Chronic Pain

Chronic pain

As a chiropractor with a post graduate degree in neurology I couldn’t wait to read the March 7, 2011 Time magazine.  On the cover was a large headline, “Understanding pain.”  I had suspected that the three in-depth articles they wrote on the topic would not mention the word chiropractic and I was dying to know if I would be right.  They did a great job discussing massage, yoga, acupuncture, herbal supplements, and bio-field therapies, but of course nothing about chiropractic. 

O.K. I was hurt, but I wasn’t mad, however, the quote from Dr. Michel Dubois of New York University’s Langone Medical Center who said, “We don’t know much more about pain than we did 200 years ago” did horrify me just a little.  Seriously, this begs the question, has this guy read a book about chronic pain that was written after 1811?   

The textbook, “Principles of Neural Science”, by Kandel, Schwartz, and Jessell is used in practically every medical school in the world and is the gold standard on all things neurological.  Chapter 24 in the fourth edition is titled, “The perception of pain.”  It’s really quite complicated, but certainly a doctor should be able to understand it.  Let me give you some real basic simple easy to understand concepts about pain.  Once we understand pain then we can have a little more hope regarding chronic pain.

There are basically three basic types of nerve fibers in the human body.  They are labeled A, B, and C fibers.  Tough stuff so far, huh?  C fibers are for the transmission of pain.  Picture you wanting to go from your house in the boondocks to your nearest big city downtown area.  You could take the back roads, which would be the equivalent of traveling along a C pain fiber in the sense that you would not be able to drive very fast on such a small road.  Yes it is quite hard to believe that when you get stuck with a pin that pain signal is traveling on the slowest road in the body.

Another way to get downtown would be to take the bigger surface streets, which is equivalent of a B nerve fiber; they are bigger than C fibers.  And if you’re lucky enough to live by a freeway you could take that and if there was no traffic, you would arrive at your desired destination much quicker than if you used the other two routes. 

All pain in our body has to get to downtown, which in this case is the Thalamus portion of our brain.  If for any reason the pain signal in the C pain fiber doesn’t arrive at the thalamus you are feeling good.  An example of this would be say you chose to go to Dustin Hoffman’s Nazi dentist from the movie Marathon Man.  Lawrence Olivier, the Nazi dentist, is drilling holes into poor Dustin’s nerves under his teeth and he is not feeling all that well.  If the dentist would have been so kind as to use Novocain, Dustin would have been having a better day.  Of course the tissue damage would still be occurring, but he just wouldn’t notice it for a while. 

The point here is besides picking your dentist wisely, is that the body has all kinds of mechanisms to block pain.  One example that we are familar with is magic creams.

We’ve all heard of Ben Gay and other analgesic ointments.  They work because they irritate the B fibers in our skin.  Since a B fiber is bigger than a C fiber it gets to downtown (our thalamus) quicker and it takes the pain’s parking spot.  Well, for a little while anyway.  When the meter expires, the analgesic effect drives off and the big bad pain signal pulls in and triggers the thalamus where it is then sent to different areas of the brain.  These other areas lets you know where the pain is, what kind of pain it is, it triggers memories, and goes to your emotional center, which is going to determine just how emotional you’re going to get over this. 

 When chiropractors adjust your spine, they are firing off the A fibers, those wonderful giant freeways of nerves that gets to your thalamus (pain relay center) even quicker than the previous mentioned B fibers, hence one reason why chiropractic is so much more effective at pain control than scraping a coin up and down your skin for a while.  (Analgesic ointment) A variation on this theme and brilliantly applied by the medical team of Drs. Moe, Larry, and Curly, is the strategically placed poke in the eye to make you forget about the anvil that fell on your foot.

Additionally, pain signals have to enter the spinal cord in order to get to the thalamus.  Adjusting spinal segments modulates pain signal production at this level.  Furthermore, stimulating these large A fibers found surrounding spinal joints also alters the neurochemistry of pain.  I will discuss neurochemistry and nutritional therapies for pain management at another time.

As usual, Time magazine has done a great disservice to its readers.  I’m totally dismayed at why they would use a doctor who hasn’t read a book on the subject of chronic pain since 1811 to educate the public on such an important issue.  But seriously, it was a long piece and the result of much collaboration that included many doctors.  That the editors chose to ignore one of the most powerful and well understood natural methods for pain control is troublesome at best.  I’m going to go off the deep end and speculate that they may have a conflict of interest with their sponsors, the drug companies, whose advertisements are interspersed throughout the magazine.

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