Tuesday, December 20, 2011

Pain: the 4 letter word

Clients suffer from pain in many ways. Pain can rob clients of their lives. They may become depressed or anxious and want to end their lives. Clients are sometimes unable to do many of the things they did without pain, and this pain affects their relationships with others. This can lead to loss of employment or social issues with friends and family.
What is often overlooked is that pain has physically harmful effects. It is often actually physiologically unsafe to have pain.13 The effects of pain on the endocrine and metabolic system, cardiovascular system, gastrointestinal system, and immune system—and the potential for future pain—are but a few of examples of how unsafe unrelieved pain may be.13

Pain causes stress. The endocrine system reacts by releasing an excessive amount of hormones, ultimately resulting in carbohydrate, protein, and fat catabolism (destruction); poor glucose use; and other harmful effects. This reaction combined with inflammatory processes can produce weight loss, fast heart beat, increased respiratory rate, fever, and shock. Unrelieved pain prolongs the stress response, adversely affecting the client’s recovery.13

The cardiovascular system responds to stress of pain by activating the sympathetic nervous system, which produces a variety of unwanted effects. In the postoperative period, these include an excess of blood clotting, increased heart rate, blood pressure, cardiac work load, and oxygen demand.13

Since the stress response causes an increase in sympathetic nervous system activity (fight or flight), intestinal movement and stomach churning slow. This response can cause temporary impairment of gastrointestinal function.13,

Unrelieved pain may be especially harmful for clients with metastatic cancers. Stress and pain can suppress immune functions, including the natural killer (NK) cells that play a role in preventing tumor growth and controlling metastasis.13, 16

Unrelieved acute pain can result in chronic pain at a later date. Thus, pain now can cause pain later. A survey of clients having undergone surgery found a high percentage of chronic postsurgical pain in patients whose acute postsurgical pain was inadequately managed.20

13. Pasero C, Paice JA, McCaffery M. Basic mechanisms underlying the causes and effects of pain. In: McCaffery M, Pasero C, editors. Pain: clinical manual. 2. St. Louis, MO: Mosby; 1999. pp. 15–34.

16. Page GG, Ben-Eliyahu SJ. The immuno-suppressive nature of pain. Semin in Oncol Nurs. 1997;13(1):10–5.

20. Goldstein DH, Ellis J, Brown R, et al. Meeting proceedings: recommendations for improved acute pain services: Canadian Collaborative Acute Pain Initiative. Pain Res Manage. 2004;9(3):123–30.

Tuesday, December 13, 2011

Soothing the Stress Response System

Your Stress Response system (SRS) is what responds to the stress you are under on a daily basis. When it is over taxed it can ruin the best of days. The work piling up on your desk, sitting in traffic on I-5, waiting in lines at the bank, balancing your budget, engaging in a relationship with your spouse or significant other, taking care of children or elderly family members, not having enough time in the day and especially not having enough time for yourself can put too much stress on your body and health.

Having a healthy stress response system will allow you to deal with or respond to the stress in a healthier more efficient way.

What happens to your body when under stress?

Your body responds by sending out more adrenaline and cortisol. Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances the brain's use of glucose and increases the availability of substances that repair tissues.

Cortisol alters immune system responses and suppresses the digestive system, the reproductive system and growth processes as a first response as these systems are not as essential when under stress.

Your stress response system usually will quiet down on its own after the stress has stopped. The thing is that most stress is ongoing meaning the body is always responding to stress. An uncontrolled increase in adrenalin and cortisol can have a negative affect on health.

Over exposure to these and other stress hormones can disrupt almost all your body's processes, increasing your risk of obesity, insomnia, digestive problems, heart disease, depression, memory impairment, physical illnesses and other complications.

A healthy SRS allows reactions that are appropriately gauged to the circumstances: big reactions to big threats; small reactions to small threats. Furthermore, people who have a sluggish SRS also tend to have more stress responses, more often, to less threatening stimuli; those responses have longer lasting effects on the body.

This type of person fumes in a long checkout line, frets in heavy traffic and explodes when the dog gets into the garbage. This person may have a sluggish, but over reactive stress response and a tendency to develop depression.

What Determines the Health of the SRS?

Studies on animals reveal one reason for a sluggish stress response: lack of tactile stimulation, or touch. Touch improves the efficiency of the pituitary-adrenal axis or your stress response system.

Receiving non sexual, nurturing, non threatening touch is one of the most important ways humans and other mammals have to keep a healthy stress response. Massage moves people from a sympathetic to a parasympathetic state. This brings about several physiological and chemical changes in the body, including an increase in serotonin secretion and a decrease in cortisol.

Soothing touch, whether it be applied to a ruffled cat, a crying infant, or a frightened child, has a universally recognized power to ameliorate the signs of distress. How can it be that we overlook its usefulness on the jangled adult as well? What is it that leads us to assume that the stressed child merely needs "comforting," while the stressed adult needs "medicine"?

-- from Job's Body: A Handbook for Bodywork by Deane Juhan

"Jangled" Adults Touch and the Stress Response System By Ruth Werner Originally published in Massage & Bodywork magazine, February/March 2006.

HPA Axis - Wikipedia

Why Zebras Don't Get Ulcers, Third Edition  by Robert Sapolsky.

Saturday, December 10, 2011

The secret of "low back" pain management

It may surprise you to learn that treatment of low back pain does not always occur on the "low back". Each week I meet people who are seeking massage therapy for their low back pain. They come in abundance, the "huddled masses" that have had enough of that nagging ache or that sharp screaming pain that stabs at them continually.

Sports injuries, car accidents, occupational hazards, pregnancy and poor posture are a few of the repeat offenders we see. The cause of their pain is as diverse as their personalities, and so too are the treatments they receive.

Many times, a client's pain is actually caused by opposing muscles in other areas such as hamstrings, quadriceps, psoas, or latissimus. These muscles all have a role to play in the position of the hips. If you think of muscles as pulleys and bones as levers, you can visualize what might happen if one of those pulleys was shortened and the lever was left in an altered position, forcing all the other pulleys to adjust. In essence, there is a "tug of war" going on. If just one muscle is out of balance, the result is pain and/or stiffness.

There are many dynamics that we look at as massage therapists when considering a client's low back pain. In a clinical context, we check posture, position of the hips in relation to one another, and the texture of surrounding soft tissue. Equally relevant information would be the background of the client; health history, prior injuries, pain tolerance, and commitment level in correlation with that clients expectations. That is to say, treatment for low back pain in a 50 year old that is sedentary would differ greatly from an active 30 year old client who has been in a motor vehicle accident.

The patterns of dysfunction and the methods that can treat them are numerous. In massage therapy, we employ techniques such as deep tissue massage including myofascial release, trigger point therapy and neuromuscular therapy, as well as complimentary techniques like kinesio tape, stretching and craniosacral therapy etc. By using one or a combination of these techniques, a massage therapist has a unique role in the treatment of lower back pain through manually elongating shortened muscle fibers and connective tissues to restore balance in the lower back.

There is one common factor in the successful outcome of a massage therapy treatment session, and that is a client who is actively involved in the solution. Clients who are engaged in their care and perform stretches and exercises at home along with ice and/or heat on a consistent basis are much more likely to step out of the pain cycle.