Back Clinic Chiropractic and Physical Therapy Migraine Team. Migraine is a genetic neurological disease, characterized by episodes called Migraine attacks. They are quite different from regular headaches which are non-migrainous. About 100 million people suffer from headaches in the U.S. And 37 million of these people suffer migraines. The World Health Organization estimates that 18 percent of women and 7 percent of men in the U.S. suffer from these headaches. Migraines are called primary headaches because the pain is not caused by a disorder or disease i.e. a brain tumor or head injury.
Some cause pain only on the right side or left side of the head. While others result in pain everywhere. Migraine sufferers can have moderate or severe pain but usually can’t participate in regular activities because of the pain. When a migraine strikes, a quiet dark room may help with the symptoms. They can last for four hours or can last for days. The range of time someone is affected by an attack is actually longer than the headache itself. This is because there is a pre-monitory or build-up, and then a post-drome that can last for one to two days.
Headaches are one of the common issues that affect anyone worldwide. Different issues can cause headaches and affect other individuals depending on the issue. The pain can range from being dull to sharp and affect a person’s mood, sense of belonging, and body. Different headaches can have different effects on people since headaches can be acute or chronic and overlap with other issues affecting the body. To that point, the surrounding muscles and organs around the face may be involved with other conditions where headaches are a symptom rather than a cause. Today’s article examines the temporalis muscle, how trigger pain affects the temporalis muscle, and how to manage the pain associated with trigger points. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from trigger point pain associated with the temporal muscle pain along the side of the head. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure to find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer
Have you been dealing with a dull or sharp ache on the side of your head? What about the tension that is along your jawline? Or have you been dealing with tooth pain throughout the entire day? Encountering these symptoms can be difficult as they affect the facial region of the head and might overlap with the temporal muscle. The temporalis muscle is part of the mastication muscles, which includes the medial pterygoid, lateral pterygoid, and masseter muscles. The temporalis muscle is a flat, fan-shaped muscle that spans from the temporal fossa to the inferior temporal line of the skull. This muscle converges to form a tendon that surrounds the jaw bone and helps stabilize the jaw and its function by extending and retracting. Studies reveal that the temporalis muscle has two tendons: superficial and deep, in the back of the molars to aid chewing and are attached to the coronoid process (the skin and subcutaneous tissues that cover the superficial tendon of the temporalis muscle and the masseter muscle.) To that point, traumatic and ordinary factors can affect the temporalis muscle and cause symptoms associated with the muscle.
How Do Trigger Points Affect The Temporalis Muscle?
When traumatic or ordinary factors begin to affect the body, including the oral-facial region, it can cause unwanted symptoms to develop over time and, if not treated, make a person’s life miserable. Studies reveal that individuals dealing with chronic tension-type headaches have intense pain from the temporalis muscle. When the temporalis muscle becomes sensitive to the touch, the pain can travel to different body areas. These are known as myofascial or trigger points, and they can be a bit challenging for doctors to diagnose because they can mimic various pain symptoms. Trigger points along the temporalis muscles may potentially affect the teeth and cause headaches to form. Active trigger points in the temporalis muscle could potentially evoke local and referred pain while constituting one of the contributing sources of headache pain. Now how can the temporalis muscle induce chronic tension-type headaches? Well, trigger points are caused when the muscles are overused and can develop tiny knots along the muscle fibers.
Trigger points along the temporalis muscle could potentially induce abnormal dental pain. Studies reveal that abnormal dental pain can be referred to as neurovascular headaches associated with tension on the temporalis muscle. Since trigger points often mimic other chronic conditions that confuse many people about why they are experiencing pain from one section of their body, there are no signs of traumatic encounters. Since trigger points can cause pain to travel from one area of the body to another, many individuals try to find therapeutic ways to alleviate their pain.
An Overview Of The Temporal Muscle- Video
Have you been experiencing headaches that affect your daily activities? Does your jaw seem stiff or tender to the touch? Or have your teeth become extra sensitive when eating certain foods? Many of these symptoms may involve trigger points affecting the temporalis muscle. The video above gives an overview of the anatomy of the temporalis muscle in the body. The temporalis is a fan-shaped muscle that converges into tendons that help make the jaws move. When factors affect the body, especially the temporalis muscle, it can potentially develop trigger points along the muscle fibers. To that point, trigger points can mimic conditions affecting the body, like chronic tension-type headaches and tooth pain. Studies reveal that the pain pressure associated with trigger points along the temporalis muscle is consistently higher when there are different amounts of tooth clenching or jaw gaps. As luck would have it, there are ways to manage temporal muscle pain associated with trigger points.
Ways To Manage Temporal Muscle Pain Associated With Trigger Points
Since trigger points along the temporalis muscle could potentially cause pain in the oral facial region, the surrounding muscles like the upper trapezius and the sternocleidomastoid with their trigger points may cause jaw motor dysfunction and tooth pain. Fortunately, musculoskeletal specialists like chiropractors, physiotherapists, and massage therapists can find where the trigger points are located and use various techniques to alleviate trigger point pain along the temporalis muscle. Studies reveal that soft tissue manipulation can help release the trigger point pressure off of the temporalis muscle and cause relief. Utilizing soft manipulation on myofascial temporalis pain affecting the neck, jaw, and cranial muscles can help reduce headache pain symptoms and help many people feel relief.
The temporalis in the body is a flat, fan-shaped muscle that converges down to the jawline and works with the other mastication muscles to provide the motor function to the jaw. When ordinary or traumatic factors affect the temporalis muscle, it can develop trigger points along the muscle fibers. To that point, it causes pain-like symptoms and even causes referred pain like tension headaches and toothaches in the oral-fascial region of the head. This can make many people suffer in pain unless there are ways to manage the associated symptoms. Fortunately, many musculoskeletal specialists can incorporate techniques that target trigger-point pain related to the affected muscle. When people utilize treatment for myofascial trigger pain, they can get their lives back together.
Basit, Hajira, et al. “Anatomy, Head and Neck, Mastication Muscles – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 11 June 2022, www.ncbi.nlm.nih.gov/books/NBK541027/.
Fernández-de-Las-Peñas, César, et al. “The Local and Referred Pain from Myofascial Trigger Points in the Temporalis Muscle Contributes to Pain Profile in Chronic Tension-Type Headache.” The Clinical Journal of Pain, U.S. National Library of Medicine, 2007, pubmed.ncbi.nlm.nih.gov/18075406/.
Kuć, Joanna, et al. “Evaluation of Soft Tissue Mobilization in Patients with Temporomandibular Disorder-Myofascial Pain with Referral.” International Journal of Environmental Research and Public Health, MDPI, 21 Dec. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7767373/.
McMillan, A S, and E T Lawson. “Effect of Tooth Clenching and Jaw Opening on Pain-Pressure Thresholds in the Human Jaw Muscles.” Journal of Orofacial Pain, U.S. National Library of Medicine, 1994, pubmed.ncbi.nlm.nih.gov/7812222/.
Yu, Sun Kyoung, et al. “Morphology of the Temporalis Muscle Focusing on the Tendinous Attachment onto the Coronoid Process.” Anatomy & Cell Biology, Korean Association of Anatomists, 30 Sept. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8493017/.
Everyone has headaches at some point throughout their lives, which can be excruciating, depending on the severity. Whether it is a heavy workload that causes a person to have severe tension on their foreheads, allergies that cause immense pressure in between the sinus cavity in the middle of the face, or common factors that seem to cause a pounding sensation in the head, headaches are no joke. Often, headaches seem to go away when it’s in their acute form but can become chronic when the pain doesn’t go away, causing issues to the eyes and muscles. Today’s article looks at how headaches affect the body and how they can become a somatovisceral problem for many individuals. We refer patients to certified, skilled providers specializing in neurological treatments that help those individuals that are suffering from headaches. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.
Do you feel a pounding sensation in your forehead? Do your eyes seem to become dilated and sensitive to light? Do both arms or hands seem to lock up and have a pins-and-needles sensation that feels uncomfortable? These signs and symptoms are various forms of headaches affecting the head. The head helps protect the brain from damage as the neuron signals from the central nervous system are connected to the cervical regions of the spine. When factors like lifestyle habits, dietary food intake, and stress affect the central nervous system, they begin to co-mingle to form various forms of headaches. Each form of headache continuously shifts in many suffering individuals to never sit still for their clinicians to capture their specific profile. Some of the multiple headaches include:
When headaches begin to affect the neck and head, research shows that these headaches cause a convergence between the cervical sections of the spine and the skull base. This becomes a mediator for the neck and head to develop referred pain. Referred pain is known as pain that occurs in one section of the body than where it is located. For example, say someone has been through a traumatic injury that causes them to have whiplash in their neck; that pain in their neck muscles can mimic a headache affecting one side of their head. Additional information has mentioned that migraine headaches can cause chronic inflammatory issues in the gut-brain axis, causing dysfunctional autonomic and enteric nervous systems and affecting the body.
How The Body Deals With Migraines-Video
Have you experienced throbbing in various sections of your face? Do you feel your muscles tense up around your neck or shoulders? Or does your body feel exhausted that noise seems to cause immense pain? The various forms of headaches can cause many problems not only in the neck but in the body as well. The video above shows what happens to the body when a person is suffering from a migraine. Research studies have noticed that individuals suffering from migraines will develop associated somatic comorbid symptoms like anxiety and depression, making migraine headaches more frequent. At the same time, being the top three of the most common forms of headaches, migraines may share a common underlying mechanism involving the overlapping profiles of the cerebrovascular system that is equivalent to a repetitive stress disorder affecting the central nervous system.
How Headaches Are A Somatovisceral Problem
Research studies have found that the severity of the headache in a person, especially in women, causes a synergetic relationship that causes somatic symptoms and depression to be so high. This is due to the overlapping risk profiles that affect the mechanisms of the sympathetic nervous system, causing the production of cervicogenic headaches and chronic migraines to form. This is because the junction of the brain stem and the spinal cord is called the trigeminocervical nucleus and overlaps the nociceptive cells. When this happens, The close anatomic pain fibers from the cervical spine and the trigeminal system start to be aggravated; it creates pain impulses from the neck to the head, causing headaches to be interpreted.
Overall, headaches are no joke when they start to affect the body and cause mimic pain in different parts of the body. When various factors begin to cause somatic issues that tense the muscles but also affect the surrounding nerves, it can cause headaches to form and become excruciating. Different forms of headaches can affect other regions of the face and can go away for a short period in their acute form. However, in its chronic condition, it can cause the body to be in so much pain. Finding ways to prevent headaches from progressing further can benefit the individual.
Cámara-Lemarroy, Carlos R, et al. “Gastrointestinal Disorders Associated with Migraine: A Comprehensive Review.” World Journal of Gastroenterology, Baishideng Publishing Group Inc, 28 Sept. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5037083/.
Maizels, Morris, and Raoul Burchette. “Somatic Symptoms in Headache Patients: The Influence of Headache Diagnosis, Frequency, and Comorbidity.” Headache, U.S. National Library of Medicine, 2004, pubmed.ncbi.nlm.nih.gov/15546261/.
Tietjen;Brandes JL;Digre KB;Baggaley S;Martin V;Recober A;Geweke LO;Hafeez F;Aurora SK;Herial NA;Utley C;Khuder SA;, G E. “High Prevalence of Somatic Symptoms and Depression in Women with Disabling Chronic Headache.” Neurology, U.S. National Library of Medicine, 9 Jan. 2007, pubmed.ncbi.nlm.nih.gov/17210894/.
Chiropractic adjustments can eliminate headaches and migraines from the source. Many individuals visit medical doctors complaining of headaches and migraines. Most hope for immediate relief from these debilitating issues. However, most are sent home after a quick exam and are given a prescription for medication. Finding, treating, and eliminating the root cause should be the objective, instead of just taking medication after medication.
The root cause can be traced back to dehydration and misalignment of the spine specifically the neck. Most doctors will take out the prescription pad and move on without fully addressing the problem. There has been a significant rise in poor health and disease. This comes from unhealthy lifestyle choices and poor posture habits. Many of us lean and hunch over at a desk station then go home to more computers and television screens. Constant phone check-ins with the head tilted down creates massive pressure on the neck’s muscles and nerves.
Spinal Misalignment Nerve Pressure
Unhealthy lifestyle choices are major contributors to causing spinal misalignment. This places unnecessary and potentially dangerous pressure on the nerves responsible for the function of the organs. When the nerve’s energy is not properly dispersed and cannot reach the organs, a state of dysfunction begins to set in, which can lead to disease and chronic conditions. Healthy lifestyle changes can include learning how to improve standing, sitting, and sleeping posture habits, proper hydration, and chiropractic spinal re-alignment will eliminate headaches and migraines from the source and ensure a healthy body for the future.
There is no need to continue suffering from neck/back pain, headaches, migraines, poor posture, and diminished health. Chiropractic will help an individual regain health and vitality. Injury Medical Chiropractic Clinic Physical Therapy and Health Coaching Team Can Help.
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Bryans, Roland et al. �Evidence-based guidelines for the chiropractic treatment of adults with headache.��Journal of manipulative and physiological therapeutics�vol. 34,5 (2011): 274-89. doi:10.1016/j.jmpt.2011.04.008
Cyrex Laboratories is an advanced clinical laboratory that specializes in the functional approach in environmentally induced autoimmunity.� Cyrex works with the leading experts in medical research and provides arrays that address the cross-connections throughout the body systems. In addition to this, Cyrex�strives to deliver the best quality for the patients by always improving and using the most accurate and advanced technology.
Cyrex has multiple arrays they use to test patients depending on their symptoms. These arrays range from Alzheimer�s to Joint auto-immune reactivity screenings. Often times, patients who have issues with their joints or headaches and pain, can be traced back to an underlying issue. When a patient comes to a doctor, the practitioner will evaluate and assess the patient based on the symptoms they bring.� From here, the practitioner can go to Cyrex and order the arrays that best suit their patient�s needs. The Cyrex system revolves around immune function and measures the identifiers that can affect multiple tissues in the body, including the brain, heart, pancreas, nervous system, liver, gastrointestinal system, bones, and joints.� The turn around time for these labs is fairly quick and helps highlight the underlying route of the patient�s symptoms.
Cyrex arrays use serum (a blood draw) as their main form of testing. No matter the array the doctor orders, the patient will receive the same kit. The requisition form that is inside the kit is what matters to the phlebotomist and lab as this is where the array ordered will be marked.
The kit is a small box labeled Cyrex Laboratories, Serum Collection Kit. On top of the kit held in place by a rubber band will be a shipping label and bag for the sample to go in once collected. Inside the kit is a smaller styrofoam box that includes a serum separator tube, a serum transport tube, tube labels, a biohazard bag, and collection instructions.
As one can see from the above photo, the different arrays test for different reactions/conditions. A doctor may order one or multiple arrays depending on the patient.
Array 2 is one of the most popular, as leaky gut is a condition that affects most Americans. This test screens for IgG, IgA, and IgM of Lipopolysaccharides and Occludin/Zonulin.
Often times, practitioners will use multiple lab companies on one patient. This is not because one is superior to the other, but rather because they specialize in different areas. Even though the doctor may order labs from different companies, it is in the patient�s best interest because it allows the practitioner to view multiple areas to truly understand the underlying issue.
Patients who come in with symptoms like aching joints, headaches, trouble falling asleep, difficulty staying asleep, leaky gut, and brain fog will certainly benefit from using multiple lab companies.
Using Cyrex array 2 and DUTCH + CAR the patient will get extremely accurate information in regards to what is occurring in their body. The Cyrex array test will show the practitioner if the patient has a leaky gut and how severe. While the DUTCH + CAR allows the doctor to determine the cortisol patterns in the individual�s body. Sometimes, these levels are not rising and falling at the right times, causing the patient to be tired or having trouble staying asleep.
The patient�s health should always come first, and when doctors are knowledgable enough to use more than one lab, the patient benefits are outstanding. By using the companies together, the doctor is able to check multiple areas, leaving no guesswork when it comes to a treatment protocol. However, it is important to remember that labs vary on patient needs. Some patients are able to use the same company for all labs and obtain the accurate results they need.
Cyrex tests for many conditions and has multiple arrays. Although many
Cyrex labs are a great tool for practitioners and health coaches to use! By using these arrays, it helps the practitioner not only treat the symptoms, but it allows them the insight they need to treat the problem at the route source. The tools that Cyrex provides go a long way in evaluating the complex disorders the human body may have. By using Cyrex and coupling it with other tests from DUTCH or labrix, the patient is able to get proper treatment and get back to the hobbies they used to love and enjoy. These companies are all fantastic and provide specialities in different areas. By using more than one company, the pateint truly gets the best results and the doctors are able to construct a solid treatment protocol with all of the information obtained.�� Kenna Vaughn, Senior Health Coach�
*All information was obtained from Cyrex.com
The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or chronic disorders of the musculoskeletal system. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Damaris Foreman suffered from migraines before she received chiropractic care with the chiropractor, Dr. Alex Jimenez. After various treatment approaches were unable to provide Damaris Foreman with the migraine pain relief she needed, she was skeptical at first about chiropractic care. However, following the migraine pain relief she found with Dr. Alex Jimenez, Damaris Foreman highly recommends chiropractic care. She emphasizes how much Dr. Jimenez has helped her and how much she has learned about her health issue. Damaris Foreman states that Dr. Alex Jimenez has provided her with the best treatment approach she has ever received for her migraines. Dr. Jimenez is the non-surgical choice for a variety of injuries and conditions, including headaches and migraines.�
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life. I have made a life of taking care of every one of my patients.
I assure you, I will only accept the best for you�
If you have enjoyed this video and we have helped you in any way, please feel free to subscribe and recommend�us.
Headaches are a real pain (insert eye-roll here). Many individuals suffer from them, and there are a variety of causes, symptoms, and treatment options. For some, they are a rare occurrence, while others deal with them weekly or even daily. They can range from minor inconveniences to full-fledged life-changing afflictions.
The first step in treating headaches is to understand the type of headache you are experiencing. Some people think they have a migraine when in fact, they are suffering from a tension headache. While tension headaches are more common, it’s estimated by the Migraine Research Foundation that 1 in 4 U.S. Households include someone with a migraine.
Determining which headache is being dealt with takes a bit of research. Individuals suffering from headaches need to ask themselves these questions to determine if they are having a migraine or experiencing a tension headache.
When in life did the headaches begin? According to the Mayo Clinic, migraines start in adolescence or early adulthood. In contrast, tension headaches can start at any time in a person’s life. If an adult just began suffering from headaches, they are most likely tension headaches.
Where does it hurt? The location of the pain is a vital indicator of the type of headache. Migraines typically occur on one side of the head. Tension headaches affect both sides of the head and can produce a feeling of pressure in the forehead area.
What kind of pain is it? If it is a dull pain, a feeling of pressure, or tenderness around the scalp, it’s most likely a tension headache. If, on the other hand, the pain is throbbing or pulsing pain, it could be a migraine. Both headaches can offer up severe pain, just different types.
Are there any other symptoms?Migraines typically come with symptoms beyond head pain. Nausea, light and sound sensitivity, bright flashing or sparkling lights, pins and needle sensations down one or both arms, or dizziness are common. Individuals who don’t experience any of these symptoms are most likely dealing with a tension headache.
Can you function? While painful and frustrating, many people with a tension headache can still perform their jobs, drive, read, and deal with daily life. A migraine is a different story. Lying in a dark, quiet room with a sleep mask on until the headache passes is how most people handle migraines. If the headache is life-disrupting, it could very well be a migraine.
Do regular painkillers work? Tension headaches can often be relieved by over-the-counter pain medications. Migraines don’t budge with these treatments. Once a migraine is in full force, the sufferer must ride it out. If a headache reacts well to a couple of non-prescription painkillers, it’s most likely a tension headache.
Most individuals will, unfortunately, deal with a headache at one point in their lives. It’s important to note that tension headaches are much more common than migraines, but that doesn’t rule out the possibility of a headache being a migraine. The answers to the above questions give insight into the type of headache occurring and how best to handle the treatment proactively. No matter the type of headache, if the pain is severe, or begins after a head injury, seek medical treatment immediately.
Damaris Foreman experienced migraine headaches for approximately 23 years. After visiting many healthcare professionals due to her migraine pain without seeing a great deal of progress, she was finally advised to find migraine pain treatment with Dr. Alex Jimenez, a chiropractor located in the city of El Paso, TX. Damaris significantly benefitted from chiropractic care and she experienced a massive sense of relief after her first spinal adjustment and manual manipulation. Damaris Foreman was able to confront a great deal of her questions and concerns and she was efficiently taught how to deal with her migraine pain. Damaris clarifies how Dr. Alex Jimenez’s migraine treatment is one of the best treatments she’s received and she highly recommends chiropractic care as the best non-surgical choice for enhancing and healing her migraine headaches.
Chiropractic Migraine Treatment & Relief
A migraine is commonly referred to as a primary headache disorder characterized by recurrent headaches as well as identified by moderate to severe in intensity. Ordinarily, the migraine headaches affect one half of the brain, are pulsating in personality, and might last from two to 72 hours. Associated symptoms may include nausea, vomiting, and sensitivity to light, noise, or odor. The pain could be aggravated by bodily activity. One third of people who suffer with migraines experience migraine with aura: normally a brief number of visual disturbance suggests that the headache will soon happen. It can also occur with minimal if any aggravation pain following it.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and recommend�us.
My treatment with Dr. Alex Jimenez has been helping me by simply making me less tired. I’m not experiencing as many headaches. The headaches are going down dramatically and my back feels much better. I would highly recommend Dr. Alex Jimenez. He’s very friendly, his staff is very friendly and everybody goes well beyond what they can do to help you. –Shane Scott
Neck pain can develop due to a variety of reasons, and it can vary tremendously from mild to severe. Most of the population has suffered from this well-known nagging health issue; however, did you know that headaches can sometimes be caused by neck pain? While these headaches are commonly referred to as cervicogenic headaches, other types, such as cluster headaches and migraines, have also been determined to be caused by neck pain.
Therefore, it’s fundamental to seek a proper diagnosis if you’ve experienced headaches or neck pain to determine the root cause of your symptoms and decide which treatment option will be best for your specific health issue. Healthcare professionals will assess your upper back, or the cervical spine, including your neck, the base of the skull and cranium, and all the surrounding muscles and nerves to find the source of your symptoms. Before seeking help from a doctor, it’s essential to understand how neck pain can cause headaches. Below, we will discuss the anatomy of the cervical spine or neck and demonstrate how neck pain is connected to headaches.
How Neck Pain Causes Headaches
The muscles between the shoulder blades, the upper portion of the shoulders, and those surrounding the neck, or cervical spine, may all cause neck pain if they become too tight or stiff. This can generally occur due to trauma or damage from an injury, as well as in consequence of bad posture or poor sitting, lifting, or work habits. The tight muscles will make your neck joints feel stiff or compressed, and it can even radiate pain toward your shoulders. Over time, the balance of the neck muscles changes, and those specific muscles that support the neck become weak. They can ultimately begin to make the head feel heavy, increasing the risk of experiencing neck pain as well as headaches.
The trigeminal nerve is the primary sensory nerve that carries messages from the face to your brain. Furthermore, the roots of the upper three cervical spinal nerves, found at C1, C2, and C3, share a pain nucleus, which routes pain signals to the brain and the trigeminal nerve. Because of the shared nerve tracts, pain is misunderstood and thus “felt” by the brain as being located in the head. Fortunately, many healthcare professionals are experienced in assessing and correcting muscular imbalances, which may lead to neck pain and headaches. Moreover, they can help to relieve muscle tension, enhance muscle length and joint mobility, and retrain correct posture.
What Causes Neck Pain and Headaches?
Cervicogenic headaches, otherwise known as “neck headaches,” are caused by painful neck joints, tendons, or other structures surrounding the neck, or cervical spine, which may refer to pain to the bottom of the skull, to your face or head. Researchers believe that neck headaches, or cervicogenic headaches, account for approximately 20 percent of all headaches diagnosed clinically. Cervicogenic headaches and neck pain are closely associated, although other types of headaches can also cause neck pain.
This type of head pain generally starts because of an injury, stiffness, or lack of proper functioning of the joints found at the top of your neck, as well as tight neck muscles or swollen nerves, which could trigger pain signals that the brain then interprets as neck pain. The usual cause of neck headaches is dysfunction in the upper three neck joints, or 0/C1, C1/C2, C2/C3, including added tension in the sub-occipital muscles. Other causes for cervicogenic headaches and neck pain can include:
Cranial tension or trauma
TMJ (JAW) tension or altered bite
The Link Between Migraines and Neck Pain
Neck pain and migraines also have an intricate connection with each other. While in some cases, severe trauma, damage, or injury to the neck can lead to severe headaches like migraines; neck pain might result from a migraine headache in different situations. However, it’s never a good idea to assume that one results from the other. Seeking treatment for neck pain when the reason for your concern is a migraine often will not lead to effective pain management or pain relief. The best thing you can do if you’re experiencing neck pain and headaches is to seek immediate medical attention from specialized healthcare professional to determine your pain’s cause and the symptoms’ root cause.
Unfortunately, neck pain, as well as a variety of headaches, are commonly misdiagnosed or even sometimes go undiagnosed for an extended period. One of the top reasons neck pain may be so challenging to treat primarily because it takes a long time for people to take this health issue seriously and seek a proper diagnosis. When a patient seeks a diagnosis for neck pain, it may already have been a persistent problem. Waiting an extended amount of time to take care of your neck pain, especially after an injury, may lead to acute pain and even make the symptoms more difficult to control, turning them into chronic pain. Also, the most frequent reasons people seek treatment for neck pain, and headaches include the following:
Chronic migraines and headaches
Restricted neck function, including difficulties moving the head
Soreness in the neck, upper back, and shoulders
Stabbing pain and other symptoms, particularly in the neck
Pain radiating from the neck and shoulders to the fingertips
Aside from the symptoms mentioned above, individuals with neck pain and headaches can also experience additional symptoms, including nausea, diminished eyesight, difficulty concentrating, severe fatigue, and even difficulty sleeping. While there are circumstances in which the cause of your headaches or neck pain may be apparent, such as being in a recent automobile accident or suffering from sport-related trauma, damage, or injuries, in several instances, the cause may not be quite as obvious.
Because neck pain and headaches can also develop as a result of bad posture or even nutritional problems, it’s fundamental to find the origin of the pain to increase the success of treatment, in addition to enabling you to prevent the health issue from happening again in the future. It’s common for healthcare professionals to devote their time working with you to ascertain what could have caused the pain in the first place.
A Health Issue You Can’t Ignore
Neck pain is typically not a problem that should be ignored. You may think that you’re only experiencing minor neck discomfort and that it’s irrelevant to any other health issues you may be having. Still, you can’t know for sure more frequently than not until you receive a proper diagnosis for your symptoms. Patients seeking immediate medical attention and treatment for their neck-centered problems are surprised to learn that some of the other health issues they may be experiencing may be correlated, such as neck pain and headaches. Thus, even if you think you can “live with” not being able to turn your neck completely, other health issues can develop, and these problems might be more challenging to deal with.
There are circumstances in which a pinched nerve in the neck is the main reason for chronic tension headaches, where a previous sports injury that was not adequately addressed before is now the cause of the individual’s limited neck mobility and in which a bruised vertebrae at the base of the neck induces throbbing sensations throughout the spine, which radiates through the shoulders into the arms, hands, and fingers. You might also blame your chronic migraines on a hectic schedule and stressful conditions. However, it might be a consequence of poor posture and the hours you spend hunched over a computer screen. Untreated neck pain might lead to problems you never expect, such as balance problems or trouble gripping objects. This is because all the neural roots located on the upper ligaments of the cervical spine or neck are connected to other parts of the human body, from your biceps to each of your tiny fingers.
Working with a healthcare professional to relieve the root cause of your neck pain and headaches may significantly enhance your quality of life. It may be able to eliminate other symptoms from turning into a significant problems. While another health issue or nutritional deficiency generally causes the most common causes of chronic migraines, you might also be amazed to learn how often the outcome may be resolved with concentrated exercises and stretches recommended by a healthcare professional, such as a chiropractor. Additionally, you may understand that the health issues you’ve been having often develop from compressed, pinched, irritated, or inflamed nerves in your upper cervical nerves.
Dr. Alex Jimenez’s Insight
Although it may be difficult to distinguish the various types of headaches, neck pain is generally considered to be a common symptom associated with head pain. Cervicogenic headaches are very similar to migraines, however, the primary difference between these two types of head pain is that a migraine occurs in the brain while a cervicogenic headache occurs in the base of the skull or in the cervical spine, or neck. Furthermore, some headaches may be caused by stress, tiredness, eyestrain and/or trauma or injury along the complex structures of the cervical spine, or neck. If you are experiencing neck pain and headaches, it’s important to seek help from a healthcare professional in order to determine the true cause of your symptoms.
Treatment for Neck Pain and Headaches
Foremost, a healthcare professional must determine the cause of an individual’s symptoms through the use of appropriate diagnostic tools as well as to make sure they have the utmost success in relieving the headache and neck pain without prolonging the duration of the symptoms and extra cost of incorrect therapy. Once an individual’s source of neck pain and headaches has been diagnosed, the kind of treatment a patient receives should depend on the type of headache. As a rule of thumb, treatment starts once the diagnosis has been made. A healthcare professional will work with you to create a treatment plan appropriate for your specific health issues. You’ll be taken through procedures that help build flexibility and strength in your sessions.
Chiropractic care is a well-known alternative treatment option focusing on diagnosing, treating, and preventing various musculoskeletal and nervous system injuries and conditions. A chiropractic doctor or chiropractor can help treat neck pain and headache symptoms by carefully correcting any spinal misalignments, or subluxations, in the cervical spine or neck, through spinal adjustments and manual manipulations, among other therapeutic techniques. Chiropractors and physical therapists may also utilize a combination of gentle Muscle Energy Techniques, muscle building, joint slides, Cranio-sacral therapy, and specific posture and muscle re-education to lower the strain being placed on the structures surrounding the cervical spine. The staff will also help you understand how to better position yourself during your daily life to prevent relapses, like ergonomic and posture tips. Contact a healthcare professional for them to be able to assist you immediately.
In cases where alternative treatment options have been utilized without any results or sometimes used together with other complementary treatment approaches, pain drugs and medications may be contemplated, such as non-steroidal anti-inflammatory drugs (NSAIDs) and anti-seizure agents such as gabapentin, tricyclic anti-depressants, or migraine prescriptions. If pain medications prove ineffective, injections may be contemplated, including peripheral nerve blocks, atlantoaxial joint blocks administered at C1-C2, or aspect joint blocks administered in C2-C3. Surgical interventions may also be other treatment options. However, healthcare professionals suggest attempting all other treatment options before considering surgery. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please ask Dr. Jimenez or contact us at 915-850-0900.
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
Back pain is one of the most prevalent causes of disability and missed days at work worldwide. Back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once. The spine is a complex structure of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and aggravated conditions, such as herniated discs, eventually lead to back pain symptoms. Sports or automobile accident injuries are often the most frequent cause of back pain; however, sometimes, the simplest movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through spinal adjustments and manual manipulations, ultimately improving pain relief.
Origin: The most common cause of�migraines/headaches�can relate to neck complications. From spending excessive time looking down at a laptop, desktop, iPad, and even from constant texting, an incorrect posture for extended periods of time can begin to place pressure on the neck and upper back leading to problems that can cause headaches. The majority of these type of headaches occurs as a result of tightness between the shoulder blades, which in turn causes the muscles on the top of the shoulders to also tighten and radiate pain into the head.
Headaches are very common health issues, and lots of people treat themselves by using basic painkillers, drinking additional water, with rest, or by simply waiting for the headache to go away on its own. As a matter of fact, a headache is among the most common reasons for doctor office visits.
Just about everyone will experience a headache sometime during their life. Most headaches are not caused by serious or sinister conditions. However, people understandably worry if headaches feel different, whether they’re especially severe, particularly frequent or unusual in any other manner. But, the most common concern is whether the headache may be a symptom of an underlying health issue, such as a brain tumor.
The following article discusses headaches generally. It explains the various types of headaches you may experience and describes those very rare situations where a headache may be a symptom of a serious disease.
Types of Headaches
Headaches can be categorized as primary, or they can be classified as secondary, meaning they are a side-effect of another injury or condition.
A healthcare professional can usually determine the possible cause of your headaches from speaking to you and examining you. When they have found the cause then you’ll have the ability to decide the best treatment approach for your head pain symptoms. This may involve taking drugs only when you get the headaches, taking daily medication to stop them altogether, and/or even stopping medication you’re already taking. Very occasionally, headaches may need further diagnosis to rule out more serious underlying causes. Chiropractic care and physical therapy are also commonly utilized to help treat headaches. Below, we will discuss the different types of headaches.
The most common types of headaches, by far, are tension headaches and migraines.
Tension headaches are generally felt as a band around the forehead. They may last for many days. They may be tiring and uncomfortable, but they don’t normally disturb sleep. Most people can carry on working with a tension headache. These often have a tendency to worsen as the day progresses, however, they aren’t usually made worse with physical activities, though it’s not strange to be somewhat sensitive to bright light or noise.
Migraines are also very common types of headaches. A typical migraine is described as a throbbing sensation. Headaches which are one-sided, headaches which throb and headaches that make you feel sick are more inclined to be migraines compared to anything else. Migraines are often severe enough to be disabling. Some individuals will need to go to bed to sleep off their aggravation.
Cluster headaches are extremely severe headaches, sometimes called “suicide headaches”. They occur in clusters, often every day for a number of days or maybe weeks. Then they vanish for weeks on end. These types of headaches are rare and often occur particularly in adult male smokers. They’re intense, one-sided headaches, which are very disabling, meaning they stop routine activity. People often describe them as the worst pain they have ever felt. Cluster headaches are typically one-sided. Patients frequently have a red watery eye on the other hand, a stuffy runny nose and a droopy eyelid.
Chronic Tension Headaches
Chronic tension headaches (or chronic daily headache) is generally caused by muscle tension in the back of the neck and affects women more frequently than men. Chronic means that the problem is persistent and ongoing. These headaches can develop due to neck injuries or tiredness and may worsen with drug/medication overuse. A headache that occurs virtually every day for 3 weeks or more is known as a chronic daily headache or a chronic tension headaches.
Medication-overuse headaches or medication-induced aggravation, is an unpleasant and long-term headache. It’s brought on by taking painkillers usually meant for headaches. Unfortunately, when painkillers are taken regularly for headaches, the body reacts by creating additional pain sensors in the brain. Finally, the pain sensors are so many that the head becomes super-sensitive and the headache won’t go away. Individuals who have these headaches often take an increasing number of painkillers to attempt and feel much better. But, the painkillers may have regularly long ceased to work. Medication-overuse headaches are the most common cause of secondary headache.
Exertional Headaches/Sexual Headaches
Exertional headaches are headaches associated with physical activity. They may get severe very quickly following a strenuous activity like coughing, running, with intercourse, and straining with bowel movements. They’re more commonly experienced by patients that also have migraines, or who have relatives with migraine.
Headaches associated with sex particularly worry patients. They can occur as sex starts, at orgasm, or following sex. Headaches at orgasm would be the most common type. They are generally acute, at the back of the head, behind the eyes or all around. They last about twenty minutes and aren’t usually an indication of any other underlying health issues or problems.
Exertional and sexual intercourse-related headaches aren’t typically an indication of serious underlying problems. Very occasionally, they can be a sign that there is a leaky blood vessel on the surface of the brain. As a result, if they are marked and repeated, it’s sensible to talk about them with your healthcare professional.
Primary Stabbing Headaches
Primary traumatic headaches are sometimes called “ice-pick headaches” or “idiopathic stabbing headache”. The term “idiopathic” is used by doctors for something that comes without a clear cause. These are brief, stabbing headaches that are extremely sudden and severe. They generally last between 5 and 30 seconds and they occur at any time of the day or night. They feel as though a sharp object, like an ice pick, is being stuck into your head. They frequently occur in or just behind the ear and they are sometimes quite frightening. Even though they aren’t migraines they’re more prevalent in those who suffer from migraines, nearly half of individuals who experience migraines have principal stabbing headaches.
They are often felt at the place on the head where the migraines have a tendency to happen. Primary stabbing headaches are too brief to take care of, even though migraine prevention medications may reduce their number.
Hemicrania continua is a major chronic daily headache. It typically induces a continuous but shifting pain on one side of the brain. The pain is generally continuous with episodes of severe pain, which can last between 20 minutes and several days. During those episodes of severe pain there may be other symptoms, such as watering or redness of the eye, runny or blocked nose, and drooping of the eyelid, around precisely the same side as the aggravation. Similar to a migraine, there may also be sensitivity to light, feeling sick, such as nausea, and being sick, such as vomiting. The headaches do not go away but there may be periods when you don’t have any headaches. Hemicrania continua headaches respond to medicine called indometacin.
Trigeminal neuralgia causes facial pain. The pain consists of very short bursts of electric shock-like sensations in the face, particularly at the area of the eyes, nose, scalp, brow, lips or limbs. It’s usually one-sided and is more common in people over age 50. It may be triggered by touch or a light breeze on the surface area.
Occasionally, headaches have underlying causes, and treatment of the headache involves treating the cause. Individuals often fear that headaches are caused by serious illness, or by high blood pressure. Both of these are extremely uncommon causes of headache, really increased blood pressure usually causes no symptoms in any way.
Chemicals, Drugs and Substance Withdrawal
Headaches can be because of a substance, or its withdrawal, for example:
Carbon monoxide, that is made by gas heaters which aren’t properly ventilated
Drinking alcohol, with headache often experienced the morning afterwards
Deficiency of body fluid or dehydration
Headaches Due to Referred Pain
Some headaches may be caused by pain in some other portion of the head, such as ear or tooth pain, pain in the jaw joint and pain in the neck.
Sinusitis is also a frequent cause of headaches. The sinuses are “holes” in the skull which are there to stop it from becoming too heavy for the neck to transport around. They are lined with mucous membranes, such as the lining of the nose, and this creates mucus in response to colds or allergy. The liner membranes also swell and can block the drainage of the mucus out of the space. It subsequently becomes cracked and infected, resulting in headache. The headache of sinusitis is often felt at the front of the head and also in the face or teeth.
Frequently the face feels tender to tension, particularly just below the eyes beside the nose. You might have a stuffy nose and the pain is often worse when you bend forwards. Acute sinusitis is the kind that comes on fast in conjunction with a cold or abrupt allergy. You may have a temperature and be generating a lot of mucus. Chronic sinusitis may be caused by allergy, by overusing decongestants or with the acute sinusitis that doesn’t settle. The sinuses become chronically infected and the nasal linings chronically swollen. The contents of this uterus may be thick but frequently not infected.
Acute glaucoma can cause severe headaches. In this condition, the pressure inside the eyes goes up suddenly and this causes a surprisingly, very severe headache behind the eye. Even the eyeball can feel really hard to touch, the eye is red, the front part of the eye, or cornea, can seem cloudy and the eyesight is generally blurred.
What Types of Headaches are Dangerous or Serious?
All headaches are unpleasant and some, such as headache from medication abuse, are serious in the sense that if not treated correctly they might never go away. But a few headaches are indications of serious underlying issues. These are uncommon, in many cases very rare. Dangerous headaches often occur suddenly, and also eventually become increasingly worse over time. They are more common in elderly people. They comprise of the following:
Bleeding Around the Brain (Subarachnoid Haemorrhage)
Subarachnoid haemorrhage is a really serious condition which occurs when a tiny blood vessel pops on the surface of the brain. Patients develop a serious headache and stiff neck and may become unconscious. This is a rare cause of acute headache.
Meningitis and Brain Infections
Meningitis is infection of the tissues around and on the surface of the brain and encephalitis is infection of the brain itself. Brain infections can be caused by germs called bacteria, viruses or parasites and they are thankfully rare. They cause a severe, disabling headache. Normally, patients may feel sick or vomit and can’t bear bright lights, something known as photophobia. Often they have a rigid neck, too stiff for your physician to have the ability to bend the head down so that the chin touches the chest, even in the event that you attempt to relax. Patients are generally also unwell, experiencing hot, sweaty and overall sick sensations.
Giant Cell Arteritis (Temporal Arteritis)
Giant cell arteritis (temporal arteritis) is, generally, just seen in people over the age of 50. It is due to swelling, or inflammation, of the arteries at the temples and behind the eye. It causes a headache behind the forehead, also referred to as a sinus headache. Typically the blood vessels at the forehead are tender and individuals detect pain from the scalp when they comb their own hair. Frequently the pain gets worse with chewing. Temporal arteritis is severe because if it’s not treated it can cause sudden loss of eyesight. Treatment is with a course of steroids. The need to keep these steroids is generally monitored by the GP through blood tests, and they are typically needed for several months.
Brain tumors are a very uncommon cause of headache, although most patients with long-term, severe or persistent headaches start to worry that this might be the reason. Brain tumors can lead to headaches. Usually the aggravation of brain tumors exists on waking in the morning, is worse on sitting up, and becoming steadily worse in the day to day, never easing and never disappearing. It can sometimes be worse on coughing and sneezing, as may sinus headaches and migraines.
When Should I Worry About a Headache?
Most headaches do not have a serious underlying cause. However, healthcare professionals are trained to ask you about the signs and symptoms that might suggest your headache needs further diagnosis, just to make certain it’s nothing serious.
The things which would suggest to your physician and nurse that your headache may need additional evaluation include the following. They don’t mean that your headache is severe or sinister, but they imply that the healthcare professional may wish to do some additional evaluations to make sure if:
You have had a substantial head injury in the previous three months.
Your headaches are worsening and accompanied with high temperature or fever.
Your headaches begin extremely unexpectedly.
You’ve developed problems with speech and balance as well as headache.
You’ve developed problems with your memory or changes in your behavior or personality in addition to headache.
You’re confused or muddled along with your headache.
Your headache started when you coughed, sneezed or strained.
Your headache is much worse when you sit or stand.
Your headache is associated with red or painful eyes.
Your headaches are not like anything you’ve ever experienced before.
You have unexplained nausea together with the aggravation.
You have low immunity, for instance, when you have HIV, or are about oral steroid medicine or immune suppressing drugs.
You have or have had a type of cancer that can spread throughout the body.
Dr. Alex Jimenez’s Insight
Headaches are extremely common health issues which affect a wide range of the population around the world. Although frequent, a headache which is described to be like no other ever experienced before, may often become a concern. There are several types of headaches which can be caused by a variety of injuries and/or underlying conditions. As a healthcare professional, it’s essential to be able to determine between sinister or dangerous types of headaches and benign types of headaches, in order to decide the best treatment approach. By properly diagnosing the source of a patient’s headaches, both benign and sinister types of headaches can be treated accordingly.
Many headaches, whilst unpleasant, are harmless and react to a variety of treatments, including chiropractic care. Migraine, tension headaches and medication-overuse headaches are very common. The majority of the populace will experience one or more of these. Working out exactly the underlying cause of any headaches through discussion with your doctor is often the best method to resolve them. It is possible to develop a persistent or chronic and constant headache through taking drugs and/or medications that you took to get rid of your headache. Your physician can support you through the practice of quitting painkillers when that is the case.
Headaches are, quite infrequently, an indication of a serious or sinister underlying illness, and many headaches go away on their own.
If you have a headache which is uncommon for you then you need to discuss it with your doctor. You should also speak to your doctor about headaches which are particularly severe or that affect your regular activities, those that are associated with other symptoms, such as tingling or weakness, and those which make your own scalp tender, especially if you’re over 50 years old. Finally, always speak to a healthcare professional when you have an unremitting morning headache which is present for at least three days or is becoming gradually worse.
Remember that headaches are not as likely to occur in people who:
Handle their anxiety levels well.
Eat a balanced, regular diet.
Take balanced routine exercise.
Focus on posture and core muscles.
Sleep on two pillows or fewer.
Drink loads of water.
Have plenty of sleep.
Anything that you can do to enhance one or more of these aspects of your life will improve your health and well-being and cut back the number of headaches you experience. Make sure to seek the appropriate medical attention from a qualified and experienced healthcare professional in the event of a severe headache unlike anything you’ve ever experienced before. 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
Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Chiropractic Benefits: If you have ever had a migraine before then you know that it is much more than a simple headache. The symptoms of a migraine can be debilitating, lasting hours and even days. According to the Migraine Research Foundation, it is the eighth most disabling disease in the world. It is estimated that 38 million people in the United States alone suffer from migraine headaches. That�s around one in every ten people.
According to the Migraine Research Foundation, migraine headaches are extremely difficult to treat and even more difficult to control. This is mainly due to the fact that doctors still don�t know exactly what causes it. This leaves it undiagnosed in many patients and often terribly under treated in those with a diagnosis.
The best many doctors seem to be able to do is prescribe pain medication that has undesirable side effects in an effort to manage the symptoms. However, chiropractic has been shown in several studies to not only effectively manage the pain of migraines, it also helps stop and prevent them.
Anatomy Of A Migraine Headache
There are two types of migraines, those with an aura and those without an aura. An aura can appear up to an hour before the onset of a migraine. It is a warning sign that usually presents as a disturbance that is either visual or olfactory. The person may see flashes of light or smell particular odors before the headache begins. About one in six migraines are preceded by an aura.
Once the migraine itself begins, the pain is typically on one side of the head, although this is not always the case. Other symptoms may include nausea, vomiting, sensitivity to noise, sensitivity to light, and sensitivity to smell. Some patients experience an inability to concentrate, hot or cold flashes, stiffness in neck or shoulders, slurred speech, loss of coordination, and in rare cases, loss of consciousness.
The migraine can last several minutes, hours, or even days. Afterwards the patient may feel fatigued or washed out. They may be unable to concentrate and either lethargic or extremely energetic.
Studies Show: Chiropractic As A Migraine Treatment
There have been several clinical studies on chiropractic as a treatment for migraine headaches. The results of one study reported that 22 percent of patients who received chiropractic treatment for their migraines reported that their attacks were reduced by more than 90 percent. Additionally, 49 percent reported that the intensity of their migraines was significantly reduced.
Another study randomly assigned people with migraine headaches several different treatments. One group was given Elavil, a daily medication, another group was given chiropractic treatment and a third group received a combination of the two treatments. The results showed that chiropractic was as effective in reducing migraines as the medication and it had fewer side effects. Other studies have also found that chiropractic is as effective as medication for the treatment and prevention of migraine or tension headaches.
Chiropractic Benefits For Migraines Headaches
Spinal adjustments are very effective as a treatment for migraines. The whole body approach of chiropractic also utilizes dietary recommendations, including foods to avoid, as well as lifestyle changes.
The patient may be counseled on managing stress, advised to engage in exercise, and given supplements. The treatments may be used to reduce the pain and severity of a migraine once it begins or it can be used to prevent migraines and reduce their frequency.
Chiropractic benefits everyone and is a safer treatment with fewer side effects than�prescription medications. Chiropractic is quickly becoming the treatment of choice for many migraine sufferers. As the studies show, it works! So if you or a loved one suffer from migraines, give us a call. Our Doctor of Chiropractic is here to help!
Suffer Migraines: If you�ve ever had a migraine you know that it�s more than just a headache. The debilitating pain can be accompanied by nausea and other symptoms � and it�s more common than you may think. Research shows that in every four American households, one person is a migraine sufferer. In fact, 12 percent of the U.S. population suffers from migraines, including children. This means migraines affect more people that asthma and diabetes combined.
It is estimated that 18 percent of women suffer from migraines while 6 percent of men are migraine sufferers. It most commonly affects people who are between the ages of 25 and 55, but even young children have been diagnosed. Migraines can stop you in your tracks, but there are treatments that can help. Chiropractic care has been shown to help ease the pain, intensity, and frequency of migraines.
Suffer From Migraines
What Is A Migraine?
Migraines are vicious headaches that can last several minutes to several hours or even days. It is characterized by intense pulsing or a throbbing sensation that is typically confined to one area of the head. It is often accompanied by vomiting, nausea, and extreme sensitivity to sound and light. The pain can be so severe that you can barely function. Many people find themselves confined to bed in a darkened room, waiting for it to pass.
Many times migraine sufferers report experiencing an aura, or sensory warning symptoms, such as strange smells, blind spots, flashes of light, or tingling in your leg or arm. They also tend to run in families. If one parent is a migraine sufferer the child has a 40 percent chance of having migraines as well. If both parents get migraines that chance jumps to 90 percent. It is the 8th most debilitating illness on a global scale.
For the most part, doctors do not know much about what causes migraines. However, there are some things that have been identified as migraine triggers:
Hormonal changes � at certain times during the month, women experience fluctuations in estrogen which can trigger migraines
Oral contraceptives � medications that change or replace hormones can make headaches worse
Certain foods � processed foods, MSG, salty foods, aged cheeses
Fasting or skipping meals
Intense physical exertion
Too much or too little sleep
How Chiropractic Care Can Help Migraine Sufferers
Many doctors believe that headaches and migraines may be caused by a spine that is out of alignment. When your spine is misaligned your entire body suffers. It can irritate the nerves that run from the brain to the spine causing a headache. Chiropractic adjustments can help relieve the pain of migraines. In fact, many people report a distinct difference after just one session.
A Doctor of Chiropractic will align your spine and work with you to create a wellness plan that includes lifestyle changes and diet. Making changes to your sleep patterns and eliminating certain foods from your diet can help prevent migraines. By creating a whole body wellness program, you and your chiropractor can not only help prevent your migraines, but other health conditions as well.
Your chiropractor may also recommend that you keep a journal to help you pinpoint your own unique migraine triggers. You will record the foods you eat, environmental factors that may affect you, stressors, and sleep patterns, as well as when you have migraines, how long they last, and their severity. By tracking these things, you can determine what may be causing your migraines and make adjustments to your lifestyle, thus preventing them. Incorporating chiropractic care as part of your whole body maintenance, as well as migraine prevention, can help you stave off these headaches so you can get on with your life.
If you or a loved one suffers from migraine headaches, make sure you give us a call. Our Doctor of Chiropractic is here to help!
Damaris Foreman started chiropractic care with Dr. Alex Jimenez for her migraine headache pain. When every traditional treatment she received proved ineffective, she turned to spinal adjustments and manual manipulations for relief. Damaris Foreman experienced the benefits of chiropractic care almost immediately after her first visit with Dr. Alex Jimenez and she experienced reduced migraine headache pain symptoms. Furthermore, Damaris Foreman highly recommends chiropractic care with Dr. Alex Jimenez as a non-surgical choice for the effective treatment of migraines.
Globally, approximately 15 percent of people are affected by migraines. It often begins at puberty and is worst through middle age. In many women they become common during menopause. As of 2016, it is among the most common cause of disability. Migraines present with recurrent severe headache associated symptoms. Approximately 15 to 30 percent of people with migraines experience an aura. Those who have migraines with aura also frequently have migraines without aura. The seriousness of the pain, length of the headache, and frequency of the migraine may differ.
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Damaris Foreman suffered from migraines for about 23 years. After receiving traditional treatment for her migraine pain without much improvement, she was finally recommended to seek migraine pain treatment with Dr. Alex Jimenez, a chiropractor in El Paso, TX. Damaris greatly benefitted from chiropractic care and she experienced a tremendous sense of relief following her first spinal adjustment and manual manipulation. Damaris Foreman was able to confront many of her misconceptions and she learned very much about her migraine pain. Damaris describes Dr. Alex Jimenez’s migraine pain treatment as one of the best treatment she’s received and she highly recommends chiropractic care as the best non-surgical choice for improving and managing her migraines.
A migraine can be identified as a primary headache disorder characterized by recurrent headaches characterized from moderate to severe in intensity. Typically, the headaches affect one half of the head, are pulsating in nature, and can last from two to 72 hours. Associated symptoms may include nausea, vomiting, and sensitivity to light, sound, or smell. The pain may be aggravated by physical activity. Up to one-third of people who suffer from migraines experience migraine with aura: typically a brief period of visual disturbance that signals that the headache will soon happen. An aura can occur with little or no headache pain following it.
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Everyone experiences pain from time to time. Pain is a physical feeling of discomfort caused by injury or illness. When you pull a muscle or cut your finger, for instance, a signal is sent through the nerve roots to the brain, signaling you that something is wrong in the body. Pain may be different for everyone and there are several ways of feeling and describing pain. After an injury or illness heals, the pain will subside, however, what happens if the pain continues even after you’ve healed?
Chronic pain is often defined as any pain which lasts more than 12 weeks. Chronic pain can range from mild to severe and it can be the result of previous injury or surgery, migraine and headache, arthritis, nerve damage, infection and fibromyalgia. Chronic pain can affect an individual’s emotional and mental disposition, making it more difficult to relieve the symptoms. Research studies have demonstrated that psychological interventions can assist the chronic pain recovery process. Several healthcare professionals, like a doctor of chiropractic, can provide chiropractic care together with psychological interventions to help restore the overall health and wellness of their patients. The purpose of the following article is to demonstrate the role of psychological interventions in the management of patients with chronic pain, including headache and back pain.
The Role of Psychological Interventions in the Management of Patients with Chronic Pain
Chronic pain can be best understood from a biopsychosocial perspective through which pain is viewed as a complex, multifaceted experience emerging from the dynamic interplay of a patient�s physiological state, thoughts, emotions, behaviors, and sociocultural influences. A biopsychosocial perspective focuses on viewing chronic pain as an illness rather than disease, thus recognizing that it is a subjective experience and that treatment approaches are aimed at the management, rather than the cure, of chronic pain. Current psychological approaches to the management of chronic pain include interventions that aim to achieve increased self-management, behavioral change, and cognitive change rather than directly eliminate the locus of pain. Benefits of including psychological treatments in multidisciplinary approaches to the management of chronic pain include, but are not limited to, increased self-management of pain, improved pain-coping resources, reduced pain-related disability, and reduced emotional distress � improvements that are effected via a variety of effective self-regulatory, behavioral, and cognitive techniques. Through implementation of these changes, psychologists can effectively help patients feel more in command of their pain control and enable them to live as normal a life as possible despite pain. Moreover, the skills learned through psychological interventions empower and enable patients to become active participants in the management of their illness and instill valuable skills that patients can employ throughout their lives.
Chronic pain has previously been determined to affect the psychological health of those with persistent symptoms, ultimately altering their overall mental and emotional disposition. In addition, patients with overlapping conditions, including stress, anxiety and depression, can make treatment a challenge. The role of chiropractic care is to restore as well as maintain and improve the original alignment of the spine through the use of spinal adjustments and manual manipulations. Chiropractic care allows the body to naturally heal itself without the need for drugs/medications and surgical interventions, although these can be referred to by a chiropractor if needed. However, chiropractic care focuses on the body as a whole, rather than on a single injury and/or condition and its symptoms. Spinal adjustments and manual manipulations, among other treatment methods and techniques commonly used by a chiropractor, require awareness of the patient’s mental and emotional disposition in order to effectively provide them with overall health and wellness. Patients who visit my clinic with emotional distress from their chronic pain are often more susceptible to experience psychological issues as a result. Therefore, chiropractic care can be a fundamental psychological intervention for chronic pain management, along with those demonstrated below.
Pain is a ubiquitous human experience. It is estimated that approximately 20%�35% of adults experience chronic pain.[1,2] The National Institute of Nursing Research reports that pain affects more Americans than diabetes, heart disease, and cancer combined. Pain has been cited as the primary reason to seek medical care in the United States. Furthermore, pain relievers are the second most commonly prescribed medications in physicians� offices and emergency rooms. Further solidifying the importance of adequate assessment of pain, the Joint Commission on the Accreditation of Healthcare Organizations issued a mandate requiring that pain be evaluated as the fifth vital sign during medical visits.
The International Association for the Study of Pain (IASP) defines pain as �an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage�. The IASP�s definition highlights the multidimensional and subjective nature of pain, a complex experience that is unique to each individual. Chronic pain is typically differentiated from acute pain based on its chronicity or persistence, its physiological maintenance mechanisms, and/or its detrimental impact on an individual�s life. Generally, it is accepted that pain that persists beyond the expected period of time for tissue healing following an injury or surgery is considered chronic pain. However, the specific timeframe constituting an expected healing period is variable and often difficult to ascertain. For ease of classification, certain guidelines suggest that pain persisting beyond a 3�6 month time window is considered chronic pain. Nevertheless, classification of pain based solely on duration is a strictly practical and, in some instances, arbitrary criterion. More commonly, additional factors such as etiology, pain intensity, and impact are considered alongside duration when classifying chronic pain. An alternative way to characterize chronic pain has been based on its physiological maintenance mechanism; that is, pain that is thought to emerge as a result of peripheral and central reorganization. Common chronic pain conditions include musculoskeletal disorders, neuropathic pain conditions, headache pain, cancer pain, and visceral pain. More broadly, pain conditions may be primarily nociceptive (producing mechanical or chemical pain), neuropathic (resulting from nerve damage), or central (resulting from dysfunction in the neurons of the central nervous system).
Unfortunately, the experience of pain is frequently characterized by undue physical, psychological, social, and financial suffering. Chronic pain has been recognized as the leading cause of long-term disability in the working- age American population. Because chronic pain affects the individual at multiple domains of his/her existence it also constitutes an enormous financial burden to our society. The combined direct and indirect costs of pain have been estimated to range from $125 billion to $215 billion, annually.[10,11] The widespread implications of chronic pain include increased reports of emotional distress (eg, depression, anxiety, and frustration), increased rates of pain-related disability, pain-related alterations in cognition, and reduced quality of life. Thus, chronic pain can be best understood from a biopsychosocial perspective through which pain is viewed as a complex, multifaceted experience emerging from the dynamic interplay of a patient�s physiological state, thoughts, emotions, behaviors, and sociocultural influences.
Given the widespread prevalence of pain and its multi-dimensional nature, an ideal pain management regimen will be comprehensive, integrative, and interdisciplinary. Current approaches to the management of chronic pain have increasingly transcended the reductionist and strictly surgical, physical, or pharmacological approach to treatment. Current approaches recognize the value of a multidisciplinary treatment framework that targets not only nociceptive aspects of pain but also cognitive-evaluative, and motivational-affective aspects alongside equally unpleasant and impacting sequelae. The interdisciplinary management of chronic pain typically includes multimodal treatments such as combinations of analgesics, physical therapy, behavioral therapy, and psychological therapy. The multimodal approach more adequately and comprehensively addresses pain management at the molecular, behavioral, cognitive-affective, and functional levels. These approaches have been shown to lead to superior and long-lasting subjective and objective outcomes including pain reports, mood, restoration of daily functioning, work status, and medication or health care use; multimodal approaches have also been shown to be more cost-effective than unimodal approaches.[12,13] The focus of this review will be specifically on elucidating the benefits of psychology in the management of chronic pain.
Patients will typically initially present to a physician�s office in the pursuit of a cure or treatment for their ailment/acute pain. For many patients, depending on the etiology and pathology of their pain alongside biopsychosocial influences on the pain experience, acute pain will resolve with the passage of time, or following treatments aimed at targeting the presumed cause of pain or its transmission. Nonetheless, some patients will not achieve resolution of their pain despite numerous medical and complementary interventions and will transition from an acute pain state to a state of chronic, intractable pain. For instance, research has demonstrated that approximately 30% of patients presenting to their primary-care physician for complaints related to acute back pain will continue to experience pain and, for many others, severe activity limitations and suffering 12 months later. As pain and its consequences continue to develop and manifest in diverse aspects of life, chronic pain may become primarily a biopsychosocial problem, whereby numerous biopsychosocial aspects may serve to perpetuate and maintain pain, thus continuing to negatively impact the affected individual�s life. It is at this point that the original treatment regimen may diversify to include other therapeutic components, including psychological approaches to pain management.
Psychological approaches for the management of chronic pain initially gained popularity in the late 1960s with the emergence of Melzack and Wall�s �gate-control theory of pain� and the subsequent �neuromatrix theory of pain�. Briefly, these theories posit that psychosocial and physiological processes interact to affect perception, transmission, and evaluation of pain, and recognize the influence of these processes as maintenance factors involved in the states of chronic or prolonged pain. Namely, these theories served as integral catalysts for instituting change in the dominant and unimodal approach to the treatment of pain, one heavily dominated by strictly biological perspectives. Clinicians and patients alike gained an increasing recognition and appreciation for the complexity of pain processing and maintenance; consequently, the acceptance of and preference for multidimensional conceptualizations of pain were established. Currently, the biopsychosocial model of pain is, perhaps, the most widely accepted heuristic approach to understanding pain. A biopsychosocial perspective focuses on viewing chronic pain as an illness rather than disease, thus recognizing that it is a subjective experience and that treatment approaches are aimed at the management, rather than the cure, of chronic pain. As the utility of a broader and more comprehensive approach to the management of chronic pain has become evident, psychologically-based interventions have witnessed a remarkable rise in popularity and recognition as adjunct treatments. The types of psychological interventions employed as part of a multidisciplinary pain treatment program vary according to therapist orientation, pain etiology, and patient characteristics. Likewise, research on the effectiveness of psychologically based interventions for chronic pain has shown variable, albeit promising, results on key variables studied. This overview will briefly describe frequently employed psychologically based treatment options and their respective effectiveness on key outcomes.
Current psychological approaches to the management of chronic pain include interventions that aim to achieve increased self-management, behavioral change, and cognitive change rather than directly eliminate the locus of pain. As such, they target the frequently overlooked behavioral, emotional, and cognitive components of chronic pain and factors contributing to its maintenance. Informed by the framework offered by Hoffman et al and Kerns et al, the following frequently employed psychologically-based treatment domains are reviewed: psychophysiological techniques, behavioral approaches to treatment, cognitive behavioral therapy, and acceptance-based interventions.
Biofeedback is a learning technique through which patients learn to interpret feedback (in the form of physiological data) regarding certain physiological functions. For instance, a patient may use biofeedback equipment to learn to recognize areas of tension in their body and subsequently learn to relax those areas to reduce muscular tension. Feedback is provided by a variety of measurement instruments that can yield information about brain electrical activity, blood pressure, blood flow, muscle tone, electrodermal activity, heart rate, and skin temperature, among other physiological functions in a rapid manner. The goal of biofeedback approaches is for the patient to learn how to initiate physiological self-regulatory processes by achieving voluntary control over certain physiological responses to ultimately increase physiological flexibility through greater awareness and specific training. Thus a patient will use specific self-regulatory skills in an attempt to reduce an undesired event (eg, pain) or maladaptive physiological reactions to an undesired event (eg, stress response). Many psychologists are trained in biofeedback techniques and provide these services as part of therapy. Biofeedback has been designated as an efficacious treatment for pain associated with headache and temporomandibular disorders (TMD). A meta-analysis of 55 studies revealed that biofeedback interventions (including various biofeedback modalities) yielded significant improvements with regard to frequency of migraine attacks and perceptions of headache management self-efficacy when compared to control conditions. Studies have provided empirical support for biofeedback for TMD, albeit more robust improvements with regard to pain and pain-related disability have been found for protocols that combine biofeedback with cognitive behavioral skills training, under the assumption that a combined treatment approach more comprehensively addresses the gamut of biopsychosocial problems that may be encountered as a result of TMD.
It is generally accepted that stress is a key factor involved in the exacerbation and maintenance of chronic pain.[16,23] Stress can be predominantly of an environmental, physical, or psychological/emotional basis, though typically these mechanisms are intricately intertwined. The focus of relaxation training is to reduce tension levels (physical and mental) through activation of the parasympathetic nervous system and through attainment of greater awareness of physiological and psychological states, thereby achieving reductions in pain and increasing control over pain. Patients can be taught several relaxation techniques and practice them individually or in conjunction with one another, as well as adjuvant components to other behavioral and cognitive pain management techniques. The following are brief descriptions of relaxation techniques commonly taught by psychologists specializing in the management of chronic pain.
Diaphragmatic breathing. Diaphragmatic breathing is a basic relaxation technique whereby patients are instructed to use the muscles of their diaphragm as opposed to the muscles of their chest to engage in deep breathing exercises. Breathing by contracting the diaphragm allows the lungs to expand down (marked by expansion of abdomen during inhalation) and thus increase oxygen intake.
Progressive muscle relaxation (PMR). PMR is characterized by engaging in a combination of muscle tension and relaxation exercises of specific muscles or muscle groups throughout the body. The patient is typically instructed to engage in the tension/relaxation exercises in a sequential manner until all areas of the body have been addressed.
Autogenic training (AT). AT is a self-regulatory relaxation technique in which a patient repeats a phrase in conjunction with visualization to induce a state of relaxation.[26,27] This method combines passive concentration, visualization, and deep breathing techniques.
Visualization/Guided imagery. This technique encourages patients to use all of their senses in imagining a vivid, serene, and safe environment to achieve a sense of relaxation and distraction from their pain and pain-related thoughts and sensations.
Collectively, relaxation techniques have generally been found to be beneficial in the management of a variety of types of acute and chronic pain conditions as well as in the management of important pain sequelae (eg, health-related quality of life).[28�31] Relaxation techniques are usually practiced in conjunction with other pain management modalities, and there is considerable overlap in the presumed mechanisms of relaxation and biofeedback, for instance.
Operant Behavior Therapy
Operant behavior therapy for chronic pain is guided by the original operant conditioning principles proposed by Skinner and refined by Fordyce to be applicable to pain management. The main tenets of the operant conditioning model as it relates to pain hold that pain behavior can eventually evolve into and be maintained as chronic pain manifestations as a result of positive or negative reinforcement of a given pain behavior as well as punishment of more adaptive, non-pain behavior. If reinforcement and the ensuing consequences occur with sufficient frequency, they can serve to condition the behavior, thus increasing the likelihood of repeating the behavior in the future. Therefore, conditioned behaviors occur as a product of learning of the consequences (actual or anticipated) of engaging in the given behavior. An example of a conditioned behavior is continued use of medication � a behavior that results from learning through repeated associations that taking medication is followed by removal of an aversive sensation (pain). Likewise, pain behaviors (eg, verbal expressions of pain, low activity levels) can be become conditioned behaviors that serve to perpetuate chronic pain and its sequelae. Treatments that are guided by operant behavior principles aim to extinguish maladaptive pain behaviors through the same learning principles that these may have been established by. In general, treatment components of operant behavior therapy include graded activation, time contingent medication schedules, and use of reinforcement principles to increase well behaviors and decrease maladaptive pain behaviors.
Graded activation. Psychologists can implement graded activity programs for chronic pain patients who have vastly reduced their activity levels (increasing likelihood of physical deconditioning) and subsequently experience high levels of pain upon engaging in activity. Patients are instructed to safely break the cycle of inactivity and deconditioning by engaging in activity in a controlled and time-limited fashion. In this manner, patients can gradually increase the length of time and intensity of activity to improve functioning. Psychologists can oversee progress and provide appropriate reinforcement for compliance, correction of misperceptions or misinterpretations of pain resulting from activity, where appropriate, and problem-solve barriers to adherence. This approach is frequently embedded within cognitive-behavioral pain management treatments.
Time-contingent medication schedules. A psychologist can be an important adjunct healthcare provider in overseeing the management of pain medications. In some cases, psychologists have the opportunity for more frequent and in-depth contact with patients than physicians and thus can serve as valuable collaborators of an integrated multidisciplinary treatment approach. Psychologists can institute time-contingent medication schedules to reduce the likelihood of dependence on pain medications for attaining adequate control over pain. Furthermore, psychologists are well equipped to engage patients in important conversations regarding the importance of proper adherence to medications and medical recommendations and problem-solve perceived barriers to safe adherence.
Fear-avoidance. The fear-avoidance model of chronic pain is a heuristic most frequently applied in the context of chronic low back pain (LBP). This model draws largely from the operant behavior principles described previously. In essence, the fear-avoidance model posits that when acute pain states are repeatedly misinterpreted as danger signals or signs of serious injury, patients may be at risk of engaging in fear-driven avoidance behaviors and cognitions that further reinforce the belief that pain is a danger signal and perpetuate physical deconditioning. As the cycle continues, avoidance may generalize to broader types of activity and result in hypervigilance of physical sensations characterized by misinformed catastrophic interpretations of physical sensations. Research has shown that a high degree of pain catastrophizing is associated with maintenance of the cycle. Treatments aimed at breaking the fear-avoidance cycle employ systematic graded exposure to feared activities to disconfirm the feared, often catastrophic, consequences of engaging in activities. Graded exposure is typically supplemented with psychoeducation about pain and cognitive restructuring elements that target maladaptive cognitions and expectations about activity and pain. Psychologists are in an excellent position to execute these types of interventions that closely mimic exposure treatments traditionally used in the treatment of some anxiety disorders.
Though specific graded exposure treatments have been shown to be effective in the treatment of complex regional pain syndrome type I (CRPS-1) and LBP in single-case designs, a larger-scale randomized controlled trial comparing systematic graded exposure treatment combined with multidisciplinary pain program treatment with multidisciplinary pain program treatment alone and with a wait-list control group found that the two active treatments resulted in significant improvements on outcome measures of pain intensity, fear of movement/injury, pain self-efficacy, depression, and activity level. Results from this trial suggest that both interventions were associated with significant treatment effectiveness such that the graded exposure treatment did not appear to result in additional treatment gains. A cautionary note in the interpretation of these results highlights that the randomized controlled trial (RCT) included a variety of chronic pain conditions that extended beyond LBP and CRPS-1 and did not exclusively include patients with high levels of pain-related fear; the interventions were also delivered in group formats rather than individual formats. Although in-vivo exposure treatments are superior at reducing pain catastrophizing and perceptions of harmfulness of activities, exposure treatments seem to be as effective as graded activity interventions in improving functional disability and chief complaints. Another clinical trial compared the effectiveness of treatment-based classification (TBC) physical therapy alone to TBC augmented with graded activity or graded exposure for patients with acute and sub-acute LBP. Outcomes revealed that there were no differences in 4-week and 6-month outcomes for reduction of disability, pain intensity, pain catastrophizing, and physical impairment among treatment groups, although graded exposure and TBC yielded larger reductions in fear-avoidance beliefs at 6 months. Findings from this clinical trial suggest that enhancing TBC with graded activity or graded exposure does not lead to improved outcomes with regard to measures associated with the development of chronic LBP beyond improvements achieved with TBC alone.
Cognitive-behavioral therapy (CBT) interventions for chronic pain utilize psychological principles to effect adaptive changes in the patient�s behaviors, cognitions or evaluations, and emotions. These interventions are generally comprised of basic psychoeducation about pain and the patient�s particular pain syndrome, several behavioral components, coping skills training, problem-solving approaches, and a cognitive restructuring component, though the exact treatment components vary according to the clinician. Behavioral components may include a variety of relaxation skills (as reviewed in the behavioral approaches section), activity pacing instructions/graded activation, behavioral activation strategies, and promotion of resumption of physical activity if there is a significant history of activity avoidance and subsequent deconditioning. The primary aim in coping skills training is to identify current maladaptive coping strategies (eg, catastrophizing, avoidance) that the patient is engaging in alongside their use of adaptive coping strategies (eg, use of positive self-statements, social support). As a cautionary note, the degree to which a strategy is adaptive or maladaptive and the perceived effectiveness of particular coping strategies varies from individual to individual. Throughout treatment, problem-solving techniques are honed to aid patients in their adherence efforts and to help them increase their self-efficacy. Cognitive restructuring entails recognition of current maladaptive cognitions the patient is engaging in, challenging of the identified negative cognitions, and reformulation of thoughts to generate balanced, adaptive alternative thoughts. Through cognitive restructuring exercises, patients become increasingly adept at recognizing how their emotions, cognitions, and interpretations modulate their pain in positive and negative directions. As a result, it is presumed that the patients will attain a greater perception of control over their pain, be better able to manage their behavior and thoughts as they relate to pain, and be able to more adaptively evaluate the meaning they ascribe to their pain. Additional components sometimes included in a CBT intervention include social skills training, communication training, and broader approaches to stress management. Via a pain-oriented CBT intervention, many patients profit from improvements with regard to their emotional and functional well-being, and ultimately their global perceived health-related quality of life.
CBT interventions are delivered within a supportive and empathetic environment that strives to understand the patient�s pain from a biopsychosocial perspective and in an integrated manner. Therapists see their role as �teachers� or �coaches� and the message communicated to patients is that of learning to better manage their pain and improve their daily function and quality of life as opposed to aiming to cure or eradicate the pain. The overarching goal is to increase the patients� understanding of their pain and their efforts to manage pain and its sequelae in a safe and adaptive manner; therefore, teaching patients to self-monitor their behavior, thoughts, and emotions is an integral component of therapy and a useful strategy to enhance self-efficacy. Additionally, the therapist endeavors to foster an optimistic, realistic, and encouraging environment in which the patient can become increasingly skilled at recognizing and learning from their successes and learning from and improving upon unsuccessful attempts. In this manner, therapists and patients work together to identify patient successes, barriers to adherence, and to develop maintenance and relapse-prevention plans in a constructive, collaborative, and trustworthy atmosphere. An appealing feature of the cognitive behavioral approach is its endorsement of the patient as an active participant of his/her pain rehabilitation or management program.
Research has found CBT to be an effective treatment for chronic pain and its sequelae as marked by significant changes in various domains (ie, measures of pain experience, mood/affect, cognitive coping and appraisal, pain behavior and activity level, and social role function) when compared with wait-list control conditions. When compared with other active treatments or control conditions, CBT has resulted in notable improvements, albeit smaller effects (effect size ~ 0.50), with regard to pain experience, cognitive coping and appraisal, and social role function. A more recent meta-analysis of 52 published studies compared behavior therapy (BT) and CBT against treatment as usual control conditions and active control conditions at various time-points. This meta-analysis concluded that their data did not lend support for BT beyond improvements in pain immediately following treatment when compared with treatment as usual control conditions. With regard to CBT, they concluded that CBT has limited positive effects for pain disability, and mood; nonetheless, there are insufficient data available to investigate the specific influence of treatment content on selected outcomes. Overall, it appears that CBT and BT are effective treatment approaches to improve mood; outcomes that remain robust at follow-up data points. However, as highlighted by several reviews and meta-analyses, a critical factor to consider in evaluating the effectiveness of CBT for the management of chronic pain is centered on issues of effective delivery, lack of uniform treatment components, differences in delivery across clinicians and treatment populations, and variability in outcome variables of interest across research trials. Further complicating the interpretation of effectiveness findings are patient characteristics and additional variables that may independently affect treatment outcome.
Acceptance-based approaches are frequently identified as third-wave cognitive-behavioral therapies. Acceptance and commitment therapy (ACT) is the most common of the acceptance-based psychotherapies. ACT emphasizes the importance of facilitating the client�s progress toward attaining a more valued and fulfilling life by increasing psychological flexibility rather than strictly focusing on restructuring cognitions. In the context of chronic pain, ACT targets ineffective control strategies and experiential avoidance by fostering techniques that establish psychological flexibility. The six core processes of ACT include: acceptance, cognitive defusion, being present, self as context, values, and committed action. Briefly, acceptance encourages chronic pain patients to actively embrace pain and its sequelae rather than attempt to change it, in doing so encouraging the patient to cease a futile fight directed at the eradication of their pain. Cognitive defusion (deliteralization) techniques are employed to modify the function of thoughts rather than to reduce their frequency or restructure their content. In this manner, cognitive defusion may simply alter the undesirable meaning or function of negative thoughts and thus decrease the attachment and subsequent emotional and behavioral response to such thoughts. The core process of being present emphasizes a non-judgmental interaction between the self and private thoughts and events. Values are utilized as guides for electing behaviors and interpretations that are characterized by those values an individual strives to instantiate in everyday life. Finally, through committed action, patients can realize behavior changes aligned with individual values. Thus, ACT utilizes the six core principles in conjunction with one another to take a holistic approach toward increasing psychological flexibility and decreasing suffering. Patients are encouraged to view pain as inevitable and accept it in a nonjudgmental manner so that they can continue to derive meaning from life despite the presence of pain. The interrelated core processes exemplify mindfulness and acceptance processes and commitment and behavior change processes.
Results of research on the effectiveness of ACT-based approaches for the management of chronic pain are promising, albeit still warranting further evaluation. A RCT comparing ACT with a waitlist control condition reported significant improvements in pain catastrophizing, pain-related disability, life satisfaction, fear of movements, and psychological distress that were maintained at the 7 month follow-up. A larger trial reported significant improvements for pain, depression, pain-related anxiety, disability, medical visits, work status, and physical performance. A recent meta-analysis evaluating acceptance-based interventions (ACT and mindfulness-based stress reduction) in patients with chronic pain found that, in general, acceptance-based therapies lead to favorable outcomes for patients with chronic pain. Specifically, the meta-analysis revealed small to medium effect sizes for pain intensity, depression, anxiety, physical wellbeing, and quality of life, with smaller effects found when controlled clinical trials were excluded and only RCTs were included in the analyses. Other acceptance-based interventions include contextual cognitive-behavioral therapy and mindfulness-based cognitive therapy, though empirical research on the effectiveness of these therapies for the management of chronic pain is still in its infancy.
An important and vastly overlooked common underlying element of all treatment approaches is consideration of the patient�s expectation for treatment success. Despite the numerous advances in the formulation and delivery of effective multidisciplinary treatments for chronic pain, relatively little emphasis has been placed on recognizing the importance of expectations for success and on focusing efforts on enhancement of patients� expectations. The recognition that placebo for pain is characterized by active properties leading to reliable, observable, and quantifiable changes with neurobiological underpinnings is currently at the vanguard of pain research. Numerous studies have confirmed that, when induced in a manner that optimizes expectations (via manipulation of explicit expectations and/or conditioning), analgesic placebos can result in observable and measurable changes in pain perception at a conscious self-reported level as well as a neurological pain-processing level.[49,50] Analgesic placebos have been broadly defined as simulated treatments or procedures that occur within a psychosocial context and exert effects on an individual�s experience and/or physiology. The current conceptualization of placebo emphasizes the importance of the psychosocial context within which placebos are embedded. Underlying the psychosocial context and ritual of treatment are patients� expectations. Therefore, it is not surprising that the placebo effect is intricately embedded in virtually every treatment; as such, clinicians and patients alike will likely benefit from recognition that therein lies an additional avenue by which current treatment approaches to pain can be enhanced.
It has been proposed that outcome expectancies are core influences driving the positive changes attained through the various modes of relaxation training, hypnosis, exposure treatments, and many cognitive-oriented therapeutic approaches. Thus, a sensible approach to the management of chronic pain capitalizes on the power of patients� expectations for success. Regrettably, too often, health care providers neglect to directly address and emphasize the importance of patients� expectations as integral factors contributing to successful management of chronic pain. The zeitgeist in our society is that of mounting medicalization of ailments fueling the general expectation that pain (even chronic pain) ought to be eradicated through medical advancements. These all too commonly held expectations leave many patients disillusioned with current treatment outcomes and contribute to an incessant search for the �cure�. Finding the �cure� is the exception rather than the rule with respect to chronic pain conditions. In our current climate, where chronic pain afflicts millions of Americans annually, it is in our best interest to instill and continue to advocate a conceptual shift that instead focuses on effective management of chronic pain. A viable and promising route to achieving this is to make the most of patients� positive (realistic) expectations and educate pain patients as well as the lay public (20% of whom will at some future point become pain patients) on what constitutes realistic expectations regarding the management of pain. Perhaps, this can occur initially through current, evidence-based education regarding placebo and nonspecific treatment effects such that patients can correct misinformed beliefs they may have previously held. Subsequently clinicians can aim to enhance patients� expectations within treatment contexts (in a realistic fashion) and minimize pessimistic expectations that deter from treatment success, therefore, learning to enhance their current multidisciplinary treatments through efforts guided at capitalizing on the improvements placebo can yield, even within an �active treatment�. Psychologists can readily address these issues with their patients and help them become advocates of their own treatment success.
Emotional Concomitants of Pain
An often challenging aspect of the management of chronic pain is the unequivocally high prevalence of comorbid emotional distress. Research has demonstrated that depression and anxiety disorders are upward to three times more prevalent among chronic pain patients than among the general population.[52,53] Frequently, pain patients with psychiatric comorbidities are labeled �difficult patients� by healthcare providers, possibly diminishing the quality of care they will receive. Patients with depression have poorer outcomes for both depression and pain treatments, compared with patients with single diagnoses of pain or depression.[54,55] Psychologists are remarkably suited to address most of the psychiatric comorbidities typically encountered in chronic pain populations and thus improve pain treatment outcomes and decrease the emotional suffering of patients. Psychologists can address key symptoms (eg, anhedonia, low motivation, problem-solving barriers) of depression that readily interfere with treatment participation and emotional distress. Moreover, irrespective of a psychiatric comorbidity, psychologists can help chronic pain patients process important role transitions they may undergo (eg, loss of job, disability), interpersonal difficulties they may be encountering (eg, sense of isolation brought about by pain), and emotional suffering (eg, anxiety, anger, sadness, disappointment) implicated in their experience. Thus, psychologists can positively impact the treatment course by reducing the influence of emotional concomitants that are addressed as part of therapy.
Benefits of including psychological treatments in multidisciplinary approaches to the management of chronic pain are abundant. These include, but are not limited to, increased self-management of pain, improved pain-coping resources, reduced pain-related disability, and reduced emotional distress-improvements that are effected via a variety of effective self-regulatory, behavioral, and cognitive techniques. Through implementation of these changes, a psychologist can effectively help patients feel more in command of their pain control and enable them to live as normal a life as possible despite pain. Moreover, the skills learned through psychological interventions empower and enable patients to become active participants in the management of their illness and instill valuable skills that patients can employ throughout their lives. Additional benefits of an integrated and holistic approach to the management of chronic pain may include increased rates of return to work, reductions in health care costs, and increased health-related quality of life for millions of patients throughout the world.
Disclosure:No conflicts of interest were declared in relation to this paper.
In conclusion, psychological interventions can be effectively used to help relieve symptoms of chronic pain along with the use of other treatment modalities, such as chiropractic care. Furthermore, the research study above demonstrated how specific psychological interventions can improve the outcome measures of chronic pain management. Information referenced from the National Center for Biotechnology Information (NCBI). 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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