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SCIENCE OF NERVES A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 87 why rubbing a painful body area reduces the pain experienced in that moment. Massage therapists should take note that some of the positive effects of massage related to pain management may very well be attributed to mechanisms described by the gate theory. We have yet to research this fully, but certain techniques like active engagement methods, where there is simultaneous massage along with concentric or eccentric muscle engagement, may be capitalizing on the pain-gating process. It is likely that proprioceptive information coming from the massage technique, along with the joint movement and muscle contraction, closes the gate on nociceptive signals and thereby decreases pain. NEW DEVELOPMENTS IN OUR UNDERSTANDING OF PAIN Our current understanding of pain-signal transmission also sheds some interesting light on pain experiences our clients present to us. When nociceptive signals reach the central nervous system, they travel through the spinal cord and then ascend through the lower, mid, and upper portions of the brain until they are fully processed. As they travel through these different sections, the intensity of the signals can be altered. Various factors can cause pain signals to be amplified; this is called ascending facilitation. Think of it as "turning up the volume" on the nociceptive signals that are arriving. Ascending facilitation can create two characteristic clinical experiences: hyperalgesia and allodynia. Hyperalgesia is when something is much more painful than it ordinarily should be. Allodynia is when something is painful that shouldn't be (like when a client reports that gently stroking the skin is painful). Obviously, our goals of pain treatment are to decrease any ascending facilitation that may be occurring. There is a corresponding process that "turns down the volume" on nociceptive signals and is very helpful for decreasing the client's pain experience. When various pleasurable sensations (like massage) are experienced, the upper portions of the brain can send signals to the lower sections and block a certain amount of nociceptive input, decreasing the person's sensations of pain. This process is called descending inhibition (or descending modulation). There is some research that now suggests this may be one of the most important benefits of massage when it comes to pain management. 2 There are fascinating new developments in our understanding of how pain is experienced and the various strategies we can use to help manage our clients' pain. The more we understand about the pain process, the better we will be at adapting our massage treatment to take the best advantage of how pain transmission occurs in the body. In upcoming installments, we will further explore some of these important concepts about how to use this new research to best help our clients. Notes 1. D. Butler and G. L. Moseley, Explain Pain Supercharged (Adelaide, Australia: Noigroup Publications, 2017). 2. A. D. Vigotsky and R. P. Bruhns, "The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review," Pain Research and Treatment (2015), doi:10.1155/2015/292805. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at 3 Schematic representation of the gate control theory. Mediclip image copyright (1998) Williams & Wilkins. All rights reserved. Nociceptive signal from periphery Nociceptive signal is inhibited when it reaches the central nervous system because proprioceptive signal arrived first. Proprioceptive signal from periphery

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