Osteopathy Management of Pain Syndromes

We grow up with the medical model of injury and disease in our heads, its our way of understanding what happens to us. When a pain or other problem occurs, the doctor investigates and pins down the fault to a particular organ or body system, targeting the treatment to improve the malfunctioning of the part. The problem then goes away or is managed such as healing in a fracture, recovery from pneumonia after antibiotics and replacing an arthritic joint. However, there is a group of pain conditions which do not fit well into this system and are not widely recognised or treated.

If we sprain an ankle the pain signals rush up the nerve towards the spinal cord and cross over onto the next relay of nerves up to the brain. This next relay of nerves is made highly sensitive by the incoming pain and they start to react more and more strongly to the incoming barrage, amplifying the pain we experience in our mind. This will settle down as the injury heals and the system resets to normal, however this does not always occur or a pain can start without any incoming tissue pain at all. This is a pain syndrome, a collection of painful and other symptoms which do not appear to have an underlying pathology.

Complex regional pain syndrome (CRPS), fibromyalgia syndrome (FMS) and chronic widespread pain (CWP) are typical pain syndromes. CRPS can develop in a wrist or ankle after a moderate or minor injury such as a small fracture or a sprain, with the joint rapidly becoming painful, stiff and swollen. A wrist and hand like this has very limited function and needs to be free of immobilisation as soon as possible to start rehabilitation. Early Osteopathy intervention is vital to get the passive and active ranges of movement as soon as possible and educate the patient in what they have to do.

Widespread pain syndromes are very challenging problems for the patient and are very difficult to treat with any success. CWP shows trigger point hypersensitivity in the bellies of the muscles, specific points which are very painful to palpate and refer pain down to structures nearby. Osteopathy treatment consists of an exercise programme, stretching, acupressure, postural correction advice and acupuncture. Fibromyalgia has the typical symptoms of CWP with the addition of difficulties concentrating, IBS, severe fatigue, unrestored sleep, poor sleep, hypersensitivity to pressure and an over-reaction to activity.

Psychological interviewing of these patients is vital as having a long-term pain problem is very likely to produce low mood, depression and anxiety which in turn lead to poor coping and difficulties engaging with therapy. The clinical psychologist may find that the patient discloses a significant history of abuse, either in childhood and/or in adult relationships. This will have lead to important difficulties in dealing with other people, negative thinking, passive communication, anger and problems sticking to a treatment once agreed. The clinical psychologist will have an important role in supporting these patients through a course of treatment.

A FMS pain management programme covers several psychological skills and strategies, including pacing activity, realistic and negative thinking, assertiveness and communication skills, mindfulness and acceptance, goal setting and planning, validation of the reality of the condition and reduction of isolation by meeting others with the same condition. Passive communication with families, friends and others is very common and this leads to anger and frustration as they are unable to make their needs clear. The overall very negative nature of the pain experience leads to a negative bias in thinking about the world and their problems.

Medical treatment is not very successful in pain syndromes but drugs such as amitriptyline can be useful with their nerve transmission altering affects. Many FMS sufferers react adversely to drugs and this limits their usefulness, especially if morphine-related chemicals add to lack of mental clarity and fatigue. A graded exercise programme, carefully guided to avoid overdoing, is useful in the longer term as these patients have lost of lot of strength and fitness. Stretching is often reported to be helpful and may be all a person can do if they are having a worsening but overall a structured plan is necessary for a pain syndrome.

Andrew Mitchell, clinical director of the Osteopath Network, writes papers about musculo-skeletal conditions and physiotherapists in London. The Osteopath Network has more than 550 clinics located throughout the UK and offers treatment at weekends and after hours.