Massage & Bodywork

JANUARY | FEBRUARY 2015

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F r e e m u s i c d o w n l o a d s f o r C e r t i f i e d m e m b e r s : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 37 THE PROBLEM Chronic pain is a huge problem in our society. It is a potentially life-threatening problem, as people who can't relieve their pain may seek an early exit from their lives. It is certainly a quality-of-life-threatening problem. It costs our economy untold billions of dollars, not only in direct medical care (much of which is risky, expensive, addicting, and ultimately ineffective), but also in terms of the lost productivity and lost contributions to the worlds of those who are affected. Obviously, not all pain is a bad thing. Pain has the useful function of telling us about present or incipient damage. It gives us good reasons to avoid that damage, or to avoid activities that might make existing damage worse. In its best sense, pain is our friend. But when pain signals become amplified and self-sustaining, pain no longer serves a useful purpose. This is discussed in some detail in "Pervasive Pain" (Massage and Bodywork, March/April 2013, page 42). When pathological pain is perceived as coming from a limb—including a "phantom" limb (a body part that has been amputated)—several complex processes allow for the possibility of rerouting central nervous system (CNS) signals to reduce that sensation and to improve motor function. But the body's solution can sometimes lead to further problems, most often seen in these forms: Phantom limb pain (PLP): This is a common complication of amputation and can be caused by several factors. The longer the problem persists, the more likely it is to be related to a CNS processing issue. A person with PLP may sense that their phantom muscles are cramping, that the limb is twisted uncomfortably, or that it itches, tingles, or has sharp, shooting pain. Complex regional pain syndrome (CRPS): This used to be called reflex-sympathetic dystrophy. The label encompasses subtypes of trauma that lead to ongoing, centrally generated, and often spreading, sensations of pain, along with tissue changes that include swelling, accelerated hair and nail growth, and atrophy of the affected bones and joints. Post-stroke: CRPS is a common post-stroke complication, but even some stroke survivors without CRPS find that their muscular paralysis and accompanying pain can be improved with mirror therapy. THE TRADITION Until quite recently, the common wisdom among neurologists was that the brain was hardwired and its functions strictly segregated. Everybody knew that the ability to make cross connections between areas in the brain was limited, and that any CNS damage was permanent. The best way to deal with CNS problems was to make the functioning part of the body able to do as much as possible and to give up on the nonfunctioning part. The treatment options that arose out of this paradigm are still predominant, simply because they seem to be the best we have. They include pain medications, including highly addictive opioids; surgery to remove lesions (which can create its own set of problems) or to implant pain management devices; and nerve blocks that are often impermanent and unsuccessful. We now know that the brain is far more complex than we thought. It changes and adapts, sometimes in ways that cause problems. It contains 100 billion neurons, and each one is capable of 1,000–10,000 connections with other neurons. Consequently, to suppose that our cognitive, sensory, and motor functions are fully separate is simply not realistic. AN AMAZING OBSERVATION Picture a person with an amputated hand, just above the wrist. She has PLP; it feels like her hand is cramping and her forearm is twisted, and she can't do anything about it. She is sitting at a table. Her healthy hand is supine in front of her, and her phantom hand is hidden in a mirror box on the table. She is positioned in such a way that she can see the reflection of her intact hand in the mirror, exactly where the missing hand would be (Image 1). If she slowly closes and opens her intact hand, and mentally does the same with her phantom hand while she watches in the mirror, a truly amazing thing may happen. Within a few minutes—if she's A mirror box reflects the healthy hand, tricking the brain into perceiving sensation in the amputated hand. Lily Rose Creations.

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