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Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
May, 2011, Vol. 11, Issue 05
Understanding Central Sensitization and Pain
By Leon Chaitow, ND, DO
Central sensitization is defined as 'an augmentation of responsiveness of central pain-signalling neurons to input from low-threshold mechanoreceptors' (Nijs 2009). The evolution of chronic pain has been shown to have strong association with the process of central sensitization, in which there is enhanced sensitivity to various modes of painful and non-painful stimuli (Buchgreitz et al 2006).
Staud (2006) has described the ways in which peripheral pain impulses can lead to central sensitization. In many chronic pain states, including chronic migraine, irritable bowel syndrome, fibromyalgia syndrome, repetitive, persistent or recurrent peripheral nociceptive features can lead to neuroplastic changes in the spinal cord and brain, that results in central sensitization and consequent pain.
Yi-Meng Xu et al (2010) have explained that even the nociceptive input from latent trigger points can contribute to central sensitization, and that only minimal nociceptive input (resulting from touch, pressure or heat) may be required to maintain the chronic pain state, once central sensitization has evolved.
A generalized central sensitization is identified as operating in fibromyalgia syndrome which is also common accompanying diagnosis in patients with chronic headache. Yunus (2007) has described the overlap of a number of chronic pain as Central Sensitivity Syndromes - asserting that in such conditions hyperexitability exists of central neurons resulting from the influence of various neurotransmitter and neurochemical activities, with this (central sensitization) itself being contingent - for both development and maintenance – on abnormal or continued peripheral inputs.
Background to sensitization
Selye (1984) defined both the general adaptation syndrome (GAS) affecting the individual as a whole, and the local adaptation syndrome (LAS), affecting a local area of the body that is subjected to stressors demanding adaptation. The GAS and LAS models explain how adaptation progresses, over time, with modifications to function occurring, leading eventually to adaptive capacity becoming exhausted, and symptoms emerging.
Neuromusculoskeletal adaptive changes involved in such processes can be seen to represent a record of the body's attempts to adapt and adjust to the multiple and varied stresses which have been imposed upon it, over time. The results of repeated postural and traumatic insults over a lifetime, combined with the somatic effects of emotional and psychological origin, will often present a confusing pattern of tense, shortened, bunched, fatigued and, ultimately, fibrous soft-tissues. Some of the many forms of biomechanical stressors that affect the body include the following (Lewit 2009).
Widespread functional changes develop – for example, affecting respiratory function and posture – with implications for the total economy of the body. (Timmons & Ley 1994) In the presence of a constant neurological feedback of impulses to the CNS/brain, from neural reporting stations, there will be increased levels of psychological arousal and a reduction in the ability of the individual, or local hypertonic tissues, to relax effectively, with consequent reinforcement of hypertonicity, and inevitably relative ischemia – an environment ideal for myofascial trigger point evolution (Shah 2005).
Functional patterns of use, of a biologically unsustainable nature, are likely to evolve, leading to chronic musculoskeletal problems and pain. (Crockett et al 2002) At this stage, restoration of normal function would require therapeutic input to address both the multiple changes that have occurred, as well as there being a need for re-education of the individual as to how to use the body, to breathe, and to display posture in more sustainable ways.
For more on the topic of adaptation the following two links will take you to some of my blog postings on this subject:
Soft tissue changes
Soft-tissue changes involving pain, hyper- or hypotonicity, joint dysfunction, antagonist muscle imbalances, overactive synergist muscles, lead to localized areas of hyper-reactivity, in the form of myofascial trigger points, and/or neural entrapment. (Lewit 2009) Additionally, pain due to damage or inflammation of peripheral tissues is clearly capable of causing chronic widespread pain. Another example of a local musculoskeletal disorder associated with chronic pain, frequently seen in manual therapy practice, is arthritis, possibly causing continuous activation of local nociceptors that initiate or sustain, central sensitization.
Reducing the nociceptive barrage Yunus (2007) has suggested that effective manual therapy in sub-acute cases of musculoskeletal dysfunction should be capable of limiting the afferent barrage of noxious input to the central nervous system, so preventing chronicity. Nijs et al (2009) goes further and affirms the importance of decreasing the afferent nociceptive barrage of trigger points, by means of soft-tissue mobilization, in comprehensive care of cases of chronic pain.
Neuromuscular therapies (NMT) aim to reduce the effects of adaptation/compensation as described above, by enhancing musculoskeletal function – including improved posture, respiratory function, and general mobility and stability, and by reducing noxious inputs resulting from the active presence of, for example, myofascial trigger points.
Recognizing Central Sensitization in patients Nijls et al (2010) have summarized the many associated features of central sensitization;
The presence of some or all of these symptom, together with information gathered during the history taking and the medical diagnosis, and confirmatory results from assessments listed below, can all help in recognition of the existence, in a given patient, of central sensitization. In this assessment the following tests have been suggested (Yunus 2007):
Symptom exacerbation, at both symptomatic and distant sites, indicates central sensitization. It is important to note that a variety of other indications may also suggest this, including increased pain during, or following, exercise
A fundamental principle emerges from current understanding of the sensitization process – sensitization can be reversed.
Affaitati et al (2011) have clearly demonstrated – in fibromyalgia - that therapeutic strategies that reduce the overall stress burden, whether these relate to biomechanics, biochemistry or psychosocial features, will reduce central sensitization.
Click here for more information about Leon Chaitow, ND, DO.
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