There Are Two Types of Pain:
Which Are You Suffering From?
There are SO many low back conditions. Things like sciatica, scoliosis, facet imbrication, sprains, strains, degeneration, herniated discs, and so on and so on. However, we can really narrow all of these conditions into two types of pain;
Inflammatory and Non-Inflammatory.
Now, that being said, you may exclusively have one, the other, or a combination of both. But, why does this matter? We’re going to get into the nitty gritty in a moment but to make this extremely easy to understand let me say this. If you have a non-inflammatory pain condition, anti-inflammatory treatments will NEVER WORK for you.
Determining the right treatment plan for you and your specific low back pain requires investigation. Simply reaching for the ibuprofen that doesn’t work, and hasn’t worked for the past 3 weeks, and won’t work for the next indefinite years is EXACTLY why so many low back pain sufferers find inconsistent relief and no long term solutions.
Let me try and bring some clarity to this issue.
Inflammation is the bodies natural response to damaged tissue. It is the way in which God designed our magnificent bodies to heal. This response happens at any level of tissue damage, micro or macro. Macro tissue damage, we’re all familiar with. This is the type of injury that typically has a name to it, like an ACL tear, muscle sprain, or fracture. However, when tissue gets damaged on a smaller scale we call this micro damage.
Micro damage to a tissue are not significant enough to earn the title of a medical diagnosis. They will, however, earn our attention because they can hurt just as bad and sometimes more than macro damage. The point that you should be pulling from all of this is that tissue damage, whether macro or micro, can cause pain. Well why?
When a tissue gets damaged the cells that were connecting the tissue together die. Because they’ve died there is now cellular debris in the region where that tissue damage occurred. Things like the cell wall, organelles, cellular fluid and such are now occupying space where healing needs to occur. As I mentioned earlier, this stimulates an inflammatory response.
Within the inflammatory fluid there are cells called macrophages and neutrophils (not that their name is important for any reason but that’s what they’re called). These cells are essentially the clean up crew. They flow into the region of injury and begin eating up all of the cellular debris to prepare the injured site for healing. (For more information on how Anti-inflammatory drugs stop this process and delay healing Click Here.)
This all sounds great, but why does it cause pain?
Inflammation is a fluid in our body. It travels through a circulatory system, much like our blood. Blood travels through arteries and veins called blood vessels to deliver blood to various tissues. Well inflammation travels through vessels in the lymphatic system called lymphatic vessels to deliver inflammatory and other lymphatic fluid to the tissues as well. This is called the Lymphatic System and is too complicated to discuss in detail for the purposes of this post.
While the blood and the lymphatic system are similar in that they are circulatory systems, the blood, luckily, has the convenience of a heart. Because blood is a vital fluid, and without it we would be in big trouble, the heart acts as the pump that fuels the circulation of the blood ensuring it gets too and from tissues. The lymphatic system, however, does not have the convenience of a heart, to pump the lymphatic fluid through the system. That means that inflammation can get stagnant, stay in a region for too long, and create irritation of various structures. When the nervous system recognizes inflammation being stagnant at a site of injury for too long it sends a pain signal to the brain. Without getting overly complicated (hopefully that hasn’t happened already) this is why inflammation causes pain and is one type of pain we can experience. (For information on how to prevent pain from inflammation Click Here.)
This type of pain, inflammatory pain, can manifest as a variety of different sensations ranging from sharp to dull to simply numbness of a nerve. As we talked about in previous posts during this blog series titled The End of Low Back Pain, inflammation is just another one of the triggers of the pain sensation and not necessarily a cause.
An easy way to tell if you are experiencing inflammatory pain is to try anti-inflammatory treatment methods. Now, this is not medical advice and you should ALWAYS consult a professional before taking any medication, but here are 3 questions I always ask my patients during exams.
- Have you tried any anti-inflammatory medications like ibuprofen, advil, or alieve?
- Does it help at all?
- If it helps, do you experience complete relief or does it just take the edge off?
These three questions pose extremely valuable information as a doctor trying to diagnose this persons condition. The first question is to establish if the patient has attempted any anti-inflammatory remedies at all yet. The second is trying to pull the valuable information out. Does it help at ALL suggests 1 of 2 things. There either is, or there is NOT inflammation causing a painful stimulus. Bottom line, if you have inflammation causing pain and you take an anti-inflammatory medication, it will help you. If you do NOT have inflammation causing pain you can take ibuprofen all day long it’s not going to help you at all. This question helps us identify if there is an inflammatory component to my patient’s pain.
The last question above is probably the most valuable of the three. Do your achieve COMPLETE pain relief or not. Inflammatory pain vs non-inflammatory pain is not a all or nothing scenario. It is a spectrum. There may or may not be an inflammatory component causing pain, and if there is, I want to know how much. Most patients land somewhere in that spectrum.
Here’s the big take away. If you take anti-inflammatory medications and it completely relieves your pain 100% until the medication wears off, then you exclusively have pain caused by inflammation and you should focus on anti-inflammatory treatments. If you take anti-inflammatory medications and it does absolutely nothing, then you do not have an inflammatory component, something else is going on. If you take anti-inflammatory medications and it only reduces the intensity of your pain, but you still have pain present, then there is an inflammatory component but that’s not the whole story. Something else is going on and we need to figure it out.
Commonly, the reason why anti-inflammatory meds like ibuprofen and others “take the edge off” is because the real reason you are having pain is not being addressed. The painful condition is now causing irritation and stimulating an inflammatory response. Just focusing on the inflammation NEVER gets to the root of the problem and solves anything.
So what could be the other pain causing stimuli? If it’s not inflammation, what is it?
There are a whole variety of named conditions and medical “diagnoses” that fall into this category. Some examples you may be familiar with are muscles spasms, nerve impingement, space occupying lesions (things occupying space where they’re not supposed to), trigger points, “knots”, and so on and so on. To explain what’s happening ins all of these scenarios is going to be too cumbersome for this section, but I’ll do my best to address these issues in later posts. Be sure to like, follow, and subscribe to get email updates when we post a new article.
For the purpose of this post I’d like to focus on a very common type of non-inflammatory pain that originates in your muscles called, trigger points. I’m sure you and your family give each other neck massages from time to time. I’d like you to think back to the last time you lovingly helped your spouse, family member, or friend with some neck tension by giving them a neck/shoulder massage. You may recall feeling what’s commonly called a “knot” in their muscles?
My wife is always so curious about these things and when I find one she asks, “what is THAT!” which is more often than not followed with, “is it on the other side?”
Now my wife is not a doctor, or even in the medical industry at all, but she intuitively asks a great diagnostic question; and something you can ask yourself when discovering trigger points in your own body. There are lots of tendons, muscles, bones, ligaments, etc in our body. How do you know if the hard lump you just brushed over is normal anatomy or a problematic pain generating trigger point?
Without getting into to much detail here, if it is located on the other side, it is more likely than not just normal anatomy. However, if the lumpy bumpy thing you feel is only on one side of the body, it’s likely a trigger point. That’s not to say trigger points can’t be on both sides of the body. But what’s the probability that you have 2 trigger points in the exact same locations in two opposite regions of your body? I can tell you from my experience, pretty unlikely.
Now here is an interesting thing about trigger points some of us may not know. This “knot”, known as a trigger point, causes pain. But not just where the trigger point is located. It can cause pain into other regions of our body into what are called referral patterns. The next time you find one of these knots in your spouse, family member, or friend I want you to let the person you’re working on know, you’re going to press firmly on that spot and hold it for a few seconds.
If they give you the OK, go slowly and start increasing the amount of pressure you’re pressing into the knot. Maintain a firm pressure and try to keep the “knot” centered under your thumb. Once you get a firm pressure on the trigger point ask the person if they fell any pain OTHER than where you are pressing. Don’t be surprised if they tell you they feel pain sensations radiating down their arms, legs, up their head, re-creating the headaches they feel, etc! When you do this, and you realize how incredible it is, you may become interested in wanting to know how to treat these things. For information on how to become a therapist click here.
Aside from being blown away by what just happened, I’ll explain more about trigger points in the next article in this series, “The End of Low Back Pain“. Stay Tuned!
Click here for a great resource to learn about trigger point locations, pain referral patterns, and such.