Many people come to us seeking solutions for pain. When a patient asks me if I can get rid of their pain, I usually respond in the following manner:
First, I tell them, “I’m actually not interested in getting rid of your pain. ” I let that statement sink in, as they most likely ask themselves if they are in the right office. I then proceed to tell them that I am interested in getting rid of the problem causing their pain. I remind them that pain provides a very useful service. For example, it can alert us to an underlying structural condition by providing an undeniable symptom (pain) when we attempt certain movements. As a result, it may prevent us from further damaging an already injured area.
I think you would agree that our goal as practitioners should be to identify and correct the underlying source of the problem. Once that happens, the pain would no longer be necessary and should resolve on its own. Nevertheless, most conventional approaches are focused on getting rid of symptoms, such as pain, which, of course, could lead to ongoing tissue damage and degeneration. This approach is akin to “killing the messenger. ”
The pharmaceutical industry has historically made a huge portion of its profits by promoting and distributing powerful pain medication, despite the abundance of evidence for deleterious side effects and addictive potential.
As practitioners, we may provide various forms of manual therapy, as well as electrotherapy, laser, acupuncture, or other modalities. In many cases, we are successful in helping our patients to varying degrees.
Nevertheless, there is always a subset of patients for whom nothing we try seems to help for very long, if at all. In those cases, we may become frustrated and even blame the patient for sabotaging their care or “not wanting to get better.” Eventually, we either give up on them, or they leave our care to seek other potential solutions.
Unresolved painful conditions that persist for longer than three to six months can evolve into the condition known as chronic pain.1 About 25% of chronic pain sufferers may go on to develop a condition called chronic pain syndrome (CPS), which is accompanied by other symptoms, such as depression or anxiety.2
The Chronic Pain Vicious Cycle'
In his book, The Brain’s Way of Healing, Dr. Norman Doidge explains that chronic pain is a phenomenon governed by the tendency of the nervous system to neuroplastically increase the number of neurological connections within the brain associated with the negative sensation of pain.3 4 These connections tend to increase over time and ultimately develop a life of their own, becoming more easily triggered with minimal stimulation.
These impulses may even spill over into adjacent parts of the brain. This can lead to so-called “referred pain,” giving the patient the sensation that the pain is coming from other areas in addition to the original site of injury.
As humans, we have the unique ability to consciously focus on pain in ways that can add to its neuroplastic augmentation within the portions of the brain that interpret pain stimuli. This is often due to our state of mind regarding the condition, which can increase certain negative emotions, such as anxiety or fear. A similar cycle was first described by Dr. John Samo in his book Mind Over Back Pain.5
cle (Figure 1).
Fear and anxiety about a painful condition may be aggravated, for example, by receiving a frightening diagnosis from a well-meaning health professional. Sadly, many diagnoses are incorrect (the Mayo Clinic reports that only 12% of diagnoses are correct). There is also a wide range of scary medical shows presenting stories about people succumbing to an endless variety of health challenges. These factors can contribute to a heightened perception and a lowered threshold for pain.6
Stress, tension, and the biochemical changes associated with anxiety may become amplified as the pain persists. Ultimately, the number of neurons and the complexity of their synaptic connections may also increase, resulting in the likelihood that the pain response will be more readily and chronically triggered. This becomes a vicious cycle, referred to as the chronic pain cy-
Addressing the Hidden, Underlying Cause of Many Cases of Chronic Pain
Structural Change and Bone Expansion
Research has demonstrated that the molecular elements within certain tissues at the site of injury expand and become rigid. One of the most common tissues affected by this phenomenon is bone because of its density.7 You may be surprised to identify these differences in your own body by simply noticing the fact that one of your wrists or knees is larger than the other. Common injuries, such as falling on an outstretched hand or knee, are all too common (Figure 2).
The expanded osseous structures can become an ongoing source of mechanical stress on pain-sensitive soft tissues (ligaments, tendons, and other articular elements) and contribute to the cycle of strain and chronic pain.
We now also know that these changes can alter the ability of bone and other tissues to conduct electrical current. This may also contribute to the sensation of pain by disrupting cell physiology, which leads to tissue degeneration and inflammation.8
Reversing Chronic Pain Step 1: Resolving the Structural Injury The revelation that bone enlargement and subsequent tissue stress are key contributors to the ongoing stimulation of pain receptors is a radical departure for most practitioners. However, being able to precisely locate and reverse these influences is essential to resolving the injury at its source. Practitioners using the Matrix Repatteming technique have successfully provided this important component of treatment.910 In most cases, this approach will break the cycle of tissue tension, allowing for a more rapid resolution of inflammation and pain.
Step 2: Addressing the Chronic Pain Cycle Pain may be perceived in a specific area of the body. We may even feel that it has a definite boundary. By helping our patients recognize that pain is accentuated by unconscious reactive muscle tension, we can encourage them to adapt their conscious awareness of pain to break the vicious cycle of chronicity.
Instead of becoming fearful and tensing up against the pain, we can instruct them to consciously relax the area as soon as they get even the slightest hint of discomfort. This can help break the chronic pain cycle and, overtime, reduce the amount of “cerebral real estate” occupied by the pain-reporting centers associated with that area of the body.
You might be surprised by how quickly your patients can release the tension surrounding the area of pain, leading to a significant level of relief. This can often be demonstrated to them within a few minutes with your guidance. As they accomplish this, they are doing much more than just reducing their pain. They are also improving circulation (nutrient supply and waste removal) to support cellular repair and the effectiveness of your treatments. They are literally supporting their own healing ability by connecting with the injured part that is asking, through the message of pain, to receive the support it needs to restore balance.
By coming to an understanding of the purpose and opportunity provided by pain, we can decide to respond to it in a more appropriate and helpful manner. A positive response to pain can actually help our patients overcome the injury that caused it in the first place. The following exercise is designed to alter the perception of pain by using a positive mental image to reduce its intensity and degree.
Instead of perpetuating a vicious cycle, we can replace it with a “virtuous cycle.”
Visualization Exercise to Break the Chronic Pain Cycle
1. Encourage your patients to find a comfortable position (sitting or supine).
2. Ask them to focus their attention on the area of pain and identify the current boundary of the painful area.
3. Suggest that they visualize the boundary beginning to soften around the edges by consciously relaxing the muscles and tissues in the area. They can imagine the boundary of the pain melting or dissolving. As they do this, ask them to focus on their breathing, making it comfortably full and relaxed.
4. Next, encourage them to imagine the area of pain shrinking away from the former boundary. They should do this in several steps, allowing the painful area to become smaller and smaller, each time feeling the new boundary softening as in the previous step.
With a little practice, your patients will be able to diminish the intensity of pain and therefore reduce the overall level of stress and tension. This can help break the cycle of pain-stress-pain that can often become so debilitating.
Don’t worry if they’re not successful right away. If your treatment plan is appropriate for the underlying structural issues that created the problem, the pain will begin to reduce enough for your patients to apply this exercise more effectively. Throughout the day, whenever they feel even the slightest twinge of pain or discomfort, suggest they use that as their cue to immediately relax and soften the area around it to disperse the tension. This will help them develop a much more constructive habit with respect to any pain that might arise in the future as they pursue your treatment plan.
The combination of physical treatments and mental approaches may be more powerful than either one individually. In this way, your patients can become an active part of their recovery.
Dr. George Roth, BSc, DC, ND, CMRP is recognized as an authority and pioneer in the field of physical medicine. He is the developer of Matrix Repatterning, a breakthrough treatment system that is recognized worldwide. He is the author of The Matrix Repatterning Program for Pain Relief and his contribution to the treatment of concussion and traumatic brain injury has been acknowledged by Dr. Norman Doidge in his best-selling book, The Brain's Way of Healing.
References
1. Cleveland Clinic Website (Chronic Pain) : Chronic Pain: What Is It, Causes, Symptoms & Treatment (clevelandclinic.org).
2. WatsonS., What is Chronic Pain Syndrome, WebMD, WebMD.com, Nov. 23, 2020.
3. Doidge N., The Brain s Way of Healing, Penguin Books, New York, 2016.
4. Zimmerman M, Herdegen T, “Plasticity of the Nervous System at the Systemic, Cellular and Molecular Levels: A Mechanism of Chronic Pain and Hyperalgesia, ” in G. Carli and M. Zimmerman, eds., Towards the Neurobiology of Chronic Pain (Amsterdam: Elsevier, 1996), pp. 233-259.
5. Saino JE, Mind Over Back Pain, Berkley Press, New York, 1986.
6. MelzackR, Wall PD, Pain mechanisms: a new theory Science 150: 971-979, 1965.
7. Fantner GE, Hassenkam T, Kindt JH, Weaver JC, Birkedal H, Pechenik L, Cutroni JA, Cidade GA, Stucky GD, Morse DE, Hansma PK, Sacrificial bonds and hidden length dissipate energy as mineralized fibrils separate during bone fracture, Nat Mater 2005 Aug:4(8): 612-6. Epub 2005 Jul 17.
8. Chakkalakal DA, Mechanoelectric transduction in bone. J Mater Res. 1989:4: 1034-1046.
9. Roth GB, Matrix Repatterning, Advanced Structural Therapy, Matrix Institute, Toronto, 2019.
10. Roth GB, The Matrix Repatterning Program for Pain Relief, New Harbinger Books, Oakland, 2005.
