Osteopathy and chronic pain

Definition of chronic pain

"Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in these terms" (IASP). The term “Sensory” means that the characteristics of the pain can be specified: its location? What to compare it to? Its intensity? How it evolves over time? The term “Emotional” means that, by nature, pain is unpleasant, it can be more or less bearable, painful or distressing.

Pain is a subjective and individual phenomenon, which makes it difficult to communicate.

Pain functions as an alarm signal. Its main role is to protect the body. Without it, we would not be aware that there is a “physical” injury (for example, a fracture). It prompts us to pay attention to the injured area, to be aware of the danger (for example, a burn causes an immediate reaction of withdrawal to stop the injury), and to seek care. When the pain persists, it can also be “remembered”. This is how, in a situation that risks causing pain that has already been experienced, the spontaneous, thoughtless reaction will be to avoid it.

Acute pain acts as an alarm that will allow the body to react and protect itself against a mechanical, chemical or thermal stimulus. Take for example a burn to the hand: in the injured area, there is a local release of substances that will cause the excitation of “specialized” nerve endings. These endings send an alarm signal to the brain: “Danger! Alarm!” This is acute pain.

If acute pain persists beyond three months, it develops into chronic pain. This sensation then loses its significance as an alarm signal: pain is no longer a symptom but becomes an illness. This category includes certain muscular and joint pains, migraines or pain associated with nerve damage. The persistence of pain has physical and psychological consequences and leads to changes that will contribute to the pain: this is pain-illness.

Chronic pain characteristics

Persistence over time: pain persists well beyond the expected healing time, often more than three to six months.
Independence from initial stimulus: whereas acute pain is directly linked to an injury or illness, chronic pain may persist even after the initial cause has disappeared, or even without an identifiable cause.
Emotional modulation: Chronic pain is often associated with mood disorders, such as depression, anxiety and feelings of hopelessness, which can aggravate pain perception.
Central sensitization: Chronic pain is often linked to a phenomenon of central sensitization, where the nervous system becomes hyper-reactive, amplifying the response to normally innocuous stimuli (such as light touch).
Functional impairment: Chronic pain sufferers may experience a reduction in their ability to function in daily life, with disruption of sleep, mobility, and social and professional activities.

Factors of pain chronicization

Biological factors :
- Nerve or neuropathic damage: Damage to the nervous system, as in neuropathic pain (e.g. diabetic neuropathy, postherpetic pain), can lead to persistent pain.
- Prolonged inflammation: Chronic inflammatory diseases, such as arthritis or fibromyalgia, can perpetuate pain due to the continuous activation of nociceptors (pain receptors) .
- Neuronal plasticity: lasting changes in pain processing at the level of neural circuits, such as hyperexcitability of spinal cord neurons or loss of natural inhibitory mechanisms, can maintain pain .
Psychological factors:
- Stress and anxiety: Chronic stress and anxiety are major factors in the transition to chronic pain. Depression: Depression is frequently associated with chronic pain, not only as a consequence, but also as an aggravating factor. It contributes to a heightened perception of pain and makes pain management more difficult.
- Catastrophism: A tendency to exaggerate the negative consequences of pain can reinforce sensitization pathways in the brain, thereby increasing perceived pain .
Social factors :
- Social isolation: Lack of social support, whether at home or at work, can aggravate chronic pain by increasing stress and anxiety levels.
Economic factors:
- Unemployment or financial problems can create a vicious circle where psychological stress and material difficulties reinforce pain and reduce opportunities for treatment or rehabilitation .
Behavioral factors :
- Physical inactivity: Physical deconditioning is common in patients with chronic pain. Prolonged inactivity can aggravate pain by reducing muscle strength, flexibility and endurance.
- Self-medication: Prolonged use of medications, such as opioids, without comprehensive pain management can lead to dependency and worsen pain through phenomena such as opioid-induced hyperalgesia.

Osteopathy and chronic pain

Osteopathy is recognized for its effectiveness in the management of chronic pain, notably through non-invasive manual approaches aimed at restoring the structural and functional balance of different body systems. Several scientific studies highlight the beneficial effect of osteopathy, particularly for chronic musculoskeletal pain, such as low-back pain, neck pain and tension headaches. Research indicates that osteopathic techniques reduce pain and improve patients' quality of life, while being safe and without side-effects for the patient.

Conclusion

Chronic pain is a multifactorial process involving biological, psychological and social dimensions. A multimodal approach is often required to manage chronic pain, involving medical, psychological and behavioral treatments to counter the various factors contributing to the persistence of pain.

Dr. Charbel Kortbawi, osteopath, has completed a university diploma in chronic pain management at the Université Paris Sorbonne, as well as a diploma in pain management of the musculoskeletal system at the Université polytechnique Hauts de France, and his expertise will be able to help you manage your chronic pain.