Pain Management

Chapter 16


Pain Management




Objectives


After completing this chapter, the student will be able to perform the following:


1 Describe pain in relationship to injury and rehabilitation.


2 Apply massage targeting pain management mechanisms.



Key Terms



















Pain



Objective




Pain is a major issue for athletes and for those in rehabilitation. Pain management is most effective as a multidisciplinary intervention. Clients involved in physical rehabilitation likely have pain from the injury and from the rehabilitation. Athletes often play and practice with pain. Massage coupled with other pain management strategies is essential for exercise compliance, persistence in training protocols, and enhanced performance.


Pain is a universal experience. The degree to which a person reacts to pain results from biological, psychological, and cultural makeup. Past encounters with painful injury or illness also can influence pain sensitivity. Athletes who are prone to recurring injury in the same area can experience increasing pain sensation for the same or even a lesser degree of injury.


When pain persists beyond the time expected for an injury to heal or an illness to end, it can become a chronic condition. No longer is pain just the symptom of another disease, it is a separate condition unto itself. Unfortunately, pain coexists with athletic training, performance, and competition. The massage therapist must understand pain and must use massage methods to effectively manage pain. This chapter expands on content in Units One and Two and provides specific massage strategies for pain management.




Peripheral Nerves


Peripheral nerves encompass a network of nerve fibers that branch throughout the body. Attached to some of these fibers are special nerve endings (nociceptors) that can sense an unpleasant stimulus, such as a cut, a burn, or painful pressure.


Millions of nociceptors reside in skin, bones, joints, and muscles and in protective membranes around the internal organs. Nociceptors are concentrated in areas prone to injury, such as the fingers and toes. As many as 1300 nociceptors may be present in just 1 square inch of skin. Skin stimulation during massage that is intense enough to stimulate the “good hurt” response causes the nociceptors to fire. This is one of the mechanisms of counterirritation and is a major component of massage benefits for pain management.


Muscles, protected beneath the skin, have few nerve endings. Internal organs—protected by skin, muscle, and bone—have even fewer. Some nociceptors sense sharp blows; others sense heat. One type senses pressure, temperature, and chemical changes. Nociceptors also can detect inflammation caused by injury, disease, or infection.


Massage that addresses these receptors must have enough compressive force to elicit a neuroresponse, but must not be so aggressive as to cause an increase in nociceptor sensitivity or actual tissue damage.


When nociceptors detect a harmful stimulus, they relay their pain messages in the form of electrical impulses along a peripheral nerve to the spinal cord and brain. The speed with which the messages travel can vary. Sensations of severe pain are transmitted almost instantaneously. Dull, aching pain—such as an upset stomach, earache, or aching joint—is relayed on fibers that transmit at slower speed.


When pain messages reach the spinal cord, they meet up with specialized nerve cells that act as gatekeepers, which filter pain messages on their way to the interpretive areas of the brain, where the pain is felt and understood, and coping strategies are developed.


For severe pain that is linked to bodily harm, the “gate” is wide open, and messages take an express route to the brain. Nerve cells in the spinal cord respond to these urgent warnings by triggering other parts of the nervous system into action, especially the motor nerves to signal muscles to move away from harm—a process described as a reflex arc. Weak pain messages, however, such as those resulting from a scratch, may be filtered or blocked out by the gate. Often athletes do not realize that they have these minor injuries, and the massage therapist is the first to notice them. Athletes can be unaware of even major injury in the excitement of competition.

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Jun 22, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Pain Management

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