Understanding Your Pain to Establish a Proper Treatment
Pain is your body’s way of telling you that something has gone wrong. It is a warning signal to change what you are doing before damage progresses. Not all pain is the same, nor is all pain bad. Knowing what type of pain, you have is of utmost importance for, without the proper diagnosis, you cannot receive the proper treatment. Too often we assume that all pain is inflammatory and overuse NSAIDs and steroids, but most musculoskeletal disorders are mechanical and will not respond to these treatments.
When your pain continues, instead of the anti-inflammatories not being strong enough, could it be that your pain is not from inflammation?
Chemical versus Mechanical Pain?
Mechanical Pain occurs when stress is placed on a joint or soft tissue, such as when you bend your finger all the way back or stretch your calf. If you go back far enough, you will feel pain. As soon as you release, the pain immediately abates. There is no injury or damage to the tissue. Mechanical pain arises when a mechanical force stresses a tissue. It is resolved when a different movement or positions remove the mechanical stress. Bending your finger backward produces a mechanical stress that causes pain. Movement in opposite direction relieves the pain. Mechanical pain is usually intermittent, but it can be constant as when the stress is constant – holding your finger backward. When you have pain that comes and goes or changes with different movements and/or positions it is mechanical.
Chemical pain, on the other hand, is caused by the body’s inflammatory response to injury. It is a complex chemical reaction and occurs to aide tissue damage by releasing chemicals from the blood, fibroblasts and local macrophages to clean up the area and start the healing process. An example of chemical pain would be hitting your thumb with a hammer or a toothache. Chemical pain is described as throbbing, constant and does not change with movement. Pain that comes and goes cannot be chemical. Back pain that is worse with sitting and bending but a bit better with walking is not chemical or inflammatory pain, because it changes with movement and will not respond to chemical treatments such as anti-inflammatories and muscle relaxers. Inflammation can be uncomfortable, but it is part of the miraculous natural healing process. It usually lasts only a few days to weeks. Symptoms of a localized injury that continue after a few weeks are the result of re-injury / re-tearing of poorly healed tissue or an unresolved mechanical problem.
Examples of mechanical injuries:
- Herniated disc
- Meniscal or labral tears
- Scarred and shortened muscle or tendons that have healed but are not fully recovered.
Initially, these conditions may have an inflammatory component and may be helped by anti-inflammatories early on, but the main cause of pain will be mechanical, not chemical.
Mechanical pain only responds to a mechanical treatment – change of position or movement. Mechanical treatment is targeted to a specific joint or tissue to change the current mechanical position or property of that tissue. For example, a shoulder dislocation requires morphine. But if you are able to relocate the shoulder, 90% of the pain is resolved because the mechanical stress is removed.
Differentiating between pain that is caused by a mechanical or chemical irritation is critical because you have to know if you need to remove a mechanical stress or an inflammatory component to get relief. The two treatments are totally different.
Only a correct diagnosis will produce the proper treatment and outcome.