Diffuse OOS ("Chronic Pain Syndrome")Medical Theories
Nerve injury
Physiologist Dr Bruce Lynn and physiotherapist Jane Greening have done some study on the arm nerves. Although inconclusive at this stage, it has been shown that changes do occur which affect the nerves.Adrenalin and stress
Occupational therapists will often champion this theory. They say that stress releases adrenalin which tenses the muscles and that's what causes OOS. It has long been known that stress releases adrenalin. The question is, is this a cause or a result of occupational overuse of the arms? It can conversely be true that an injury will cause stress which releases adrenalin.Consequently, this theory can actually be a cause of injury or an effect of injury, or even both ("both" is what we opt for).
Substance P over produced
Pain specialists believe this. They say that the brain process has been interrupted through repeating the same movement too much and that this has led to a cycle of pain which leads to feeling pain when there is really no cause for it. This theory has led to a lot of confusion among practitioners and patients. Worse, because some practitioners believe there is "no injury", they have advocated "working through the pain" and caused more damage.However, substance P is probably released because it is responding to our constant disability which has not been resolved.
Muscle scarring
According to masseuse Denise Lester in Invercargill, the upper body muscles eventually get stuck to the ribs. This lady is doing three types of massage: sports, therapeutic and relaxation at the Southern Relaxation and Sport Massage Clinic.This lady says that what can happen is that a muscle seems to develop a "memory" where it automatically tenses when a certain activity is attempted.
"It's only pain"
Followed by many ACC assessors in New Zealand, this theory attributes the cause of diffuse OOS to a mixture of one or more of the following:1/ psychosocial causes
2/ low pain threshold
3/ substance P over-release (see above)
Doctors who can blithely face a patient and tell them that what they are experiencing is "only pain" and that they should "work through the pain", have usually not experienced severe pain in any form. They are also usually in the pay of ACC. Beware doctors who try to tell you this. They are only thinking of ACC and employers, not you, the injured person. Do not continue with the same activity on the same level as it can cause more serious injury.
Doctors will ask you to assess your pain on a level of 1 to 10. Do not be "brave" and under-estimate your pain. Be real about it. How much is it affecting your daily living activities? Can you lift your arms anymore? Can you write for long? Has your sexual relationship with your partner been adversely affected? Are you able to do housework, lawns, gardening, hobbies? Do you have difficulty with fine activities like stroking your cat or holding a piece of paper? This can happen! It means that your tiny muscles/tendons/ligaments/nerves have been badly damaged by overuse.
Sometimes we have lived with this disability for so long that we have got used to it. Normal life has long gone and we are disabled for life. How bad can it get? BAD! Remember then, don't underestimate your pain level when asked by a doctor.
SO...... What IS Pain?!
First, let's remember that we are examining the process of how we feel pain but not actually the reason for feeling particular pain. The process of sensation does not specifically comment on injury nor disease process. It is only about the mechanism of HOW we feel pain.
Readings:
"Current Concepts of Pain Mechanism"
By Chin H. Huang, M.D.
(presented at the CAMS 1998 Annual Scientific Meeting)
http://www.camsociety.org/issues/ann98huang.html
since the beginning of the present century, theories of pain mechanism have evolved from specificity and summation models to the popular gate control theory. This latter pain theory, proposed by Melzack/Wall/Casey, has become the most important development in the field of pain management. More and more discoveries in recent years show that pain perception is no longer a straight forward afferent transmission of pain signal. It is a complex mechanism involving modulation coming from both peripheral and central nervous system. In the chronic pain state, pain signal generation can actually in the central nervous system without peripheral noxious stimulation.
Anatomically, there are numerous ascending excitatory and descending inhibitory pathways in pain signal transmission. Centralization (cephalad relocation in the central nervous system) of the pain signal generators occur spontaneously or after these neural pathways are interrupted, leading to totally unexpected pain syndromes. Advanced reflex sympathetic dystrophy, deafferentation pain and phantom pain phenomenon are just a few examples. Traditionally, we believe that pain is an important biological reaction of defense and a fortunate warning to put us on our guard against diseases. Although this may be true in disease states such as appendicitis, fracture and angina, it does not explain the unnecessary pain in conditions such as migraine, post-therapeutic neuralgia and pain in labor and delivery. Scientific evidence shows that acute persistent pain eventually sensitizes wide dynamic neurons in the dorsal horn of the spinal cord ("wind-up phenomenon"), constituting the basis of developing chronic pain syndromes. Persistent and excessive pain has no biological function. It is actually harmful to our well being. Therefore, pain needs to be treated as early and as completely as possible, not to be left alone.
Practically, pain can be classified into five different types, i.e., visceral, somatic, referred, neuropathic and psychogenic, according to their origins of pain signal generation. Commonly, we see pain syndromes with different mixtures of these five types. In acute pain (predominantly nociceptive), visceral, somatic and referred mechanisms play important roles in the pain perception. In chronic pain (frequently non-nociceptive), neuropathic and psychogenic mechanisms prevail, resulting in protracted suffering and disability both physically and mentally.
We used to believe that destruction of the pathways of pain transmission could alliviate the pain. This has proven to be wrong. Due to the plasticity of our nervous system, the pain relief achieved by neuroablation is always short lived. In pain management, modulation of pain signal transmission is a far better choice than destruction.
Dr. Huang is Clinical Assistant Professor at UMDNJ-New Jersey Medical School."
