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Chronic Pain

So the big question is, why does chronic pain even develop? Often a pet or a person may succumb to an injury – it could be a slip on the ice, a break, or a ruptured cruciate ligament. In these circumstances, if your veterinarian or doctor acts quickly, in terms of making recommendations be they physical or surgical, then the outcome can be vastly different than if the initial trauma is ignored and failure to treat continues to persist.

Indeed, what occurs is that initially the pain is felt at the area of injury, your knee throbs, or you feel that shoulder aching. However, if left ignored, particularly for a lengthy period of time, the neurological system or the sequence of nerves in our body can rewire. Think of them as an electrical system, where electrical impulses are transmitted down the wires or neurons, and at each junction throw a pulse to the next wire. Well, in situations where chronic pain develops, we have a scenario where the rewiring or re-patterning of the central nervous system and peripheral nervous system occurs.

Significantly, at its most severe, this re wiring or cross wiring of sensory information into the pathways results in a condition called Allodynia. And immediately the disease that comes to mind for me is fibromyalgia, which through talking to my clients and friends, is becoming more pervasive.

Let’s step back for a moment, for I want to explain how the nervous system works in the living body. Initially, we respond to a stimulus, a sensation. For example we touch a hot burner, and that information is quickly transmitted to the brain which realizes uh oh, we touched something hot, and subsequently impulses or messages are then transmitted along the pain nervous system so that we react appropriately by withdrawing our hand from the burner.

Well, this is essentially how the system works. You have the sensory system, the brain that organizes and re-organizes all the information, and the pain pathway that lets us know, that we cannot keep our hand on that burning object.

With regards to more chronic pain and the suggestion that I made that a cross wiring occurs, in essence we keep getting this chronic stimulation through the pain nervous system and the sensory nervous system telling us that I am perceiving pain. Inevitably this causes distress on the muscles that are responsible for dealing with that pain, for avoiding injury. That distress results in what’s called the myofascial trigger point. This occurs because these muscles are constantly stimulated with regards to the sensory and pain nervous systems and are therefore being overused. Or indeed under-used, creating this pain and inhibiting normal body function.

At this level, the environment of the muscle is typically unhealthy, meaning that the muscle tends to build up a lot of lactic acid, and you can think of that when you’re running and develop a cramp – the result of lactate building up in the tissue. Secondly, and just as importantly, hypoxia occurs which leads to an inadequate concentration of oxygen being received at that area. Ultimately you end up with a double-edged sword where the tissue or muscle does not have the potential to heal.

These myofascial trigger points provide a constant stream of sensitizing impulses which create another pattern of pain, called referred pain. So we have situations where we are examining our pets, and they may recoil or express discomfort at areas that are quite distant from the actual location of the initial pain, and that becomes a problem for management. This phenomenon can essentially lead to patients receiving inadequate therapy for their pain, and indeed the doctor, the physiotherapist, chiropractor or veterinarian may end up chasing referred pain rather than the original source.

In terms of chronic pain therapy it is not managed by using a single discipline. This really requires an interdisciplinary approach that involves multiple professionals, for example specialists, veterinarians, doctors, nurses, physiotherapists, acupuncturists, chiropractors, and ideally they should be able to meet to review the patient’s condition.

For example, if we have a patient that is suffering from severe osteoarthritis, there are several ways that the approach to managing this pain can be optimally dealt with. Firstly, of course we would turn to our go to anti-inflammatory and analgesics, sometimes necessitating the use of two or more medications, to essentially target all of those pathways that exist and give the overall best management of pain and inflammation. Secondly, physical rehabilitation therapy is paramount to getting these muscles back into a proper working order. There is acupuncture and myofascial trigger point needle therapy. And of course, ongoing joint supports, specifically omega 3’s, glucosamine/chondroitin products are extremely beneficial in assisting with the inflammation at the level of the muscle and cartilage health/function at the level of the joints.

Leveraging a more natural anti-inflammatory is also a wonderful opportunity to minimize the amount of stress the body endures from some of the more hard core medications. At all points, it is our utmost concern and mandate to ensure that we do not stress the liver, kidneys and other organs in our desire to remove the source of pain.

Furthermore, there may be some other pain related concerns going on, and those have to be dealt with as well, particularly when we get into scenarios involving bone cancers.

In conclusion, I feel that as science continues to progress, and as we continue to sharpen our commitment to having clients and patients feel comfortable the vast majority of the time, we will indeed improve the overall quality of life for our dear ones, and hopefully in the near future concepts such as fibromyalgia and ongoing osteoarthritis may become more of a dim memory.

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