Why all the focus on pain and symptoms? I feel one of the issues for lack of success with chronic pain is just this? We spend so much time researching treatments and methods that look at pain/symptoms and tissues causing pain that we miss uncovering all the predisposing and causative patterns of dysfunction setting up the area/tissues causing symptoms (or otherwise slowing recovery) in the first place. Pain and any tissue that is painful is simply the end effect (not the cause) and it occurs in tissues that are overloaded, stretched or compressed in some way.
If I pushed you over so you were off balance and held you there for a few hours – you would start to become fatigued and show pain – the tissues tighten up to try to stabilise you but after a while they can’t cope any longer and break down. Yet these are all effects. Meanwhile – it takes me much less effort to hold you off balance and I’m probably healthy, well and pain free. Yet I would be the cause. What good would a massage to the tight tissues do or giving a pain killer? At best this would enable you to cope with (and thus compensate for once again) the stress of me pushing you over for a few more minutes to hours where you would get overloaded again and manifest symptoms again. If you treat the cause – i.e. me, you’re not pushed over and your tissues are no longer stressed and overloaded and thus can recover. It’s that simple – yet training often focuses treatment approaches on pain, symptoms etc and the underlying causes go undiscovered and few think to unravel the pattern of dysfunction from the effects fully back to the predisposing causes.
Chronic disease is not as hard to manage if the correct approach is taken and much good can be done if approached in the right way. Chronic problems can likened to a fishing line with many knots all tangled together. It’s not just one knot – its many knots all clumped together and you simply have to start at a healthy end of the line and start untangling (but that’s the issue isn’t it – are we trained to learn how to do this or are we distracted by the end effects – pain and symptoms?). We can’t just grab the line and start pulling and pushing haphazardly and hope we will untangle the line without understanding how its entangled and retracing the steps via appropriate untangling. Chronic or complicated health problems can also be likened to a complex (rather than simple) mathematical equations – i.e. (X+Y)2 / L3 + (UV)4 + T = Z, Z being pain and the rest of the equation all the components involved in contributing to it in some way. For example – X could = a tight muscle, Y = joint, complicated by L = an underlying liver problem. This also could be related to or complicated by marital stress (U) and emotional issues (V) and also contributed to by the effects of gravity and faulty technique or posture (T). A good physician – regardless of his/her field – will problem solve and unravel (just like the tangled fishing line) bit by bit the entire equation and if successful – pain eases (but this requires a wholistic assessment which can recognise and assess the contribution from all of these components). A bad physician – just tries a remedy approach and hopes for the best – and even if successful in accidently hitting all the involved components, really has no idea why and so can accredit success to potentially the wrong thing. At any rate – chronic health issues are not always as difficult as we make them out to be – just a little more entangled and all we need to do is educate the health care providers how to scientifically explore and recognise the involved patterns of dysfunction underlying – so they can be included into the overall management plan and dealt with. The over focus on pain distracts from this and to balance this out our training programs needs to also include training on how to uncover the underlying, predisposing, maintaining and causative patterns setting up the symptom picture or otherwise slowing recovery in some way. Recognising these patterns and including them in our working diagnoses will vastly improve our success in treatment. See http://www.turnerpublications.com/publications/ for more information and ideas on how to improve wholistic assessment and treatment.
I hope this has given you food for thought, Paul Turner.