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Pain
Most chronic pain is caused due to damage from an injury or illness, problems with posture, and conditions such as arthritis or osteoporosis.
For advice on arthritis and joint pain, use this link.
Pain is felt as a result of the brain's response to electrical (neural) and chemical (hormonal) changes in the body as a result of damage, disease or injury. Signals from damage or injury are picked up by sensory receptors in nerve endings. The nerves then transmit the signal via the nerves leading from from the injury to the spinal cord, then into the brain where the signal is interpreted as pain. Pain is a self-protective mechanism which forces us to move away from danger, and afterwards, to rest the injured part, giving the body the chance to heal itself.
The nervous system
It is important to have some understanding of the way the nervous system is arranged in order to use massage and pressure points effectively as a means of relieving pain.
The diagram below shows the major nerve pathways that carry nerve signals to the brain. The brain and the spinal cord make up the central nervous system which between them co-ordinate and integrate all neural responses. All other nerves form the peripheral nervous system which includes spinal nerves, cranial nerves and the autonomic nervous system.
Diagram of major nerve pathways (click on image to
enlarge)
From the spinal cord branch the 31 pairs of spinal nerves which pass out from the vertebral canal through the spaces between the vertebrae. Each nerve has 2 roots, the anterior which carries motor nerve fibres, and the posterior which carries sensory impulses. As both leave the spinal cord, the form a mixed spinal nerve on either side of the spinal column.
The autonomic nervous system is the part of the nervous system which regulates our body functions without our conscious control (such as heart beat, sweating, digestion). The autonomic nervous system is subdivided into the parasympathetic nervous system (which comprises of nerves which leave the brain and lower part of the spinal cord, supporting mainly the blood vessels and organs), and the sympathetic nervous system (nerves which leave the spinal cord from the thoracic and lumbar regions serving blood vessels, the heart, lungs, intestines, sweat glands, salivary glands and the genitals). Both the sympathetic and parasympathetic systems often work together antagonistically in that the oppose each other in order to regulate body activities.
How can massage help?
Often when we have a minor injury, it helps to 'rub it better'. By stimulating the surrounding area, the pain seem less. This is an important concept when using massage to help combat pain. Acupuncture, Acupressure and Shiatsu use similar methods to relieve pain by stimulating nerve pathways in order to interrupt the pain signal to the brain. Traditional acupuncture and shiatsu uses the ancient meridian channels to restore the natural balance of energy called qi by applying needles or pressure on selected points along the meridian lines (energy channels) in the body. Modern acupuncture and shiatsu also works on or near the actual pain sites and follows more closely the nerve pathways which are similar to the meridian lines.
CAUTION: As already mentioned, pain is a warning that damage has occurred, therefore to directly massage an injured area risks further damage which is why massage and pressure techniques should not be used for acute pain (short term pain) or when the cause of the pain has not been properly established.
In some cases, pain is chronic (more persistent and has lasted a long time - for example, arthritic or rheumatic joints and some back problems). These types of pain are ideally suited for relief through using massage and pressure, including the use of TENS.
How does stimulating the pain nerve pathway work?
By stimulating the nerve carrying a pain signal to the brain, the therapist is interfering with the pain signal. This prevents the effective transmission of the signal reaching the brain properly so signals which would normally be interpreted as pain can be modified and the perception of pain decreased. The underlying cause of the pain however, will not be affected. This is sometimes referred to as the Pain gate mechanism or theory.
Normal pain response Modified pain response
(click on images to enlarge images)
Pain response diagrams © Jane Ellwood 2001
The modified pain response also includes the increased amount of
endorphins
released as a result of the stimulation. Endorphins
are the body's own natural pain killer and serve to further block the perception
of pain in the brain.
What conditions are suitable for these sorts of pain relief?
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Chronic (long term) pain for which there is little conventional relief available (back pain, arthritis) |
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Muscle pain |
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Skin sensitivity due to shingles |
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Menstrual pain |
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Headaches due to posture and neck problems |
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Pain from surgery or injury |
CAUTION Avoid stimulation of the neck and heart areas, recent injury or trauma, and when the cause of pain has not been ascertained.
Muscle pain - although a short-lasting and acute pain, this is an exception to the non-massage rule. Muscle pain occurs when the waste by-products of exercise are trapped inside the muscle. After 48 hours, any localised bleed into the damaged tissue will have ceased and it is safe to help stimulate the circulation around the affected area in order to help the body eliminate the waste products from the tissues.
Bruising - the general rule is wait 48 hours before massage to ensure no further damage to the tissues. Heavy bruising should not be massaged directly, but by stimulating the surrounding area, circulation and healing can be encouraged.
Remember - pain is a warning sign STOP if the treatment is causing pain.
Finding relief
The therapist can interrupt the transmission of pain signals to the brain by massaging or applying pressure to the specific sensory nerves which carry the pain signal from the affected area. This can be done by massaging or applying the pressure to the spinal side of the area, with further stimulation on or around the site (if tolerable). Painful joints can be massaged above and below, with acupressure or TENS points applied to the relevant sensory nerves.
Further information
Graphic on this page (except Pain response diagrams) are adapted from copyright-free clipart images
See bibliography for TENS TENS fact sheet
Dawes N (1995) Shiatsu: step by step guide London: Piaktus
Doody, S.B., Smith, C., & Webb, J. (1991). Nonpharmacologic interventions for pain management. Critical Care Nursing Clinics of North America, 3(1), 69-75.
Gray H (1998) Gray's Anatomy Bristol: Parragon
McLaughan C (1998) Simple techniques for pain relief London: Marshal Publishing
Taylor, A.G., West, B.A., Simon, B., Skeleton, J., Rowlingson. (1983). How effective is TENS for acute pain? American Journal of Nursing, 83, 1171-1174.
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help for those in chronic pain
Jane Ellwood
May 2001