Chronic Pain

There is currently a lot of interest into the concept of chronic pain and chronic pain syndromes. We know that not all patients who experience back pain for the first time will develop into a chronic pain syndrome however we do know there are risk factors that we can identify that may be contributing factors such as a history of depression or anxiety or even poor job satisfaction.

Chronic pain syndromes however are a different story and many health care professionals believe these syndromes are not a mechanically based complaint but a neurological. This means the central nervous system is ‘over wired’ and becomes highly sensitive to any stimulus, sometimes even touch. We call this Central Sensitisation.

Patients who have this ‘sensitive wiring’ are usually highly receptive to certain treatments and can feel worse after a therapy. Generally, these patients may doctor shop around trying to find the one and only therapy that may ‘cure’ their pain.

However we know that this vicious cycle often compounds their pain experience. So how do we identify if a patient has this ‘central sensitisation’? Unfortunately, there is no one clinical test we can use to identify central sensitisation however we do have a questionnaire called the CSI which may identify the risk. If Niki asks you to complete the questionnaire, she will advise you of the score and likelihood of your complaint been compounded by a highly sensitive central nervous system.

Some examples of clinical syndromes that central sensitization may contribute are:

• Patello-femoral pain syndrome
• Osteoarthritis
• Rheumatoid Arthritis
• Temporomandibular Disorders
• Fibromyalgia
• Chronic neck pain from Whiplash
• CRPS
• Neuropathic and post-surgical pain If you would like to discuss your complaint with

Our Physiotherapists and Chiropractors are trained in managing and treating your chronic pain syndrome. They will assess your range of motion along with orthopaedic testing to work out a diagnosis for your pain. Sometimes you may also be referred for further imaging by our allied health team, such as an MRI or Xray to rule out any underlying pathology or injury or even referred to one of closely connected specialist such as Rheumatologist your joint or Orthopaedic surgeon, if relevant.

If you would like to discuss your complaint but not sure who to book in with, why not book our FREE health discussion with one of our allied health practitioners.

References

Sensitisation in chronic pain: pain itself can change how pain works’ Paul Ingram Mar 29,2019. www.painscience.com/articles ‘Central sensitisation: Implications for the diagnosis and treatment of pain’ Clifford Woolf. PMC. Mar 2011; 152(3) S2-15. www.ncbi.nlm.gov/pmc/articles/PMC4268359