Let’s talk about pain, shall we? I am a chiropractor after all, and most patients that come to the office are seeking treatment because something hurts. When a new patient arrives at the office, I have a few main objectives I need to cover. With regards to the patient complaint, my first course of action is to classify the pain through a thorough patient history and physical exam. We will breakdown the classification process and its importance a little later. Today, I am only going to focus on differentiating between pain of chemical origin, mechanical origin and chronic pain. This differentiation is important for a clinician to grasp because it dictates which type of treatment will be best for the patient.
So, let’s start with some key factors we will see with each pain identification:
- Pain of chemical origin (for the sake of this article, just think inflammation)
- Constant. Never a moment the pain is not present.
- Pain began recently
- Classic signs of inflammation may be present: redness, swelling, heat, tenderness, and obviously pain.
- Any and all movements may aggravate the discomfort.
- Patient may note in history that NSAIDs (ibuprofen, Tylenol, etc) offer relevant pain relief.
- Pain of mechanical origin (think sprain/strain of soft-tissues, shoulder impingement or a disc bulge)
- More commonly intermittent (periods of time where you do not notice the pain), but may be constant.
- Movements/postures in one direction will improve symptom while movement in another may worsen.
- Patient movement quality will improve as the symptoms improve.
- Chronic pain
- More time has passed since initial onset of injury, think weeks to months or more.
- May be influenced by non-mechanical factors
- Response to intervention may be normal, but may also slower.
- Multi-disciplinary approach to care may be needed because of additional factors at play (neurophysiological, psychological, social).
- Original tissues generating pain may be degenerating
Ok, so what do we do with this way over-simplified part of the pain classification? We are going to determine which route of therapy is the best choice. Here is a very simple rule to start with: chemical pain responds to chemical intervention whereas mechanical pain responds to mechanical intervention. Chronic pain can be multi-faceted in treatment necessities.
Scenario 1: Patient’s history and exam reveal that the cause of his knee pain is of chemical origin. We have determined that there is a strong inflammatory component to this episode. Our treatment recommendations will be from a list of various anti-inflammatory tools we have at our disposal. We may suggest a supplement with curcumin, boswelia, ginger and other components to combat inflammation. This patient is likely to feel better if taking NSAIDs. It is also highly likely we will try and work with this patient on an anti-inflammatory diet. If more significant sources of inflammation such as rheumatoid arthritis are present, co-management with a medical doctor may be needed. This patient is very unlikely to respond favorably from mechanical interventions like joint manipulation and soft-tissue therapies.
Scenario 2: Patient’s history and exam reveal that the patient’s low back pain complaint is of mechanical origin (let’s assume a disc derangement). We may have heard from this patient during the history something like, “I’ve been taking ibuprofen for the past 2 days. It seems to take the edge off, but does not make the pain go away.” In this scenario, our treatment recommendations are going to be focused on a mechanical foundation. We may use repetitive movements that improve the symptoms, joint manipulation, soft-tissue therapy and/or rehabilitative exercises, or in more extreme cases where conservative therapy is not enough, a surgery consult. This patient may continue to take NSAIDs, but without mechanical intervention, it will not appropriately resolve. Here’s an illustration to explain why. Let’s say you have knee pain when you walk and after an exam, we determine it is because you have a rock within your knee. You have been taking ibuprofen and it seems to dull the pain a little bit. That’s great, but until you remove the rock (mechanical intervention), your injury/pain will not resolve.
Scenario 3: Chronic pain patient. This is a topic for a blog post in and of itself. For now, we will say it is likely this patient would require therapies of various origins and possible co-management among providers.
Hopefully this article offers up a little bit of a clarification as to what may be driving your pain and what type of interventions you may want to seek out. If you are suffering pain, it is well worth your time and peace of mind to work with a provider that is qualified to classify your pain and help steer you in the direction of proper treatments. If you’ve been suffering from pain, whether very recent or for a long time, you can always stop by or give the office a call and we’d love to sit down with you and figure out what the pain generator is, offer up treatment and get you back to living life the way you want.Schedule Appointment