Issue link: https://www.massageandbodyworkdigital.com/i/969285
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 71 Pain can be perpetuated through what is called long-term potentiation (LTP). LTP is a process by which a neurological pattern is strengthened through repeated reinforcement, which increases signal transmission between the associated neurons. LTP can be observed in different situations. For example, motor skill improvement (e.g., ice skating) occurs due to repeated practice of neuromuscular patterns. LTP indicates that the more frequently the motor patterns are practiced, the stronger they become. The same thing can occur with pain patterns. The more frequently a pain sensation is felt, the more that sensory pathway is reinforced. In addition, the more frequently that pathway is used, the fewer stimuli are needed to set off the pain sensation. 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. 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 increased. There is a corresponding process that turns down the volume on nociceptive signals. The brain does this by blocking signals as they travel up through these pathways. This process of turning down the volume or limiting nociceptive input is called descending modulation. APPLICATIONS The above concepts are important core principles of current pain science research that can inform massage therapists' thinking about musculoskeletal conditions. However, these principles don't require a radical change in what we actually do in the clinic as massage therapists. Pain science principles should inform our understanding of the various factors in the experience of pain. However, that knowledge may or may not change our treatment. There are elements of pain science application that are outside the scope of practice for massage therapists to pursue, such as probing potential psychosocial factors. Let's now look specifically at how we might use pain science concepts effectively in massage treatment. Interestingly, much of the broader implications of the new pain science theory indicate that treatment should be more holistic and consider other factors at play. The idea of the body/person as a whole has been a founding concept in massage therapy for years. This is not news to us. In fact, our treatment approach—with safe, quiet, calm, relaxing settings and the emphasis on client/practitioner relationship—is a hallmark of what we do. Massage therapists have pioneered a whole host of highly therapeutic approaches to the treatment of pain. The effectiveness of massage and its unique applications is well-recognized by the people who matter most: our clients. The most important takeaway regarding pain science is that massage therapists should become better at what they do, not necessarily change what have been historically effective treatment approaches to pain. Before any consideration of "other neurological factors" come into play, the relevant biological factors must be investigated thoroughly. One cannot leap into issues of complex neuroscience or psychosocial considerations without fully exploring a client's complaint. To do so would be poor treatment. For close to 30 years, I have been beating the drum on the importance of assessment. (For more on the importance of assessment, read Ben Benjamin's "Pain Points," page 60, in this issue of Massage & Bodywork.) It continues to be one of the most important Two people exposed to the exact same stimuli may have very different pain experiences. This is not just about pain tolerance. It is a complex process.