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THE STORY OF PAIN, BY MITCHELL YASS, PT
- Pain is an impulse created by a tissue in distress. It is not a self contained entity and therefore should not be considered something to be treated. The distressed tissue needs to be treated to resolve the pain.
- Pain is created by receptors found mostly in connective tissue. Connective tissue is found in most organs including the heart, lungs, intestines, skin, muscle, ligaments and tendons. When a tissue is in distress, the pain receptor is activated to identify that a problem is occurring.
- Because pain is transmitted through nerves does not indicate that the tissue in distress is the nerve. For example, when pain is experienced in the lower back, the identification of an impinged nerve root due to a herniated disc does not mean that the nerve root is causing the pain. The pain can be coming from a muscle in the lower back. The pain receptors in the connective tissue found in the muscle are triggering the sensation of pain secondary to the muscle being in distress.
- Since daily functional activity requires movement and movement is created by muscles, I have found that most often the cause of pain is distress of muscle due to straining. Pain associated with structural abnormalities such as herniated discs, arthritis, stenosis and meniscal tears are severely over diagnosed. Studies are showing that these structural variations can be found in as many people with no pain as those with pain. Therefore, the identification of these, through x-ray and MRI, as causes of pain is now being called into question.
- Chronic pain in most cases is nothing more than misdiagnosed acute pain.
- The use of drugs such as anti-inflammatories, pain killers such as Vikodin, Fentanyl or Oxycotin, epidural nerve blocks or cortisone shots, will never resolve the cause of pain. They work to mask the symptom which is pain, not resolve the cause of pain which is the tissue that is in distress creating the pain impulse.
- Pain at one location can be caused by weakness at another area. For instance, pain at the lower back can be caused by weakness at the hip muscles. Since these muscles work in conjunction of the lower back muscles, straining of the hip muscles can cause the lower back muscles to overwork, strain and create pain. Another example is pain experienced at the front of the shoulder can be caused by weakness of the muscles between the shoulder blades. Since pain at the front of the shoulder can be caused by an improper posture called forward shoulder posture, resolution of this posture and associated pain can be resolved through strengthening of the muscles between the shoulder blades. These muscles draw the shoulders back and prevent injuring the bicep which runs through the front of the shoulder and can become impinged and create pain. Never fall into the mindset that the cause of pain is always where the pain is experienced.
- Pain can be experienced locally, where a muscle is strained or the muscle can refer pain to another area called a referred pain. If you have pain at the side of your shoulder and upper arm, this is commonly due to a strain of the brachialis muscle, the muscle located where you are having your pain. If you strain the infraspinatus, a rotator cuff muscle, you may experience pain at the hand. This is a referred pain. Knowing that pain can be referred to other areas than where a muscle is strained is a key to diagnosing a cause of pain.
- Pain associated with the irritation of a nerve can have a muscular cause. A great example of this is sciatica. The symptom is pain from the gluteal region down the leg, often times to the foot. The cause of the pain is a strain of the piriformis muscle that becomes thickened and impinges on the sciatic nerve creating the pain symptom. Resolution of the pain is achieved by decreasing the thickening of the piriformis muscle by strengthening the other muscles that work in conjunction with the piriformis. This limits the piriformis muscle from straining, thickening and impinging on the sciatic nerve.
- More than one-quarter of the nation's adults suffer from persistent pain, the National Center for Health Statistics says. About 74 million deal with pain that lasts more than a day -- and the center estimates more than 42% of those people experience pain that lasts longer than a year.
- The National Center for Health Statistics reports that during a three-month period in 2007: 57 million adults had persistent back pain 29 million adults had neck pain 27.4 million adults had headaches
- Chronic pain costs $100 billion a year in lost income, lost productivity and medical expenses.
