Mapping pain: Where does it hurt?
Pain science is a complicated and growing field of research. Pain is not a one-size-fits-most experience; not only does it vary from person to person, but it is very common for pain to be felt in a different area than where the actual cause is! Furthermore, pain is deeply subjective; what one person may consider a moderately difficult experience could significantly impact, or even halt, another person’s activities of daily life. Pain is an individualized experience varying from person to person, body part to body part, and condition to condition, depending on what is causing the pain to occur in the first place.
Pain and discomfort are tremendous driving forces for a person to seek a doctor. In fact, according to the Centers of Disease Control, between 11% and 40% of US adults are living with chronic pain,1 and pain is one of the most common reasons adults seek medical care.2 Not to mention the existence of pain is debilitating over time; the overlap of chronic pain and depression is undeniable, with neural mechanisms of the brain both impacted and aggravated by the presence of both.3
Chiropractors are trained to help diagnose and treat musculoskeletal pain
Chiropractors have a keen understanding of muscle, joint, and bone conditions that cause pain and discomfort to a patient. One of the biggest differentiators that a well-trained chiropractor will look for is the type of pain. Certain conditions follow certain patterns, or presentations, of pain, and by asking the right type of questions, a chiropractor can discern if the pain is coming from a treatable condition or if the person needs to see another medical provider for more help.
A trained chiropractic physician can help differentiate when pain is being caused by visceral (organ-related) conditions that masquerade as musculoskeletal pain. In instances like these, your chiropractor will ask a series of questions about your activities of daily living including eating and sleeping habits, lifestyle management, pain quality, aggravating and alleviating factors, and more. After a thorough history is taken, the doctor can make the appropriate co-management and referral to another provider best equipped to treat the condition.
Not all pain is the same
Nerve-type pain, also called neuralgia or neuropathic pain, is an example of one condition a chiropractor can assess and treat. Nerve pain is also known as radiating pain because the pain travels in specific patterns along the route of the nerve.
Imagine a river or a stream with its origin somewhere in the mountains. Similarly, the beginning of the nerve starts at an important peak within our body – the central nervous system – located within the brain and spinal cord (spine). From the spinal cord, the nerve roots exit the spine, branch off and interweave with other nerves and travel to other parts of the body.
Radiating pain follows the course of these rivers, or nerves, and radiating pain coming from a nerve will follow the path of the nerve with sharp, shooting, or even electric-like sensations. Nerve pain can be due to problems in the central nervous system (brain and spinal cord), or in the nerves that run from there to the muscles and organs.4 It is usually caused by disease or injury.
Another pain pattern can come from muscle and joint conditions such as trigger points or joint segmental dysfunction. A trigger point is a spot that is sensitive to pressure, mainly in muscle tissue, and is often associated with aching and stiffness.5 Trigger points can be likened to “hot spots” of muscle tightness and pain that should not normally be sensitive to pain. Trigger points have common locations that, when aggravated or pressed, can recreate certain patterns.
Joint segmental dysfunction6 is a long-phrase for a short problem: a joint in the spine is "stuck," or not moving correctly. Both myofascial (muscle) trigger points and segmental dysfunction conditions create a type of pain known as referred pain. Unlike radiating pain, referred pain patterns are less focal and more generalized to the affected body part, with pain that is proximal to the location of the cause.
An important distinction between radiating and referred types of pain is the type of pattern and traveling nature. These elements aid a physician in correctly diagnosing and treating the condition within an expected timeframe for response. Some conditions, such as myofascial trigger points, can resolve in just a few treatments. Other conditions, such as nerve compression creating radiating pain, may take longer.
A good exam is instrumental to provide the correct treatment and outcome
Some patients may consult a quick internet search for pain and other symptoms. The overlapping nature of symptoms and key phrases used in the search bar can make search engine results confusing and misleading. As a result, patients can inadvertently misdiagnose themselves.
One example is a patient with a sharp pain that sometimes goes from his low back, down into his hip, and into his posterior thigh. His internet search reveals a condition called “sciatica,” which is a condition resulting from a pinched nerve in the low back. He may self-diagnose a pinched nerve when, in fact, his pain is referring from a myofascial trigger point in his lumbar erector muscles or his quadratus lumborum muscle.
This is where a good doctor is invaluable. A trained chiropractor will palpate (feel) the affected area to determine if palpation can reproduce the pain pattern.
However, if other components of the physical exam, including orthopedic tests, revealed a tracer type pain down the leg with potentially associated numbness, tingling, and weakness all the way down to the back of the heel, that patient could in fact have a nerve irritation of the sciatic nerve. The nerve compression could have a myriad of causes, ranging from irritation by a lumbar disc herniation, thickened spinal ligament, osteoarthritis, and osteophyte formation, or from a muscular entrapment at the piriformis or hamstring area. Evaluating those areas with a patient exam is vital in determining the root cause.
When to seek a chiropractor for help
A thorough musculoskeletal assessment can reveal whether further imaging such as X-ray, MRI, or other tools are required to accurately assess the pain generating cause. Seeing a chiropractor is wise if the pain does not go away in several days to several weeks.
Chiropractors are conservative providers that are well-positioned to assess and treat musculoskeletal complaints. Chiropractors utilize rehabilitation research and pain science education and advocate for guided exercise and activity, appropriate muscle and tendon loading, spinal and joint mobilization, and other forms of physical interventions that conservatively assist a patient in their healing process.
In years past, a well-intentioned doctor might prescribe just rest and medication. Rest and medication alone are not a supported treatment approach. Harvard Medical School advocates conservative approaches that have become a mainstay of musculoskeletal intervention.7
In addition to advising patients to stay active rather than rest, clinical guidelines also de-emphasize imaging and opioids to diagnose and treat pain in most patients. This leads to better outcomes for both the provider and the patient: no matter the type of pain.
References
1. Centers for Disease Control and Prevention (2018). Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016 [Online]. Available from: https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6736a2-H.pdf [Accessed 30 May 2022].
2. Yasaei, R., Peterson, E., & Saadabadi, A. Chronic Pain Syndrome. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470523 [Accessed 30 May 2022].
3. Sheng, J., Liu, S., Wang, Y., Cui, R., & Zhang, X. (2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural plasticity, 2017, 9724371.
4. “Nerve pain (neuralgia).” Retrieved from healthdirect.gov.au on 30 May 2022.
5. Gerwin, R.D., Dommerholt, J., & Shah, J.P. An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004 Dec;8(6):468–75.
6. Licciardone, J.C., & Kearns, C.M. Somatic dysfunction and its association with chronic low back pain, back-specific functioning, and general health: results from the OSTEOPATHIC Trial. J Am Osteopath Assoc. 2012 Jul;112(7):420-8.
7. Shmerling, R. “Some medications don’t help back pain as much as we thought.” Harvard Health Medical, March 2 2017. Available from: https://www.health.harvard.edu/blog/medications-dont-help-back-pain-much-thought-2017030211208 [Accessed 30 May 2022].
