To suffer with acute or chronic pain is to often unbearable. The Chronic Pain Clinic at EVND endeavors to discover the root causes and provide leading alternative therapies to reduce the symptoms of chronic pain, improve sleep quality, and elevate every individual’s quality of life.
To understand the approach of Naturopathic medicine treatment of chronic pain we have to discuss the root causes. To understand the root causes of pain, we need to know a little about the anatomy of the body. The frame or structure of the body is built on and around the skeleton. The skeleton is made up of many bones that approximate one another but do not touch. One bone adheres to the next by a ligament, and this juncture is called a joint. The body is made for movement and activity. Layered over the bones and crossing the joints are hundreds of muscles that act as pulleys. The muscles attach to the bones by tendons. Ligaments and tendons are the same tissue, with slightly different functions, the ligaments providing support to the scaffolding.
Overlying and running throughout the muscles, of course, is fascia, connective tissue, fat, and skin. Some joints are contained within a fluid filled capsule. The fluid-filled capsules, as we see in the knees, hips, and shoulders, provide a cushion for weight bearing joints. These fluid-filled joints allow for extreme force to be applied without having the bones contacting or rubbing on one another.
Ligaments and tendons(aka connective tissue) are often described as the glue that holds all things together. Though this glue is living and has a blood supply, two obvious risks exist. One is, connective tissue is very dense, which is why it is also very strong. Due to its density, the blood supply is weakest in connective tissue compared to fat, bone, and skin. This equates to slow healing if connective tissue is damaged.
It appears, for reasons we do not completely understand, that once a ligament or tendon is damaged, its recovery is limited to less than 100 percent. Secondly, connective tissue as the glue is under constant stress whether we are active or not. The constant stress, or constant wear and tear, requires time to heal and repair. If the repair process is unable to recover from an activity or an injury, the tissue becomes weak and frayed. A rubber band can illustrate this concept well. A brand new rubber band has elastic capabilities that restore it to its original shape after it is stretched or pulled. But stretch and pull a rubber band 1,000 times and see if it is any weaker than when we started. The joint of a human body at that moment becomes unstable. Both muscles and fascia. which receive proprioception from the locally damaged tissue, tighten in order to stabilize the local joint, so as not to let any further damage occur. Thus the second layer presents, sooner or later, with referred pain patterns from distal trigger points that develop along and near the in associated muscles and facsial planes.
We fail to recognize in addition the normal process of aging in which everything begins to dry out. Ligaments and tendons and particularly capsule joints often just need a little rejuvenation to rebuild the normal fluids present in our youth. The knee is an excellent example of how different forces act upon it to cause pain. The bones of the knee include the femur and the tibia. They approximate one another and are attached to the inside by ligaments called the anterior and inferior cruciate ligaments. They stabilize the knee from moving too far forward or backward. Along the medial and lateral aspects of the knee and crossing the joint from top to bottom are the collateral ligaments. These help the femur and tibia from moving too much too inside or outside. Over the ligaments, a connective tissue capsule surrounds the knee joint. Another layer called the menisci, lying inside the knee, serves as a non-liquid cushion keeping the bones from rubbing on one another. In addition, our body creates and maintains fluid as found inside the joint.
Pain then arises when one of the following occurs. First a tear in one or both of the cruciate ligaments, or menisci, strain or sprain of the lateral or medial collaterals, loss of fluid within the capsule joint, and development of pain referring from trigger points as a result of unstable joints. Even when pain is difficult to isolate, joint and muscular pain are intimately connected by the joints they serve and thus are nearly always associated with one another.
Ligament and tendon damage, along with the second root cause of pain, known as muscular and fascial trigger points, are found in under trained and even in overtrained or tight muscles. These two conditions most often coincide simultaneously to produce the localized and referred pain patterns which contribute to 80% of all chronic pain. This pain is 100% curable. The cure comes from knowing the exact injury location and the subsequently referred pain patterns that have developed because of localized tissue injury and treating accordingly.
Besides pain that arises from damage and weakness of tendons, ligaments, fascia, and joints, pain can also be associated with chronic severe or low grade inflammation. At the root of chronic inflammation can be a diagnosed or undiagnosed autoimmune disease or undiscovered and thus untreated hidden infections from parasites, Lyme disease, Bartonella, and bacterial infections.
The first step in the Naturopathic approach to treatment of chronic pain is to skillfully evaluate the joints, tendons, ligaments, trigger points, and fascial referral patterns near the reported pain. Secondly, we need to consider and evaluate through testing and trial therapies, the level and sources of chronic inflammation leading to arthritis or autoimmune activity that is the source of the chronic pain. Some patients may have a mix of both musculoskeletal trauma and inflammation and require a treatment program that is able combine both sources simultaneously.