by Charlotte Walker
Pain is often classified as either coming from the organs (viscera) or the body (soma eg back pain). It is a warning that something is wrong, and is a natural protection mechanism.
Visceral pain is the pain you feel from your internal organs, such as your stomach, bladder, uterus, or lungs. It is caused by medical conditions that produce inflammation or pressure. Visceral pain can be referred to muscles, meaning it’s often felt away from the origin.
Somatic pain is your brain’s interpretation of distress signals coming from injured tissues in the body (or SOMA), other than the viscera.
These tissues may include muscles, ligaments, fascia, nerves or ligament. Most back pain and neck pain is this type of pain. Examples of damage are:
-Structural (eg fracture/ impingement) and identified by diagnostic testing (eg x-ray/MRI)
-Non-structural (eg inflammation/micro-tearing/strains) and non-identifiable by diagnostic testing.
-A combination of the above.
It takes about 6-8 weeks for most soft tissue or bone injuries, including those related to back and neck pain, to heal and for pain to go away. eg following a broken leg or a sprained ankle. This can vary and a more severe injuries can take longer. It is generally understood that persistent pain beyond 3 months is often not due to tissue damage alone anymore. This is called chronic pain.
Chronic pain is not imagined or ‘just in your head’ but is a neurological issue whereby the set of original neural pain pathways developed during an injury have become embedded, sensitised and more easily triggered over time. The brain now senses threat more easily and is triggered to protect itself by inducing a stress response. This is also known as the ‘fight or flight’ response and its physiological consequences include muscle contraction and inflammation which cause pain. Accompanying emotions such as fear, anxiety and frustration in turn become internal threats which further maintain the stress response and pain.
This type of pain often complicates longer term back and neck pain. Sometimes chronic pain appears months or even years after the original injury, sometimes without obvious cause. It can also spread or move around, and the sufferer may find it difficult to understand why, as they are unable to attribute the pain to anything specific they have ‘done’.
The sensitised nervous system can also cause symptoms in other parts of the body to appear, such as headache, back pain, pelvic and abdominal pain.
Chronic pain is also called ‘neural-pathway induced pain’, ‘TMS’ or ‘psychophysiological disorder’ (PPD).
Here are 2 videos which explain this in more detail:
‘What is Chronic Pain?’: https://www.youtube.com/watch?v=gy5yKbduGkc
‘Why things hurt?’ : https://www.youtube.com/watch?v=gwd-wLdIHjs
‘Pain is not providing a measure of the condition of your tissues but it is providing a measure of your brain’s evaluation of your need to protect your tissues’ Dr L Molesley.
ALL types of pain, whether visceral, acute or chronic are more strongly felt when the body is:
-Oversensitised at the outset
TREATMENT OF SOMATIC PAIN
Somatic pain can be treated with painkillers, manual therapy (such as osteopathy), exercise therapy or surgery (in severe cases). When the damaged tissue heals, the pain stops.
To prevent pain from developing into a chronic problem, advice may include:
-Not putting all your focus on the pain as more attention will make it louder. This isn’t distraction (although this can be useful), it is saying “Yes – I am aware of the pain, and I simply choose to place my attention elsewhere”.
-Avoiding the creation of fear stories around the pain. Damaged tissues DO heal. Emotions may come up so observe them, but choose not to give them meaning.
-Avoiding avoidance by taking an active approach and refusing to be immobilised.
-Appreciating parts of the body that are pain free.
TREATMENT OF CHRONIC PAIN
Reading this article is a great start to understanding that recovery from chronic pain is possible and to learn a few tips to help you begin. The recovery process is about learning through education, taking responsibility for yourself and your pain and learning self-empowering strategies to help you become more stress-resilient.
Treatment using multi-factorial approach is the most effective strategy.
This involves re-programming the embedded neural pathways to create the right conditions internally to allow the pain to resolve. Both the mind and body need to be considered for the best results.
Manual therapy such as osteopathy can be useful to loosen contracted muscles, switch off sensitised trigger points and aid blood flow to reduce inflammation.
Charlotte Walker (Registered Osteopath) at the Broadgate Spine Centre combines osteopathy with SIRPA techniques to help patients recover from chronic pain.