Issue link: https://www.massageandbodyworkdigital.com/i/82405
SOMATIC RESEARCH CHRONIC PAIN SYNDROMES Clinical trials support the theory that chronic pain is best treated as a complex condition deserving of a multidisciplinary approach, rather than as a symptom with a specific remedy.11 In order to be effective as a massage therapist, one must embrace the chronic pain experience from the individual client's perspective and address its many facets. To make individual treatment plans for complex conditions manageable, break it down into a clinical decision-making process: • Understand the mechanisms of the syndrome (central or peripheral nervous system, emotional or physical, enhanced by inactivity and loss of balance). • Identify presenting symptoms; measure its intensity. • Select treatment techniques that will reduce symptoms and are consistent with the mechanisms of the syndrome. • Educate the client on self-care exercises that support the reduction of symptoms between sessions. • Reassess symptom intensity to measure progress; adjust your treatment plan accordingly. First, learn about the various conditions associated with chronic pain. Included are arthritis, back and neck pain, cancer, chronic fatigue syndrome, diabetes, irritable bowel syndrome, fibromyalgia, headache, herpes, spinal stenosis, Lyme disease, myofascial pain syndrome, phantom leg syndrome, restless leg syndrome, sciatica, etc. A few of these conditions have an identifiable origin of pain that remains constant (cancer, herpes), however, most spiral into chronic conditions that no longer resemble the original onset and cannot be successfully treated solely by addressing the soft tissue trauma. Even fibromyalgia/myofascial pain syndrome/ chronic fatigue, commonly identified by the presence of trigger points, may not be best treated by trigger point therapy alone: "While much of this Chronic pain suppresses the immune system, results in excessive inflammation, and delays healing. pain and many of the test sites are located in the muscle, the allodynia [pain due to a stimulus that does not normally provoke pain] is now believed to come primarily from central nervous system neurosensory amplification of nociception in general, and not specifically from muscle pathology."12 Chronic pain also contributes to other pathologies. As discussed above, long-term effects of pain harm nerves and trigger psychiatric disorders (anxiety, mood). People with chronic pain have been found to have lower- than-normal levels of endorphins in the spinal fluid.13 In addition, it has been found to affect blood vessels and organs, for example, chronic migraines directly increase the risk of stroke.14 Chronic pain suppresses the immune system, results in excessive inflammation, and delays healing.15 Damage to cortical areas of the brain result in cognitive impairment, such as diminished attention span and mental flexibility, memory loss, and verbal deficiency.16 SYMPTOMS OF CHRONIC PAIN Next, identify the symptoms associated with the chronic pain pathology(s) specific to the individual client. To gauge the success of the treatments you provide, rate the intensity of the symptoms as you identify them. Use the knowledge gained from the research to assist in gathering information from clients. For example, a common response to pain is to minimize movement, thereby decreasing flexibility and balance. Mobility and balance assessments will help us identify dysfunction, and charting functional limitations will help to design self-care strategies to improve quality of life. Following is a general list of pain-related symptoms supported by research, along with guidelines to assess their expression. Ask clients to report on the following: • Pain—describe and identify location, intensity, frequency, duration, and triggers. • Mental health—frequency and intensity of moods: depression, anxiety, stress.* • Cognitive impairment—episodes of forgetfulness, diminished attention span, verbal deficiency. • Activities of daily living—identify activities they no longer do because of pain and activities they must modify (not as often, not as long), and at what point the activity triggers an increase in pain. • Sleep disturbances—how many hours of sleep, how many times waking, and how they feel upon waking (fatigued/rested). *Note: Mental health assessments and treatment with talk therapy are not within a massage therapist's scope of practice. However, research supports the use of massage as an effective tool for relieving anxiety, depression, and stress. Therefore, we should responsibly track changes in mood as reported by the client to add to our knowledge base and support our clients' healing. Perform assessment tests to note the following symptoms, using techniques within our scope of practice: • Compensational patterns, muscle hypertonicity, muscle weakness, spasms—muscle tests, palpation findings, and posture. Boost your practice with ABMP's Website Builder—free for members on ABMP.com 119