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How Do Chiropractors Measure Pain?

How Do Chiropractors Measure Pain?

Measuring the amount of pain being experienced by a patient is an essential part of chiropractic assessment prior to treatment. However, unlike objective measures such as the degree of spinal curvature or the range of joint movement, the amount of pain cannot be determined directly, but is instead inferred from the patient themselves or from signs usually associated with it.  These two methods—patient self-reporting and inference by examination—are the basic tools chiropractors will use to assess a patient’s pain level.

While the degree of discomfort reported by a patient is an important guide, the subjective experience of pain means that each person will have a different level at which they call pain mild, moderate or extreme.  Likewise, patients will all have varying degrees of verbal and physical reactions to different levels of soreness.  Taken together, however, self-reporting and examination provide a combination of evidence which can be used to determine pain levels with a reasonable degree of accuracy.

Most chiropractors treating a patient will use an assessment form that asks about the kind of problem that the patient is currently experiencing and the amount of pain it is causing.  A basic diagram of the body may also be used to mark locations and levels of pain.  Further questions, either in the form of a questionnaire or through a patient interview, may be asked to ascertain the frequency of pain and the nature of movements and activities that may trigger pain or worsen it.

The level of perceived discomfort is often assessed using a pain scale in which the patient is asked to assign a figure to their experience such as from 0 (no pain) to 10 (extreme pain). Although such a scale will be subjective, most patients demonstrate a good deal of internal consistency when it comes to reporting relative pain levels.  This means that patient-reporting using this type of pain scale can be useful in determining whether a condition is responding to treatment over time or getting worse, as well as in determining how pain levels fluctuate over the course of a day or in response to certain kinds of activity.  In addition to the simple pain scale, there are several specially designed questionnaires that are also used to assess the degree of pain and disability associated with spinal injuries, such as the Quebec Back Pain Disability Scale.

Chiropractic assessment of a patient actually begins the moment the patient walks in the door.  A skilled chiropractor can tell much about a condition and how much pain someone is in by their overall posture, how they walk, facial expressions of discomfort and involuntary verbalization.  While being examined, palpation and movement of problem areas will often give rise to further articulation and tensing against painful movement, which provide further clues both to the location and degree of soreness.  A chiropractor may use pain scales during the examination so that patients can communicate in a more focused way how much a certain movement or palpation hurts.  Marking these pain levels on a chart provides a baseline measurement that a chiropractor can use to judge the effectiveness of treatment over time.

Although pain measurement is only one method of assessing both the degree of injury and success of treatment, it is an important one.  Pain is both a clear sign that something is wrong and an impediment to normal daily activity.  In contrast, a reduction in pain following chiropractic therapy increases feelings of wellbeing and provides subjective evidence of improvement.  For the chiropractor too, this is an essential indication that they are doing something right.  Together with other signs such as increased strength, range of movement and endurance, reduced pain is a welcome indicator that a patient is making progress.

Chiropractic Adjustments Help with Pain Relief

Chiropractic Adjustments Help with Pain Relief

Johns Hopkins Medicine defines pain as “an uncomfortable feeling that tells you something may be wrong.” Depending on its cause, this feeling can range from being mildly annoying to absolutely debilitating in nature, potentially preventing a person from having any quality of life whatsoever. Additionally, some pains are constant and steady, whereas others tend to come and go.

Regardless of the type, intensity, and consistency of the pain, at some point in our lives, we all experience this feeling in one form or another. However, whether or not we’re able to effectively handle it is largely determined by our individual pressure pain thresholds. In other words, the higher our thresholds, the less impact these pains have on our lives, and one fairly new study has found that chiropractic may just increase that limit.

In December of 2016, Chiropractic & Manual Therapies published a piece of research which set out to determine what effect, if any, spinal manipulation therapy (SMT) had on pressure pain threshold. Individuals were recruited from Murdoch University campus in Western Australia and, ultimately, 34 subjects ranging in age from 18 to 36 qualified for inclusion. Twenty of the participants were male, with the remaining 14 being female, all of whom were assessed at the beginning of the study and declared asymptomatic.

Using an algometer with a 1cm2 rubber probe, the participants’ deep mechanical pain sensitivity was assessed multiple times at four different sites on the body (calf, lumbar, scapula, and forehead) by asking each one to indicate the point in which the pressure turned into pain. The average of the second and third recordings was used as a baseline.

Once the initial data was recorded, each participant was then subjected to a high-velocity, low-amplitude spinal manipulation using the hypothenar mammillary push while the subject lay on his or her side. Furthermore, the thrust was aimed at the portion of the participants’ spine located between the L5 and S1 vertebrae. Upon completion, the pressure pain threshold was collected again, and then again at 10, 20, and 30 minutes after the conclusion of the treatment session.

Researchers found that, after engaging in just one session of SMT, subjects reported increases in pressure pain threshold in the calf and lumbar spine areas, with no notable reduction in the scapula or forehead. Additionally, the thresholds that did increase did so at a higher rate on the right side of the participants’ bodies than on the left.

This study shows promise for patients dealing with chronic pain issues as chiropractic adjustments seem to provide an instantaneous reduction in pain. Further research with a larger group of test subjects is warranted.

Dorron SL, Losco BE, Drummond PD, Walker BF. Effect of lumbar spinal manipulation on local and remote pressure pain threshold and pinprick sensitivity in asymptomatic individuals: a randomized trial. Chiropractic & Manual Therapies 2016;24:47.10.1186/s12998-016-0128-5

What is Pain/Types of Pain Treated?  Johns Hopkins Medicine: Blaustein Pain Treatment Center.

This article was written by Michael Melton on February 7, 2018, and is shared from the following website: https://www.chironexus.net/2018/02/chiropractic-adjustments-help-pain-relief/
Opiates Ineffective for Chronic Back or Hip Pain

Opiates Ineffective for Chronic Back or Hip Pain

A new study just published in the Journal of the American Medical Association finds that opioids are not an effective solution for chronic pain.

In this article, researchers from the University of Minnesota studied 240 patients who had chronic back, hip, or knee arthritis pain. Half of the study subjects received opiates; the other half received non-opiate pain medications. Patient progress was evaluated at 3-months, 6-months, 9-months, and one year.

The study found:

  • There was no difference in pain-related function between the two groups.
  • At 12 months, the nonopioid patients had less pain than did those who received opiates.
  • “The opioid group had significantly more medication-related symptoms over 12 months than the nonopioid group”

The study authors write:

“Among patients with chronic back pain or hip or knee osteoarthritis pain, treatment with opioids compared with nonopioid medications did not result in significantly better pain-related function over 12 months. Nonopioid treatment was associated with significantly better pain intensity, but the clinical importance of this finding is unclear.”

Previous research has found that about 20% of patients with musculoskeletal pain are prescribed narcotic pain medications for their symptoms, and another recent study found that 36% of people who overdosed from opiates had their first opioid prescription for back pain.

Another recent study found that chiropractic patients are less likely to use opiates for their pain than are medical patients.

From this research, it seems clear that it’s risky to prescribe opiates for musculoskeletal pain. Chiropractic care is a proven safe and effective approach for both chronic and acute back pain.

Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, Kroenke K, Bair MJ, Noorbaloochi S. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA. 2018 Mar 6;319(9):872-882. doi: 10.1001/jama.2018.0899.

Today’s article was written by Michael Melton and is shared from the following website: https://www.chironexus.net/2018/03/opiates-ineffective-for-chronic-back-or-hip-pain/

What is “Referred Pain”?

What is “Referred Pain”?

Billings Chiropractor“Referred pain” can be a perplexing phenomenon for anyone who experiences it. Referred pain is what happens when you feel pain in an area of your body that is not actually the original source of the pain signals. The most common example of referred pain is when pain is felt in the left arm, neck or jaw of a person suffering a heart attack, while they often have no feelings of pain in the chest area itself.

It’s important to note that referred pain is different from radiating pain, in which the pain felt in one area travels down a nerve, causing pain along the length of the nerve. This is often the case with sciatica, where pain originates in the lower back and radiates down the leg.

Researchers are still not exactly sure what causes referred pain. Some experts believe that it is due to a mix-up in nerve messaging. The central nervous system (CNS) is constantly receiving a barrage of different messages from different parts of the body. These messages may get mixed up somewhere along the path between the place where the irritated nerve is signaling and the spinal cord or brain where pain signals are processed. With an extensive network of interconnected sensory nerves that serve the same region of the body, such as the nerves of the lower back, thighs and hips, it may be more common for signals to get mixed up than you might imagine.

Although referred pain is usually felt as painful, it can also cause feelings of numbness, tingling or the sensation of pins and needles. Another example of referred pain is a tension headache, in which headache pain is due to an irritation of the nerves in the neck.

Referred pain tends not to cross sides of the body. In other words, if the pain signals are originating in the liver or gallbladder (which are on the right side of the body), you may feel pain in your right shoulder. If the signals originate in the pancreas (on the left of the body), you may feel pain in your left shoulder, etc.

Chiropractic adjustments can address the source of the referred pain, leading to long-term pain relief. Nerves in the area of the spinal cord that are irritated due to a spinal misalignment (subluxation) can be a cause of referred pain. When your chiropractor adjusts your spine, he or she removes the source of irritation, thus providing relief. Dr. Oblander is a Billings Chiropractor who is very knowledgeable about which tests can be performed to determine the underlying cause of your pain (whether direct or referred), and can treat it accordingly. If you have questions or want to seek chiropractic treatment, be sure to give us a call at Oblander Chiropractic: 406-652-3553.

What is a “Normal” Pain Tolerance?

What is a “Normal” Pain Tolerance?

man-in-pain-distorted
man-in-pain-distorted

Pain is a nearly universal human experience that has several aspects. The first thing we usually think about in relation to pain is its trigger or cause. Perhaps you stub your toe, cut your finger while chopping vegetables, or feel the beginnings of a headache coming on. When this kind of thing happens, your body initiates a physical process driven by your anatomy and physiology. Your senses transmit a message through your nerves to your brain, saying “Something is wrong.” The second aspect of pain, however, is psychological and emotional rather than physical—how do you react to the message that your body is experiencing trouble? Do you ignore the headache and continue with your activities, or do you have to stop what you’re doing and focus on the pain to try to make it go away?

When it comes to our response to pain, two factors are also in operation. These relate to the idea of sensitivity. Pain threshold is the point at which pain first begins to be felt, and pain tolerance is the point at which a person reaches the maximum level of pain they are able to tolerate. When attempting to define what “normal” responses to pain are, both factors must be examined.

“Normal” responses to pain are difficult to determine because they vary so widely.

Some people may react to a bad headache by ignoring it and continuing to work, while others may react to a headache they rate at the same subjective level of pain by becoming completely incapacitated and having to lay down and close their eyes until it goes away. So what factors determine these differences in people’s tolerance of pain, and what can we say about them?

First, there seem to be differences in pain tolerance between men and women, with men exhibiting slightly higher pain tolerance than women. But this generalization can be affected by the oddest things. For example:

  • Studies of dental patients suggest that redheads have lower pain tolerances than people with other hair colors, and actually need higher doses of anesthesia during oral surgery.
  • Athletes have been proven to have higher pain tolerances than people who don’t exercise.
  • People who smoke or are obese are more likely to have low pain tolerances.
  • People who are depressed or anxious are more sensitive to pain and have lower tolerances.

There are also biological factors such as genetics, previous spinal cord damage, and chronic diseases that cause nerve damage that affect how we perceive, interpret, and manage pain. So the problem of defining what constitutes a “normal” level of pain tolerance becomes very difficult. But we recognize intuitively that we’re beginning to approach our own pain tolerance when two things happen—first, the pain begins to interfere with our ability to function in some way and second, it causes us to seek help.

As healthcare professionals, we generally distinguish between acute pain—the pain that usually results from a specific injury or illness, lasts less than 6 months and goes away as the body heals—and chronic pain, which can persist or progress over longer periods of time and may have no clear cause.

Depending on the situation, help may come in the form of common over-the-counter analgesics like aspirin, acetaminophen, and ibuprofen, or from more powerful drugs like opioids. Sometimes it may come in the form of ice, heat or topical treatments. And other times it may come in the form of hands-on therapies like chiropractic and massage.

Whatever your level of pain tolerance happens to be, you can get better at handling pain.

Because of the many factors that can potentially affect pain tolerance, managing one’s pain can be a challenging process of trial and error. You can’t change your genetic pain receptors and how sensitive they are, and dying your hair another color if you’re a redhead isn’t going to make you less susceptible to pain. But there are coping mechanisms that can influence the brain’s perception of pain and help you manage it, effectively increasing your pain tolerance. Relaxation techniques, biofeedback, chiropractic manipulation, massage, and mindfulness meditation have all shown surprising success at enabling people who suffer from chronic pain to manage it more effectively without the ongoing use of drugs.

So if you are one of the 25% to 30% of adults living with musculoskeletal pain, contact our office and ask for help—it IS available, and doesn’t necessarily have to come in a pill bottle!