Massage & Bodywork

March/April 2013

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Pathology Perspectives • Temporomandibular joint disorder. • Tension-type, migraine, and cluster headaches. • Visceral pain, including irritable bowel syndrome, pancreatitis, angina, chronic pelvic pain syndrome, and endometriosis. • Whiplash. Conventional Treatment Options Central sensitization is a challenge for pharmacological treatment because it's a problem of perception, more than of specific damage. Unfortunately, the most effective drugs for this are ketamine (a strong tranquilizer) and its chemical equivalents, which carry unacceptable risks of dangerous side effects that include amnesia and psychosis. Other centrally acting analgesics have some efficacy, but many patients find them insufficient. These include some antidepressants and antiseizure drugs that alter both pain perception and reactivity. Cognitive behavioral therapy that explores solutions to problems that predictably cause pain events can be helpful as well. Research suggests that mild aerobic exercise can reverse some of the synaptic plasticity that causes this problem, and reduce pain.2 Antiinflammatory medications can be useful, but they usually work only when the trigger for the initial damage involved some kind of inflammation, and this is not always the case. Where Does Massage Fit? The most important takeaways about central sensitization are these: • The pain is real, not imaginary. • The pain was triggered by some event outside the CNS. • The pain is common. • The pain can be reversible—and manual therapy may help. Most of us often go through some kind of trauma or problem that could start a central-sensitization cycle, but most of us don't end up with persistent pain. Besides good luck, the main reason is probably that our normal healing mechanisms resolve the irritation before the pain pathways become deeply ingrained. But for those people who do go through this ordeal, it is important to remember that if the source of the problem can be eliminated, we can work to reduce the pain signals, and allow the CNS to return to its normal, functional state. It is a fairly new idea to link peripheral injury to CNS dysfunction, and recognizing and locating the peripheral sources of the problem can be challenging. Among many possibilities, we can consider scar tissue, adhesions that irritate nerve endings in fascia, trigger points, gait patterns that reinforce pain, or inefficient postural habits. Another intriguing possibility is that the pain signals may be generated by systemic, but extremely subtle, inflammation or oversecretion of proinflammatory chemicals. If we are patient, imaginative, and sensitive to our clients' needs, we have the opportunity to beneficially interfere in their chronic-pain cycle and help them come to a highly satisfactory resolution. Thank you to Geoffrey Bove, DC, PhD, who provided input and significant help during the development of this article. If you get a chance to take a course with him about pain, I highly recommend it. Find him on Facebook—Geoffrey Bove, DC, PhD, Bove Pain Diagnosis and Therapy. Notes 1. C. Woolf, "Central Sensitization: Implications for the Diagnosis and Treatment of Pain," Pain 152 (2011): S2–S15. 2. M. Curatolo et al., "Central Hypersensitivity in Chronic Pain: Mechanisms and Clinical Implications," Physical Medicine & Rehabilitation Clinics of North America 17 (2006): 287–302. Ruth Werner is a writer and educator approved by the National Certification Board for Therapeutic Massage & Bodywork as a provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2012), now in its fifth edition, which is used in massage schools worldwide. Contact her at or See what benefits await you. 45

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