is your chronic pain centralized or not?  could it be due to fascial adhesions?

CHRONIC PAIN
YOURS MAY NOT BE “CENTRAL SENSITIZATION” AFTER ALL

Fascia Chronic Pain

“I have so much fascia pain all over due to a signal change in my spinal cord (neck region). I’m not really sure how to address this as I know the cause and my cord has been decompressed (10 months post-op).  Unfortunately I have what appears to be permanent symptoms – burning in muscles, tissue, fascia etc etc and this constant tightness, which I assume is increased muscle tone from nerve pain etc. I’m trying to deal with this on a holistic level with a change of diet (anti-inflammatory), by drinking more water and added supplements to my regime, but I would really appreciate your thoughts on what else I can do as this is clearly all related to my spinal cord.  Thank you in advance  From a Facebook comment received last evening

An article by Angie Drakulich in the current issue of Practical Pain Management (Central Post-Stroke Pain – How Central Is It?) addresses a post-stroke form of CENTRAL SENSITIZATION.  What is Central Sensitization?  It’s where a person’s pain is said to become “centralized,” no longer originating in damaged tissues, but coming from the brain itself, playing over and over like a 1980’s CASSETTE PLAYER stuck on auto-reverse.  Not only is this not good, but according to the article’s expert, Dr. Michael Bottros, a professor of anesthesiology at St. Louis’s Washington University, this sort of centralization (CPSP — Central Post-Stroke Pain) accounts for a significant portion of all post-stroke pain.

“Pain may be prevalent in 39 to 55% of post-stroke patients but not all cases involve central pain. The types of pain that may occur after a stroke include shoulder pain (the most common), headaches, spasticity, and lastly, central post-stroke pain (CPSP). CPSP represents about 25% of post-stroke pain cases.”

After mentioning the usual array of drugs used to  deal with CPSP (ANTIDEPRESSANTS, STEROIDS, OPIOIDS, anticonvulsants, and others), and likewise suggesting that none work well and all have problems associated with their use, Bottros made this statement.  “CPSP is a result of misinterpretation of afferent sensory input by the sensitized neurons within the brain, rather than generated spontaneously by the damaged central nervous system (CNS) neurons.”  In other words, in at least some cases, sensory nerves are “misinterpeting” what they are sensing, not necessarily that CPSP is always generated by the brain itself. 

In a study from the July issue of Pain (How Central is Central Poststroke Pain? The Role of Afferent Input in Poststroke Neuropathic Pain), Bottros’ team found that by performing a nerve block in the affected extremity, they totally shut down the pain in 7 of 8 subjects within half an hour — something that would be impossible if the pain were “autonomously generated within the CNS. Rather, this pain is dependent on afferent [sensory] input from the painful region in the periphery.

In English, this means that people’s CHRONIC PAIN might not be, in many cases, as “centralized” as they’ve led to believe.  And while I don’t make any sort of claims about being able to help people with CPSP (that’s a job for a qualified FUNCTIONAL NEUROLOGIST), I have been saying this very thing for a long time — that a significant amount of pain that’s been diagnosed as “centralized” is not.  This is why I have suggested that people who are not really sure whether their pain is due to Central Sensitization or might be arising from FASCIAL ADHESIONS, should have A TREATMENT (yes, just one) and see.  If they are in fact, “centralized,” the only harm will be that they fired up their pain for a few days (HERE).

To carry the process one step further, in the PPM article, Dr. Bottros talked about “altering cytokines“.  Why is altering cytokines a big deal if you hope to improve your situation and your pain?  Because CYTOKINES are the chemical messengers made by your immune system so that cells can signal and communicate with each other.  And while integral for the healing process locally, when there are too many or too much of these chemicals coursing through your body systemically, bad things happen, including pain, fibrosis (SCAR TISSUE) and DISEASE.  Listen to these cherry-picked findings from the journal International Anesthesiology Clinics (Cytokines, Inflammation and Pain).

“Cytokines are small secreted proteins released by cells have a specific effect on the interactions and communications between cells.  Inflammatory responses in the peripheral and central nervous systems play key roles in the development and persistence of many pathological pain states. Certain inflammatory cytokines in spinal cord, dorsal root ganglion, injured nerve or skin [fascia] are known to be associated with pain behaviors and with the generation of abnormal spontaneous activity from injured nerve fibers.  There is abundant evidence that certain pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α are involved in the process of pathological pain.  In the CNS, there are two types of glial cells, microglia and astrocytes, which can be activated by excitatory neurotransmitters released from nearby neurons.  It has been well demonstrated that spinal glial activation is necessary for induction of the neuropathic pain state.  In summary, proinflammatory cytokines are involved in the development of inflammatory and neuropathic pain.”

I’ve talked extensively on my site about TNF-ALPHA and INTERLEUKIN 6, showing that inflammation will always lead to FIBROSIS that in my clinic I refer to simply as scar tissue.  Furthermore, we see that these cytokines have the propensity to activate Central Sensitization by hyper-activating microglia (HERE). This is why whether your pain is centralized or not, reducing the amount of systemic inflammation in your body is a good thing.  And when you consider that virtually every disease process (including many that you’ve been led to believe are purely genetic — HERE) is based on systemic inflammation, addressing said inflammation starts making even more sense.  Sometimes, however, you will need treatments that actually create inflammation.  Huh?

Just remember that local inflammation is needed to heal injured tissues, whether the injury is acute or chronic. TISSUE DEFORMATION (breaking scar tissue and lengthening shortened, THICKENED or “TETHERED” connective tissues) requires activation of the local inflammatory response (HERE) as well as activation of the cells that make COLLAGEN (these are known as FIBROBLASTS).  It’s why the longer you study the simple protocol I created for helping people reduce systemic inflammation (HERE), hopefully reducing their pain levels in the process, the more sense it makes.  If you like what you’re seeing be sure and like, share, or follow on FACEBOOK as it’s a great way to reach the people you love and care about most.

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