Chronic Pain

[Kristin Kelley]

At the AAOMPT conference Jo Nijs Keynote address was “Balancing Hands on/Hands off interventions in chronic musculoskeletal pain” with a huge emphasis on central sensitization.

Pls see this link:
nypost.com/2017/03/07/i-just-got-impaled-ski-instructor-gets-18-inch-branch-stuck-in-face/

Why was the ski instructor free of pain?
A)The cold temperature
B)No visual input of the injury
C)Exercise-inducedhypoalgesia
D)Stress

Interested to hear your responses!

[Tyler France]

Hey Kristin,

I’d probably say the reason he did not feel the pain initially has to do with a combination of all of the factors listed above. If I had to choose just one, however, I would go with “no visual input of the injury.” He stated in the article that he thought that his chinstrap had slipped up and was resting on his lip, which is something that he has probably trained himself to ignore at this point. Without visual input to tell his brain that something more sinister has occurred, his brain is treating the situation like business as usual and not sending pain signals. I find it amazing the things that our bodies can ignore if we do not consciously perceive them as threatening.

[Kristin Kelley]

Based on the evidence presented at the conference, the pain free state of the instructor was due to all 4 criteria. The lack of visual input and cold are more self explanatory.
Stress:
Chronic stress activates the glia through adrenaline and cortisol release
Stress activates the glia through central sensitization via activation of the amygdala and hippocampus creating neuroinflammation
Exercise:
Exercise affects pharmacology via neurotransmitters, ion channels, receptors. It also positively affects central sensitization

Never underestimate the effect of education and exercise on pain reduction for pts. We are manual therapists and should use manual therapy to treat our pts but include the use of more than just hands on techniques.

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