Musculoskeletal pain is a widespread human condition with multifactorial causes involving interactions between physiological, psychological, behavioral, and social factors. Perceived threats or stressors to the human body take many forms and their interplay is modulated within the autonomic nervous system (ANS).
The autonomic nervous system is made up of two sub-systems that work to maintain internal balance together with the immune and endocrine systems. This is an extremely complex relationship and beyond our scope, but for our purposes around the discussion of pain the sympathetic nervous system is our fight or flight. Included in this sympathetic response is a shunting of increased blood flow to the musculoskeletal system and away from the organs, release of adrenaline, increased heart rate and blood pressure. The parasympathetic system in contrast decreases heart rate, relaxes the system, and allows blood flow to digestion and other internal organs.
The involvement of the ANS is quite different in acute pain episodes verses chronic pain and this understanding can help uncover ways to treat the patient suffering with long-term discomfort. In acute pain episodes the threat to the body arouses the sympathetic system and actually suppresses pain, serving as a survival mechanism. When we look at chronic pain or chronic stress this interaction between nociception and the ANS often becomes maladapted. Studies show that the relationship between the perception of pain and the actual state of damage or derangement to the tissue becomes weaker and less predictable with time. Meaning, the longer pain persists the less it is a predictor of actual tissue damage and the more sympathetic maladaptation may have occurred creating imbalances in blood flow to the muscles, contractibility, and proprioception through altered sensitivity of the muscle spindles.
We can use this information to explore some creative ways to address the sympathetic up-regulation component of our patient’s pain. Blood flow to an area can be increased in a number of ways. A couple of the most effective we use at CHARM include the Class IV Laser which uses specific wavelengths of light found to increase metabolism at the cellular level, and the HyperVolt that uses percussion / vibration to increase blood flow, release muscle tension, and decrease the sensitivity of muscle spindles. We have found it to be quite the focal trifecta and many of our patients end up purchasing their own unit.
When it comes to release of more global muscle tension and sympathetic up-regulation, we often utilize microcurrent point stimulation on negative polarity to specific parasympathetic points to relax the system, and more direct protocols for neck and back neuromuscular tension release. The sling suspension therapy known as the Redcord Neurac method can be used in a combination of ways to down regulate the sympathetic nervous system through body weight off-loading, rocking, rotation, and high frequency vibration. This 1:1 guided therapy method also provides our patients the opportunity to release tension, guarding, and fear as they begin to re-establish proper movement patterns without the interference of pain.
The most important aspect to appreciate about musculoskeletal pain is its complexity. You are not alone and you deserve partners in your journey and recovery that listen with multi-disciplinary wisdom, experience, expertise, and compassion. We are here to help unlock your body’s healing potential.
Michele Zink Harris, PT, CNP, RAS
Reference: Autonomic Regulation in Musculoskeletal Pain: By David M. Hallman and Eugene Lyskov. Submitted: November 23rd 2011Reviewed: June 27th 2012Published: October 24th 2012. DOI: 10.5772/51086