Dysfunction and Pain

DYSFUNCTION AND PAIN

By Vladimir Djuric, M.D.

Long after the typical sprain/strain injury has had ample time to heal, it ceases to be the problem. Rather, it is the long-term consequence of tissue stretching and tearing which then accounts for ongoing pain and dysfunction. Although most of our tissues have excellent healing capacity, this diminishes with age. Furthermore, the ability of some tissues to heal is considerably lower than others. Bone, muscle, and skin for instance have good blood supply and heal quickly. Nerve, vertebral disc, cartilage and ligament on the other hand are not so fortunate; healing of these tissues is frequently incomplete. This suboptimal tissue regeneration leads to impaired function of the injured body part (soma), commonly referred to as "somatic dysfunction".

Because of its very complex and to some extent fragile biomechanical design somatic dysfunctions most frequently involve the spine. However, other joints can be equally affected. These dysfunctions may stem from an injury such as a whiplash or fall. They can develop as a result of longstanding postural abnormalities or damaging repetitive activity. In any case, they are frequently painful and can become incapacitating. Unrecognized and untreated, somatic dysfunctions may ultimately result in irreversible pain and disability.

Acute pain is indicative of tissue damage or irritation. It is a message from our body to remove or correct the offending insult. Chronic pain is something altogether different. The message has been scrambled and is no longer discernible. Like an unwelcome guest, much bigger and stronger than you, it refuses to leave; preferring instead to lounge on your favorite sofa. However unwanted, this guest continues to remind you that something is quite wrong.

Numerous strategies have been developed to deal with chronic pain. For the most part they fall into one of three categories.

  1. Correct the problem.
  2. Alter or relieve the pain sensation.
  3. Learn to live with it.

Choice #2 means relying on some sort of medication or device the ease the pain. Because it is usually an unnatural approach and fosters dependence, many patients find this choice undesirable. Choice #3 may be equally unacceptable and in some cases impossible for many individuals, regardless of how many pain management programs they’ve been through. The preferred choice is obviously #1.

Common sense tells us that prior to accepting that undesirable guest as a permanent resident, all attempts should be made to usher him out - preferably for good. This usually entails correcting the problem. Even a partial correction may lead to a considerable reduction of pain and disability.

Since in many cases chronic pain has an underlying biomechanical etiology, efforts should be geared towards restoring normal biomechanics. At times the solution is simple; frequently it is not. In instances where the dysfunction is complicated and/or long-standing, a treatment approach that is comprehensive and multifaceted is much more effective. The knowledge and skills of multiple individuals all striving towards a common goal must work in synchrony.

Making a specific diagnosis is a good way to start. This amounts to isolating the "primary pain generator", the ultimate source of dysfunction. This is not always an easy task in musculoskeletal medicine. Just because scoliosis, spondylolisthesis, degenerative disc disease, and yes, even "arthritis", exists, it does not necessarily mean that this is causing the pain. In fact, many times these findings are entirely unrelated; insignificant "red herrings". However, by understanding the pathophysiology of musculoskeletal disease, recognizing altered biomechanics and pain patterns, we can more effectively identify the problem and thereby direct the appropriate treatment.

Once the problem is identified, efforts are made to control pain. Attempts are made to relieve muscle spasm and restore motion. This in and of itself usually leads to additional relief of discomfort. The next step is to improve strength and stability, with the ultimate goal being restoration of function. By focusing on function rather than pain we are able to get to the core of the problem. As progress is made in correcting the somatic dysfunction, symptoms, including pain, gradually diminish.