctions
Massaging
Electrical stimulation
Traction
Heat/cold applications
Myofacial release
Treatment will consist of a variety of sessions over time. Each session may last anywhere from 30 minutes to an hour, based upon the chiropractor’s techniques and the medical issues and problems. For instance, treatment for lower back pain may require 1 to 3 visits weekly for up to 2 to 3 weeks. Chiropractic care is used in many different settings, like hospitals, clinics, or a private healthcare professional’s office. Most chiropractors run their business from a private office.
Furthermore, a chiropractor may utilize or recommend a series of rehabilitation stretches and exercises to improve some of the conditions associated with cerebral palsy. Daily range-of-motion (ROM) exercises are important to prevent or delay contractures which are secondary to spasticity and to keep the mobility of joints and soft tissues. Stretching exercises are performed to increase range of motion. Progressive resistance exercises must be used so as to increase strength. Also, the utilization of age-appropriate play and of adaptive toys and games based on the desired exercises are important to elicit the child’s complete alliance in the case of cerebral palsy. Strengthening knee extensor muscle exercises aids improve crouching and stride length. Postural and motor control training is essential and should follow the developmental sequence of normal kids (that is, neck and head control ought to be achieved, if at all possible, before advancing to back control).
Dr. Alex Jimenez’s Insight
Chiropractic care is an alternative treatment option which utilizes spinal adjustments and manual manipulations to carefully influence the human body’s musculoskeletal and nervous system. Chiropractic interventions focus on improving overall health and wellness by alleviating pain and discomfort associated with neck and back pain as well as for specific health conditions, such as cerebral palsy and fibromyalgia. Several research studies have demonstrated that chiropractic care is a safe and effective, treatment method towards increasing strength and range of motion in individuals with cerebral palsy, improving quality of life and affecting longevity. Because spinal adjustments and rehabilitation improve the way the brain and the rest of the body function together, evidence has shown how chiropractic care can help improve some conditions of cerebral palsy.
Things to Know Before Visiting a Chiropractor
Sometimes, young children, and parents may get fearful of a few things that happen in a chiropractor’s office, but rest assured these things are normal and there’s no need to stress. For example, when a chiropractor is in the process of performing a chiropractic adjustment, you’ll probably hear a popping noise. This does not mean that any bones are broken. It simply means that the chiropractor released gas from fluids surrounding the joints.
The individual may also experience mild discomfort, but typically, visiting a chiropractor should not be painful. If your child cries due to pain or complains that the treatments are excessively painful, don’t be afraid to talk about it with the healthcare professional, and when needed, seek out another one.
When choosing a chiropractor, especially for children with cerebral palsy, it’s suggested to locate somebody with experience not just with treating children, but also treating individuals with cerebral palsy. Other factors to consider when picking a chiropractor comprise of:
Education
Training
Accreditation or Licensing
Expertise working with other healthcare providers and readily coordinating care
If you have any questions or need tips on which chiropractor to select, start with your or your child’s primary healthcare provider. You’ll also need to contact your insurance provider, to be sure they pay for chiropractic care. While some insurances will cover it, other insurances may not cover what’s considered “complementary” care. Some insurances may cover the costs of a chiropractor only after your child’s primary care doctor grants a medical referral to a chiropractor. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Sciatica is a condition characterized by painful symptoms, often originating from the lower back all the way down to the toes. Sciatica is brought on by the irritation of the sciatic nerve. The sciatic nerve begins around the lumbar spine and runs down to the feet. Sciatica can be caused by the irritation of the sciatic nerve anywhere along its length. But the most frequent cause of sciatica is irritation to the sciatic nerve either in the lower back or in the gluteal region caused by poor posture.
Sciatica generally presents itself as a very specific collection of symptoms. If you can’t pin-point exactly where your pain is (i.e. if the entire leg just aches or if your symptoms are quite vague), it’s unlikely that you have sciatica. Sciatica typically runs as a band of pain through the low back and the buttocks, and also down the hamstring, occasionally traveling as low as the calf muscle and even the feet and toes. If you experience a sensation similar to pins and needles and/or numbness, the severity of your sciatica is much worse than if you just have pain.
Poor Posture Reasons For Sciatica
Poor workplace ergonomics can be a significant contributing aspect to the development of sciatica. Further, if you already have sciatica, inadequate workstation ergonomics is very likely to make it worse. A leading ergonomic issue in regard to sciatica is increased back pain that’s brought on by poor posture while sitting and standing. It you embrace a slouched or slumped position, or you lean forward at your desk, you place a tremendous amount of strain on your lumbar spine. This can result in your lower back muscles going into spasm. The sciatic nerve has to operate through those muscles. If they are spasmodic, there is a heightened likelihood that the sciatic nerve will end up irritated and develop symptoms of sciatica.
Sitting for extended periods of time is just another issue, for two reasons:
First, in sitting, your bodyweight is transferred from your upper body to your pelvis, throughout the lumbar spine. This implies that there is a continuous, and dull, compressive force going through the lower spine. Over time, this may result in irritation to the nerves as they leave the spinal cord canal. This is much more of a problem for people who have sciatica. Sciatica will frequently cause inflammation around the nerve root where it exits the spinal canal. This means there’s less “wiggle” room for the nerve to move and continuous compression may impinge this nerve, causing symptoms.
Second, the sciatic nerve runs throughout the gluteal region. Especially, it runs through a muscle called the piriformis muscle, which happens to be in about the region of your sitting bone. When you sit, you really literally sit on the piriformis muscles along with the sciatic nerve. Therefore, when you sit you’re compressing the sciatic nerve. Compression that is constant could lead to the piriformis muscle moving into spasm. Similarly to above, in the event the piriformis muscle goes into spasm, the sciatic nerve is very likely to be compacted and irritated, leading to some kind of sciatic symptoms.
Furthermore, healthcare professionals say that poor posture may cause more than just back pain and sciatica. Poor posture may actually cause a variety of health issues, according to research studies.
Effects of Poor Posture
Posture is an important part of preventing issues which range from back pain to fatigue. When the spine is properly aligned, the spine is stabilized and supported, however as you slouch or practice other methods of poor posture, your spine no longer gets the support it needs to remain balanced, leading to many health issues. The following health issues may also present themselves as a result of poor posture.
Sore Muscles
The most common effect of poor posture includes sore muscles. As you slouch, the muscles have to work harder to keep the spine protected and stabilized. The extra work on these muscles may cause muscle stiffness and fatigue. This can lead to chronic health issues with sore and tight muscles from the neck all the way down to the lower spine. Two big muscle groups which bare the brunt of these problems are the flexors and extensors of the back, which allow you to bend forward and lift objects.
Spinal Curvature
Among the most serious health issues that could happen with bad posture is developing a severe spinal curvature. As stated by the Chiropractic Resource Organization, the human spine has four natural curves which form an “s” shape. When poor posture is practiced, the spine can experience pressure, gradually influencing the spine curves to modify their positions. The spine is particularly designed to help absorb shock and keep you balanced, but as the spinal column position changes, this capacity becomes compromised.
Subluxations
Once the spinal curve is altered, one major problem that may occur are subluxations, or spinal misalignments. Vertebral subluxations occurs when a vertebrae becomes misaligneds from the rest of the spine. This also affects the total integrity of the remaining spine. These misalignments can eventually lead to chronic health issues, such as stress and aggravation of neighboring spinal nerves.
Blood Vessel Constriction
As bad posture changes the alignment of the spine, the consequent movement and subluxations can cause problems with blood vessel constriction. The constriction of the arteries across the spine can cut off blood supply to the cells of their muscles, which may influence nutrient and oxygen supply. Blood vessel constriction can also raise your chances of clot formation and issues using deep vein thrombosis.
Nerve Compression
One of the most frequent side effects of bad posture is nerve compression. As the spine changes in shape, the resulting movements or subluxations can put stress on the surrounding spinal nerves. Since the nerves which connect to the spine come from all over the body, these pinched nerves can not only cause neck and back pain but might also cause pain in other unrelated regions of the body.
In a 2013 study conducted Japan done by Kamitani et al, posture was connected to a decrease in lifespan and in activities of daily living. The study concluded that posture had a significant impact on quality of life as well as life expectancy.
Dr. Alex Jimenez’s Insight
Whether you’re slouching over your laptop, looking down at your mobile phone, bending over to pick up a box or simply sitting behind a desk for an extended amount of time, all of these regular activities can negatively affect your posture. Poor posture can not only cause back pain and symptoms of sciatica, it can manifest into a wide array of health issues if not properly corrected in time. Various research studies have even demonstrated that poor posture can affect longevity and life expectancy. Chiropractic care can help carefully restore the alignment of the spine, to recover the human body from the effects of poor posture.
Correcting Poor Posture to Improve Sciatica
The first thing that needs to be done to correct poor posture is to find a diagnosis from a healthcare professional, such as a chiropractor or physical therapist. They will be able to aid you with a treatment program and with hands-on therapy to alleviate your symptoms. Chiropractic care is a well-known, alternative treatment option which focuses on the diagnosis, treatment and prevention of a variety of injuries and/or conditions associated to the musculoskeletal and nervous system. Also, an ergonomic evaluation is a good idea. It is best practice to allow an expert to perform an ergonomic assessment for you when you’re injured, as opposed to attempting to do it yourself. This is because of the probability of making things worse when it is not done properly.
But if an ergonomic appraisal isn’t a possibility for you, consider these hints:
?Try to integrate some standing into your daily work day, to decrease the constant pressure on the sciatic nerve.
Take regular walks during your working day and consider a stretch to your gluteal area.
Make sure your workstation is set up ergonomically to prevent additional exacerbation, paying special attention to the following:
Ensure you are not leaning forwards;
Make sure that your backrest is large enough so that the lumbar support is comfortably supporting the lower spine;
Ensure your seat cushion isn’t too tough;
Ensure that your feet are well supported;
Make sure your office chair is not too low, as this promotes slouching.
One last note, sciatica may be a difficult condition to take care of. So where possible, involving a healthcare professional, such as a chiropractor, or doctor of chiropractic, is in your best interests, towards correcting your poor posture and improving symptoms of sciatica, among others.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
According to statistics, approximately 80% of people will experience symptoms of back pain at least once throughout their lifetimes. Back pain is a common complaint which can result due to a variety of injuries and/or conditions. Often times, the natural degeneration of the spine with age can cause back pain. Herniated discs occur when the soft, gel-like center of an intervertebral disc pushes through a tear in its surrounding, outer ring of cartilage, compressing and irritating the nerve roots. Disc herniations most commonly occur along the lower back, or lumbar spine, but they may also occur along the cervical spine, or neck. The impingement of the nerves found in the low back due to injury and/or an aggravated condition can lead to symptoms of sciatica.
The spine is divided into three different parts: the neck or cervical spine, the upper back or thoracic spine, and the lower back or lumbar spine. Each region of the spine has its own function and abilities. The lower spine helps you lift heavy objects because it is elastic. The neck is also constructed for flexibility, but the upper spine is built for stability and is also essential in supporting the body.
All your ribs stretch out from the thoracic spine. While these ribs help to create a cage that protects most of your organs, if the thoracic spine is damaged, it can cause pain and discomfort in the shoulder and back area. To be able to acquire the best, most effective treatment for your upper back pain (also known as mid-back pain), you should first understand what may be causing it. A healthcare professional, such as chiropractor, can help you figure that out, but here are some of the most common causes of upper back pain.
Causes of Upper Back Pain
Poor posture: Sitting with a rounded back and the shoulders hunched forward can place too much stress on the muscles of the upper and mid back. Because many office employees spend their work days sitting in front of the computer, poor posture is considered one of the top causes of upper back pain. Especially when you’re at your desk for so many hours per day, it’s easy to fall into the bad habit of not sitting correctly.
Improper lifting: In order to protect your spine when choosing to lift something up, you should also use correct body mechanics. Not using the proper form for lifting can cause injury and lead to upper back pain.
Carrying a heavy back pack:�Anybody who uses a heavy back pack may be at risk for back injury. An over-loaded back pack can be harmful to the spine, but most importantly, not wearing a backpack correctly (eg, only using one strap) can cause more harm.
Trauma/injury: Traumatic events, such as automobile accidents, can cause upper back pain as a result of various factors. It is possible to suffer a fracture to the vertebrae of the spine or part of your vertebrae can press on a spinal nerve, which can lead to pain.
Infection:�Even a paraspinal abscess or a spinal epidural abscess can compress the spinal cord or spinal nerves, causing upper back pain, depending on the affected region of the spine.
Osteoporosis: This is a condition which affects the bones, also you might not understand you’ve got osteoporosis until you experience a spinal fracture (eg, spinal compression fracture). Osteoporosis can weaken your bones, making them more likely to fracture and less inclined to carry your weight. You may develop upper back pain if you have osteoporosis on your thoracic spine. Weakened vertebrae don’t support your body’s weight as well, so tendons, ligaments, and muscles need to work harder to make up for that vertebrae. This can result in sprain, strain, or muscle fatigue as well as upper back pain, among other symptoms. In case you have a fracture or fractures due to osteoporosis, you will probably develop a round back from poor posture.
Kyphosis: When looked at from the side, your spine is supposed to curve in your upper back (thoracic spine) area; that curve is called a kyphotic curve or kyphosis. However, it can begin to curve out too much which is referred to as problematic kyphosis. Various conditions, such as osteoporosis, can cause kyphosis in the thoracic spine, leading to upper back pain.
Scoliosis: Scoliosis causes an unusual lateral curvature of the spine. It can make your spine look like an “S”or a “C” when seen from behind. If your spine is curving to the left or to the right in the upper back (thoracic spine), then you might have pain due to how the curve affects spinal nerves, muscles, and other soft tissues.
Other conditions: Upper back pain may develop in conjunction with other medical conditions not related to the spine. For instance:
Acid reflux (GERD)
Ulcer
Cardiac conditions, such as angina
Anatomical Structure and Upper Back Pain
The upper back, or the thoracic spine, is significantly more stable compared to the neck, or the cervical spine, and the low back, or lumbar spine. It doesn’t move as far as the other regions of the spine since one of its most important functions is to protect the inner organs in the chest. It does this in conjunction with the ribs, which are attached to the vertebrae in the thoracic spine.
However, the thoracic spine is less prone to suffer from intervertebral disc issues as well as joint problems that commonly impact the neck and low back. It is much less common, although that does not imply that you can not have a herniated disc causing your upper back pain. It is less frequent to have spinal health issues in the thoracic spine. The neck and low back move much more compared to the upper back, therefore discs and joints may wear out earlier from overuse and misuse.
Chiropractic Care for Upper Back Pain
Although less common than lower back pain, for instance, many people will visit a chiropractor’s office seeking relief for upper back pain. Working with a highly qualified doctor of chiropractic, patients can find relief from their upper back pain. In a chiropractic office, the terms of a treatment are on the patient.
Since many thoracic spine issues also consist of cervical or lumbar spinal issues, a doctor of chiropractic can assess and treat all three regions successfully. Herniation of the upper and lower spine’s discs are common due to the versatility of these two regions. If pain is at the upper of mid back, however, most frequently the reason isn’t because of slippage, but rather an injury or poor posture.
When an individual has had bad posture for many years, their thoracic spine can get used to being pulled forward and the surrounding supporting muscles can become weak. Pain can often increase or worsen from the continuous pulling due to poor posture. A chiropractor can help develop a treatment program which involves carefully restoring the original alignment of the spine in order to improve posture.
Dr. Alex Jimenez’s Insight
Neck and back pain are some of the most common health issues treated in a chiropractic office. Although rare, however, upper back pain may also develop as a result of some of the prevalent causes behind cervical and lumbar spine problems. The thoracic spine is the most stable region of the spine. Because the rib cage is attached to the vertebrae of the thoracic spine, the upper back area of the human body must function efficiently to support the body’s weight. Chiropractic care can help carefully restore the original alignment of the thoracic spine, helping to decrease upper back pain and other symptoms.
If someone becomes injured during an automobile accident, the muscles of the upper back might not be strong enough to offer proper support for the body. Overstretching of significant muscles can lead to severe pain and can trigger the vertebrae of the upper back to slip out of place. If you’re suffering from upper back pain, then drop by a chiropractic office. Finding relief for your upper back pain is a walk-in away with no lengthy insurance forms to complete or odd appointment times to remember. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
According to statistics, approximately 80% of people will experience symptoms of back pain at least once throughout their lifetimes. Back pain is a common complaint which can result due to a variety of injuries and/or conditions. Often times, the natural degeneration of the spine with age can cause back pain. Herniated discs occur when the soft, gel-like center of an intervertebral disc pushes through a tear in its surrounding, outer ring of cartilage, compressing and irritating the nerve roots. Disc herniations most commonly occur along the lower back, or lumbar spine, but they may also occur along the cervical spine, or neck. The impingement of the nerves found in the low back due to injury and/or an aggravated condition can lead to symptoms of sciatica.
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