scar tissue:  why isn’t it better understood in terms of chronic pain?

SCAR TISSUE
WHY DOES THE MEDICAL COMMUNITY LARGELY CONTINUE TO IGNORE IT?

Scar Tissue Pain

Jacques3377

Scar Tissue Chronic Pain

آرمین

“Myofascial pain syndrome is a fancy way to describe muscle pain. It refers to pain and inflammation in the body’s soft tissues.   Myofascial pain is a chronic condition that affects the fascia (connective tissue that covers the muscles). Myofascial pain syndrome may involve either a single muscle or a muscle group. In some cases, the area where a person experiences the pain may not be where the myofascial pain generator is located.”  From that bastion of health information, WebMD

“Chronic myofascial pain (CMP), also called myofascial pain syndrome, is a painful condition that affects the muscles and the sheath of the tissue — called the fascia — that surround the muscles. CMP can involve a single muscle or a group of muscles….  Other symptoms associated with CMP include a sensation of muscle weakness, tingling, and stiffness. The pain associated with CMP might also lead to problems sleeping.”  From the website of the world-famous Cleveland Clinic

“In many cases of Chronic Pain, the underlying cause is Subluxation, Fascial Restriction, and Microscopic Scar Sissue.  Soft Tissue Restriction and Fascial Adhesion go a long way toward explaining why adjustments never seem to hold more than a few days — or even a few hours — in some patients.”  Dr. Russell Schierling from Destroy Chronic Pain

It’s funny how things work.  If you develop adhesions or Scar Tissue after a surgery, doctors will often suggest that you will be hard-pressed to get better until it is removed.  Unfortunately, removing this Scar Tissue almost always involves the very same thing that likely caused it in the first place — surgery (unless you do it our way; HERE or HERE).  My point is that at least on some level, doctors understand SCAR TISSUE.  But what about Scar Tissue that’s not associated in any way, shape, or form, with surgery?  I’m talking about the Microscopic Scar Tissue that is largely responsible for any number of CHRONIC PAIN SYNDROMES.  Why is it ignored almost 100% of the time? 

Before we answer that question, I am going to take you on a short journey back in time.  I want to take a couple of minutes to show you that the concept of Scar Tissue in medical education is not anything new or novel (I’ve actually done something similar before — HERE).  In fact, looking through the scientific literature will show you that information on Scar Tissue (the medical community usually refers to this as “FIBROSIS“) is not only present, it’s abundant.  Just be aware that you might see it called by several different names.  I tend to use the terms adhesions or FASCIAL ADHESIONS, as well as Microscopic Scar Tissue, but there are others.  What I have done today is collect a few quotes from books or sources that I have on my bookshelves.   Let’s begin with a quote from Guyton.  

Dr. Aurthur Gyton (1919–2003) published the first edition of his famous Textbook of Medical Physiology back in 1956.  It is not only the premier textbook on physiology for medical students, but the name “Guyton” is synonymous with physiology itself (the study of the function of the human body) — and has been for almost half a century.   Let’s see what Guyton had to say about Scar Tissue almost fifty years ago.

Remember as you read this that it is not anything new.  We know that when cells die, they rupture their contents, leading to something called “INFLAMMATION” (tissue damage always leads to inflammation).  As you will see, the first step in Scar Tissue formation is always Inflammation.

“Multiple substances that cause dramatic secondary changes in the tissues are released by the injured tissues. The entire complex of tissue changes is called inflammation.”

Now let’s take a look at Pathophysiology: The Biologic Basis for Disease in Adults and Children by Drs. McCance & Huether (1994).

“Inflammation is usually initiated by cellular injury.  Cellular response…. occurs as a consequence of cellular injury.  These systems [the various ways your body responds to Inflammation] are interdependent so that the induction of one can result in the induction of the others.  The end result is the development of microscopic changes in the inflamed site, as well as characteristic clinical manifestations.”

What are these ‘characteristic microscopic changes’?  There are many, and we will touch on some of them shortly.  The chief one I want to talk about now is the formation of Microscopic Scar Tissue.   It is critical to remember that local Inflammation virtually always leads to Scar Tissue (HERE).  Listen to what Boyd’s Textbook of Pathology (1990) says on this subject (be aware that any decent pathology text is going to say essentially the same thing).

“Replacement of lost tissue by normal or nearly normal tissue is called regeneration.  It does occur in man, but only to a limited degree.  Usually, our injuries are repaired by scarring; the lost tissue is not regenerated, but is replaced with fibrous tissue.”

What does all of this ultimately mean for you, the injured?  It means that injury leads to Inflammation, which leads to fibrous tissue — another name for Scar Tissue (see previous link).  It is important to remember that Scar Tissue is different from normal tissue in several distinct ways.  It’s significantly weaker, significantly less elastic, significantly easier to re-injure, and as you’ll see momentarily, significantly more pain-sensitive.  Next up we have another quote from McNance and Huether’s Pathophysiology

“As described in antiquity, the superficial hallmarks of Inflammation include REDNESS (rubor), SWELLING (tumor), HEAT (calor), PAIN (dolor), and LOSS OF FUNCTION (functio laesa).”

In case you are not aware, loss of function is huge when it comes to understanding Chronic Pain.   Surround a joint or body part (A NECK, for instance) with Scar Tissue, and it’s not hard to see the potential for problems to arise.  While the swelling, heat, and redness typically go away, pain and loss of function remain — in many cases, forever.  What are the chief consequences of this loss of function over time (other than pain)?  Thanks to LOSS OF PROPRIOCEPTION, the two biggies are DEGENERATION and DISEASE (all disease).  The known cause of DJD (Degenerative Joint Disease) is abnormal function over time.    Now listen to what this same book says about pain.

“…the amount of pain the person will tolerate before outwardly responding to it….   varies greatly among people and in the same person over time…..    No direct relationship exists between the intensity of painful stimuli and an individual’s perception of pain or response to pain.”

Don’t get me wrong.  I completely realize that physicians (particularly ER DOCS) deal with drug seekers on a day-to-day basis. But all too often, this leaves people with legitimate and serious problems to be likewise thrown under the bus — especially as the OPIOID EPIDEMIC continues to ramp up.  As you’ll begin to understand as you make your way through this post, you’ll realize that figuring out which group is which is nearly impossible unless your physician has the proper “tools” for finding Scar Tissue. 

Because doctors tend to lump people with Scar Tissue into the drug seeker group, legitimately suffering people all too often get that blank, deer-in-the-headlights stare, and either patronize them, or pass them off to a specialist.  How does the medical community treat the problems they diagnose in this group of people?  Mostly they cover symptoms without ever as much as attempting to get at the underlying cause.

  • PHYSICAL THERAPY: Firstly, they may or may not prescribe some sort of THERAPY to restore joint motion (which, by the way, is not a bad choice). Therapy (exercises, STRETCHING, strengthening) is critical for tissue healing and maturation (information about the phases of SOFT TISSUE INJURY HEALING).  However, putting the cart before the horse can actually make some people worse (see our stretching link above).   You have to be aware that while it can do a good job of helping with gross (sectional) RANGES OF MOTION, it does little or nothing to restore the individual (segmental) Range of Motion at each individual vertebrae / disc — particularly in the neck (HERE). 
  • INFLAMMATION DRUGS:  NSAID’S and CORTICOSTEROIDS are frequently prescribed, even though they probably shouldn’t be — check the links.
  • PAIN MEDS:  Pain pills of all kinds, NARCOTICS, and ANTIDEPRESSANTS.  That’s right.  Way too many people are told that their Depression is the cause of their pain, when the reverse is usually closer to the truth.
  • MUSCLE RELAXERS:  Muscle Relaxers are used for spasms.  I probably don’t have to tell you that all the drugs listed here have a ton of side effects (HERE) — side effects that are underestimated and underreported by at least an order of magnitude and maybe even two (HERE).

Ultimately though, the problem is that the Scar Tissue / Inflammation complex, when left to its own devices, can cause “Supersensitivity” (CHRONIC PAIN).  What is supersensitivity you ask?  Listen to what Dr. Chan Gunn (medical neurologist and developer of modern “Dry Needling”) of Vancouver’s Institute for the Study and Treatment of Pain and author of the landmark paper, Misperceptions in Neuropathy or Type III Pain says in a paper written not quite a year ago (What is Pain?). 

“Simply put, when a nerve link to a part of the body fails, that part of the body becomes highly irritable and extremely excitable. They used the term “supersensitivity” because the sensitivity in denervated structures increases not just by a small amount but sometimes by over 1,000 times. Subsequently, they demonstrated that supersensitivity can occur in practically every part of the body including skeletal muscle, smooth muscle, spinal neurons, sympathetic ganglia, adrenal glands, sweat glands, and even brain cells. Neuropathic structures over-react to a wide variety of inputs including stretch and pressure. Supersensitive pressure receptors are the reason why neuropathic muscles are tender.”

Did you catch that?  Although Dr. Gunn (in practice since 1950), a Clinical Professor at the University of Washington and Fellow of the Royal College of Physicians uses some terms that are not medically mainstream (sounds sort of like DR. CARRICK doesn’t it?), he tell us that in certain tissues, “supersensitivity” (TYPE III PAIN) can occur; potentially increasing their sensitivity to pain by over 1,000 times.  Gulp!   But if you have been on my site previously, you were probably already aware of this (HERE).  HERE is an article I wrote about supersensitivity after whiplash injuries.

WITH EVIDENCE EVERYWHERE, WHY DOES
SCAR TISSUE CONTINUE TO BE IGNORED?

(SKULL PAIN)

Scar Tissue Solution

Mathrock

Evidence?  The problem is that all to often, the so-called “evidence” is either ignored or altered to suit someone’s financial best interest (HERE).  In other words, “science” is frequently determined by the highest bidder, which is why you’ll often find me scrutinizing one of our modern Sacred Cows — EVIDENCE-BASED MEDICINE.  But back to the question at hand — the question I asked in the title of today’s post; Why does the medical community continue to ignore Scar Tissue?  Here are a few that immediately popped into my head.

  • TOO MUCH EFFORT:  It is tragic how many patients I see struggling with pain, who tell me that their physician (particularly true of specialists) have never really examined, looked at, or even touched their area of pain.  The truth is, it’s too easy in our modern society to look at someone, ask them a couple of questions, see if they can touch their toes, tap a reflex, order a battery of tests (usually tests that they already know will be negative), and then pull out the ole prescription pad. This is particularly sad when you realize how simple it is to check CERVICAL ROM’S.
  • NO TRAINING:  What are doctor’s trained to do?  They are trained to run tests, prescribe drugs, refer patients to other doctors, and perform surgeries.  Yes, they are trained to do orthopedic and neurological examinations as well (HERE), but are rarely adept at determining the difference between problems that are pathological or merely functional.  I really should not use the word “merely” here because FUNCTIONAL PROBLEMS (or HERE) can be just as bad as gross pathology — in many cases, worse.
  • CANNOT BE VISUALIZED ON MOST TESTS:  My brother is an ER doctor.  He has told me time and time again that the things that ER doctors like to deal with are things that are easily seen and blatantly obvious (broken bones, SHOULDER DISLOCATIONS, cuts, abrasions, etc).  The things they hate?  That’s easy.  BACK PAIN, NECK PAIN and HEADACHES.  Why?  Most of the time there is no correlation between the person’s pain and their tests (HERE and HERE are common examples).  The same thing is true with most cases of microscopic Scar Tissue. Unfortunately, Fascia cannot be easily imaged with MRI (HERE).  Think for a moment about the implications of this.  The single most abundant connective tissue in the body also happens to be the most pain-sensitive as well —- and it cannot be easily imaged using advanced techniques such as MRI.  No wonder I have repeatedly said that this combination is a recipe for CHRONIC PAIN’S PERFECT STORM.
  • MONEY:  Let’s not fool ourselves here folks.  Medicine today is not like it used to be — about  a multi-generational relationship with your family doctor.  Medicine is now corporate.  Look at the medical offices around here, for instance.  Every doctor that I am aware of is affiliated with either the Crips or the Bloods (that’s not really their names, of course, but there are only two — you get the point). There is no other option.  And let’s be honest with each other for a moment.  The medical community (including BIG PHARMA) see’s you, the patient, as a COMMODITY.  Where’s the real money at? Certainly not in helping you truly get better.  The big money is in keeping you alive for as long as possible — with your Chronic Pain and as many Chronic Conditions as you can handle.  If you think that this is not happening today, THIS STUDY might change your mind. 

Certainly, there are other reasons that this problem of “Scar Tissue” is being ignored, but it cannot be said that it’s for a lack of ‘science’ or because there is not enough peer-reviewed evidence — I’ve shown you MOUNTAINS OF IT!  Before we leave, I want to take just a moment to tackle one more aspect of this problem as it relates to treatment.

WHY DO CHIROPRACTIC ADJUSTMENTS WORK SO WELL…..
PARTICULARLY ONCE SCAR TISSUE HAS BEEN PROPERLY DEALT WITH?

Let’s go back to Guyton’s Textbook of Medical Physiology for at least part of the answer.  

“The [Golgi] tendon organ… responds very intensely when the muscle tension suddenly increases.  When the Golgi tendon organ of a muscle are stimulated by increased muscle tension, signals are transmitted into the spinal cord to cause reflex effects in the respective muscle.  However, this reflex is entirely inhibitory….  Thus, this reflex provides a negative feedback mechanism that prevents the development of too much tension on the muscle.  When tension on the muscle and therefore on the tendon becomes extreme, the inhibitory effect from the tendon organ can be so great that it leads to a sudden reaction in the spinal cord and immediate relaxation of the entire muscle.” 

“It is known that pain stimuli can cause reflex spasm of local muscles, which presumable is the cause of much if not most of the muscle spasm observed in localized regions of the human body.”

Pain causes spasm, and spasm causes pain.  This isn’t what I’m saying; it’s the gospel according to the single most prestigious physiology textbook on the planet.  And as you can see, a sudden (but extremely short duration) tension on a muscle or joint, inhibits spasm.  Cool!  This, my friends, is the nature of an adjustment — whether done by hand, or via some sort of instrument.  Although it is certainly not the only effect of a Chiropractic Adjustment (HERE is another), helping shut down or reduce spasm is a wonderful thing.  Just ask anyone who deals with Chronic Pain.

The problem is for many of you, the effects of the adjustment on the Golgi Tendon Organ are short lived —- i.e. you need a continual string of adjustments to relax those spasmed muscles — and unfortunately, they never seem to stay relaxed as long as you think they should (or hope they would). So, you get adjusted over and over and over again. 

The problem is that even though these adjustments help you tremendously for awhile (a week, a day, an hour), the pain / spasm always seems to return in exactly the same place and in the exact same manner.  It’s the nature of the word “Chronic”, and it is a scenario that is almost always indicative of underlying Scar Tissue.  And never for a moment let someone tell you that this is the definition of “CHIROPRACTIC MAINTENANCE“.  This is where TISSUE REMODELING comes in. 

The other day I wrote about this phenomenon (chiropractic visits in perpetuity) in a post called HOW MANY ADJUSTMENTS?.  If you are a person who gets good results with CHIROPRACTIC ADJUSTMENTS (for many of you it’s your only form of relief), but can’t seem to hold the adjustment, take a few minutes to educate yourself by clicking on some of the links in this post.  You might even want to check out a few of our VIDEO TESTIMONIALS.   Then call Cheryl at (417) 934-6337.  Make an appointment to talk to me (HERE’S WHAT A FIRST VISIT LOOKS LIKE).  If I think I can help you, I will tell you.  If not, I WILL TELL YOU ALSO.

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