In an attempt to respond to real or perceived threat, the body initiates a number of mechanisms of over-protection. Deconstructing this construct of chronic pain, which comes from the Pain Neuroscience Education at the Neuro Orthopaedic Institute, requires a strategy to reduce these mechanisms.
In Part One of this three-part series, I addressed chronic pain as a construct of the brain and why that matters if we are to help our patients understand their pain. Here in Part Two, I explain the overprotection mechanisms the nervous systems, CNS, ANS, and ENS, may use in an attempt to respond to real and perceived threats, discuss the effect the mechanisms can have on the body, and suggest strategies healthcare providers can employ to reduce them.
Mechanisms and Strategies
Mechanism 1: Central nervous system (CNS) hypervigilance, leading to sleep disturbances and altered breathing patterns.
- Guide your patients toward proper sleep hygiene.
- Rule out sleep apnea as a significant source for sleep disturbance and chronic inflammation.
- Introduce and teach breath awareness as part of your treatment plan.
Mechanism 2: Catastrophic thoughts
- Find ways to gently reveal the presence of these thoughts to the patient within the biopsychosocial interview process by listening closely to their plain language.
- Guide the patient to experience the present moment somatic effect of these types of thoughts, for instance, by observing the ways in which their breathing, posture, and tension patterns may change. Oftentimes, patients experience a direct influence upon their symptom intensity. Dispelling these thoughts may dispel the somatic responses that perpetuate the chronic pain experience.
Mechanism 3: Elevated inflammatory biomarkers, leading to added interneurons that “exaggerate the conversation” between the dorsal and ventral horns and make the CNS more adept at perpetuating chronic pain. These elevated biomarkers and increases in circulating blood sugars accompany the chronic stress response.
- Promote physical activity as an anti-inflammatory.
- Educate patients and refer to nutritional means of reducing inflammation and proper use of supplements.
- Reframe physical activity as the beneficial analgesic, anti-inflammatory, and antidepressant that it is, rather than as fearful movement.
Mechanism 4: Chronic muscle tension that becomes active with a perpetuation of our sympathetic nervous system (SNS), especially in phasic muscles
- Teach relaxation response in addition to stretches and ergonomics.
Mechanism 5: Immune system fatigue
- Teach stress coping techniques.
- Work with physicians who will explore vitamin and mineral deficiencies.
- Address chronic dehydration and problematic elimination.
Mechanism 6: Mood changes
- Be aware of and help your patients understand the relationship between chronic inflammation, depression, low energy, irritability, loss of libido, and sleep disturbance.
- Encourage your patients to talk about feelings of social isolation, possible compromises of self-worth related to role and occupation changes, and relationship stress that are common facets of the chronic pain experience. We stay in our domain of practice when we keep encouraging the patient to notice the somatic impact of these thoughts and feelings upon posture, movement, and breath.
Mechanism 7: Hypertension caused by pain, which may lead to breath holding and compression of the spine and may also put patients at risk for cardiovascular accidents (CVA) and myocardial infarction (MI).
- Teach patients to recognize breath-holding patterns and then break them.
Mechanism 8: Suppression of digestion and elimination from sympathetic nervous system (SNS), a major contributor to patients’ fatigue and body ache.
- Advise your patients to stay hydrated. Good hydration keeps materials moving through the digestive tract.
- Instruct patients that digestion is a parasympathetic process and therefore should not be coupled with sympathetic activities like driving or charged conversations. Patients should eat, taste, and enjoy food for satiation. This strategy also helps reduce mindless overeating.
- Discuss the need for sufficient fiber in the diet to cleanse the colon.
- Help your patients increase movement, which calls for increased action of the diaphragm, essentially massaging the digestive tract.
In the third and final part of this series, we will be looking at the concept of training the A.B.S.—Attend, Befriend, and Sanctify—what it means and how to incorporate it into your practice to restore your patients’ ability to connect with their bodies and improve their quality of life.
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