Author: Dr. Bryce Hendy, DC, DNCert
Inflammation in itself can be a pain generator. Our bodies are great at creating inflammation at sites of injury and tissue damage to help start the healing process. The inflammation involved in a healing process can contribute to further discomfort by irritating surrounding tissues. In some cases the inflammation may irritate a nerve. We see this commonly in the low back where damaged or irritated tissues (muscles, ligaments and even joints) create inflammation; the nerves in the low back then become irritated by the inflammation and in some cases can mimic sciatica like symptoms.
There are 3 main types of nerve conditions that we try to differentiate from:
- Radiculopathy: when a nerve root exiting the spine gets irritated or compressed by surrounding structures; this will typically come with pain, numbness/tingling, muscle weakness and changes in sensation along the nerve root distribution (dermatome).
- Neuropathy: when a peripheral nerve (a nerve that does not directly come from the spinal cord, ex. Median nerve) gets compressed, entrapped or damaged along its distribution; this will present with pain, numbness/tingling, and muscle weakness and changes in sensation.
- Neuritis: when a peripheral nerve is irritated by surrounding structures/tissues or by chemical inflammation; presents as pain and numbness/tingling, but typically no changes in muscle contraction or changes in sensation.
In cases of neuritis where you have long standing inflammation or chronic pain that has an inflammatory component, if the inflammation is irritating the nerve for a sustained period of time, eventually the nerve itself can become inflamed as well. With neuritis the pain fibers in the nerve are constantly firing through the spine and up to the brain. When those pain signals are constantly firing and not turning off this leads to chronic pain. Chronic pain does not respond to care as quickly as acute pain does with pain gating. In pain management, a lot of the therapies are working with the theory of pain gating. Pain signals and pressure (mechanoreception) share a pathway in the spinal cord. This is why massage, cupping, dry needling and other conservative therapies can help decrease pain. When the mechanoreceptors are activated it shuts off or closes the pain pathway to allow the mechanoreception to go to the brain. In the cases of chronic pain, the pain pathway has a much higher threshold now because of the constant firing. Think of it like merging onto the freeway, much easier to do when there is less traffic, but when there is a lot of traffic it is hard to get into the lane you need to. The pain pathway stays open which means it will require more stimulus to close that pathway. This chronic pain can come from inflammation that is irritating a nerve, or from a nerve itself being inflamed.
We have great options to help decrease chronic pain and to help decrease inflammation and nerve inflammation. Pulsed Electromagnetic Frequency (PEMF) is a great way to help reduce inflammation in general or nerve inflammation and it can also help to down regulate our overall nervous system. We can also use laser therapy to help decrease inflammation, as well as approach inflammation from a nutritional stand point to help manage your inflammation.
