chronic muscle pain

Feel Your Qi and Relieve Pain

Published in the Lotus Guide. Chico, CA. January 2012

Today qi is commonly referred to as energy, yet qi is a mystery to modern science. In Chinese philosophy, qi is a subtle substance that pervades space; in Chinese medicine, qi is a physical sensation described as the feeling of something strange moving in the body experienced by patients who receive acupuncture or moxibustion.

Scientists and scholars may disagree about the existence of qi, but traditional Chinese medical dictionaries all agree the sensation of qi felt during acupuncture indicates a successful response to insertion. Some scholars discuss the question: Is qi matter or energy? And is that even the question?

What is qi? Is it matter, energy, spirit, or something else? And how will knowing what it is help explain the concept of qi? Sometimes authors look to the Greek words pneuma or psyche. Pneuma is a name for “air inside the body” and psyche is a term for ‘spirit’ used to distinguish between “living and non-living things.” When qi, an eastern concept, is compared to western concepts such as ether, energy, or spirit, these different concepts cannot be substituted for the true meaning of qi in Chinese philosophy.

I will use the Chinese pinyin spelling ‘qi’, rather than try to find a good English word to translate the term qi.

To get a better idea of the term qi, examine its use in the well known 5th century BCE humorous story from the Liezi that tells about a man from the state of Qi (same sound, different tone and character) who was worried the heavens might collapse and fall into pieces depriving him of food and sleep.

A friend consoled him with, “Heaven is only an accumulation of qi; that same qi is everywhere. Why then do you worry about a collapse of heaven?”

The man said, “If it’s true that heaven is an accumulation of qi, why don’t the sun, moon, and stars fall down to earth?”

His friend replied, “Those bright lights are only shining masses of condensed qi. Even if they did fall they wouldn’t hurt anybody.”

The man continues to question and his friend continues to give answers until a sage declares, “What does it matter? One cannot know when the end will come. Why then worry if the world will be destroyed or not?”

Here qi seems to be a subtle substance found everywhere. This is not the complex theory of qi found in traditional Chinese medicine. A fundamental theory of ancient medicine is the theory of that many types of qi form a complex interacting system found everywhere in the human being.

The next author Xun Zi (312-230 BCE) makes a distinction between qi and life, two agents of change. He then explains the role qi plays in the lives of people and the power people have in controlling the qi in their lives.

Xun discusses the concepts of qi, life, awareness, and judgment stating all can change the world. The subtle qi of water and fire changes things but has no life; furthermore, some living things have awareness but only people possess judgment. Therefore people have qi, life, awareness, and judgment. Judgment is the power to distinguish and influence change.

All ideas and theories are in the head, but the experience of qi is in the body. Patients receiving the traditional Chinese method of acupuncture experience qi regularly. Though the sensation can be uncomfortable, it is a favorable sign. Patients say qi sensations feel like they are radiating, tingly, achy, heavy, and various other sensations. The qi sensation changes with the diagnosis and how the needle is inserted.

Erica D. says, “Sometimes it feels like a small energy bomb shooting sensations like beams toward distant parts of the body.”

 

Massage Helps Chronic Pain

Published in the Lotus Guide, Chico, CA. October 2010

Don, a triathlete, stopped competing and started physical therapy while attending medical school. It started with a running injury in which he tore a hamstring muscle. The pain gradually worsened, leaving him with right hip and lower back pain that stopped his participation in sports. He saw two orthopedists and went to physical therapy for two years; he even tried some cortisone injections, which helped slightly, but did not cure the condition. Don gained weight, lost energy, and grew despondent.

Don’s case is one of a multitude of cases that fall under the medical name Chronic Pain Syndrome, persistent pain from unknown causes. In this case, the injury healed, but pain remained. It is estimated between 15 and 20% of Americans suffer from chronic pain.

The September 2009 issue of the Scientific American Mind magazine published a special report focusing on Chronic Pain Syndrome. The magazine, citing the latest studies, reported, “No one knows for sure why some injuries, even minor ones, result in persistent pain or why it occurs in some people but not in others. Nevertheless, researchers are pinpointing telltale changes in the neurons that underlie persistent pain. In particular, they have documented abnormal excitability among neurons at every level of the body’s pain network.”

Pain is a sensation that defies explanation and keeps authorities arguing. However, all agree that pain stimulates a sense of alarm that requests a response. Most definitions note the suffering; some note the protective benefits of pain. However, recent studies report the way people define pain, changes the way they experience it. So choose your definition well.

The Oxford English Dictionary, a venerable reference book, defines the sense of pain as, “A primary condition of sensation or consciousness, the opposite of pleasure; the sensation which one feels when hurt (in body or mind); suffering, distress.”

Today scholars say, “…pain is a complex perceptual experience influenced by a wide range of psychosocial factors, including emotions, social and environmental context, sociocultural background, the meaning of pain to the person, and beliefs, attitudes, and expectations, as well as biological factors.”

Western medicine distinguishes between two types of pain:  acute and chronic pain. There are important distinctions, which affect diagnosis and treatment.

The word ‘acute’ means sharp or pointed. “Acu” is used in words such as acuity, acumen, acupuncture, and acupressure. Acute pain occurs during healing from physical injuries, vigorous exercise, and rehabilitation therapy. A period of acute pain comes to a natural end after the healing crisis.

‘Chronic’ is a medical term that applies to long-standing diseases. Chronic pain is lingering and incurable, the opposite of acute pain that heals and stops hurting.  Chronic Pain Syndrome disables and demoralizes people, because the constant pain holds victims hostage for months or years at a time, keeping them from what they love.

Western culture defines pain in terms of its discomfort and its role in suffering. Eastern culture defines pain in terms of its association with the life force (qi) and its role in healing. Traditional Chinese medicine states qi, the life force, is meant to move throughout the body. Pain results when the flow of qi is impeded.

Qi and blood are partners: qi moves blood and blood nourishes qi. They are like yin and yang, always found together but in different quantities. This is especially true in the muscles and connective tissue where qi and blood disorders can be felt. The feeling of stuck qi is tender tissue, and the feeling of congealed blood is stiff tissue.

While fear is a natural response to pain, and avoiding activities that provoke pain is reasonable for acute pain, it serves no purpose when treating chronic pain. Anxiety and fear intensify the pain experience, increasing the sensitivity to pain-related activities. Prolonged states of anxiety reduce tolerance for pain. Fear of re-injury is a better predictor of disability than the signs, symptoms, and severity of the pain.

Pain makes exercise more difficult, resulting in loss of flexibility, strength, and coordination, which further complicates recovery, and when the victim believes painful activity may aggravate the initial injury, it results in avoidance of therapeutic activity, which could reduce pain and promote healing.

A therapeutic massage can stimulate mild acute pain to desensitize the fearful patients. It can reduce the anxiety by releasing endorphins and relieve chronic pain with a little acute pain that improves circulation throughout the painful injured tissue.

A massage therapist can coach a suffering patient and talk about the problems caused by their painful condition. Mary Ewing, owner of Back To Basics, an integrative health center, is a massage therapist and chiropractor. I asked Dr. Mary how she coaches a patient. She said, “When people come into my office, I listen to what they tell me and the language and terminology they use to describe their problem. I talk to them about rewiring what they say about their pain.”

Besides being good listeners, some therapists have a healing touch¾their hands dissolve pain. Some massage therapists go deeper into more painful places, and patients find the relief outweighs any discomfort during therapy. It is as if acute pain defeats chronic pain.

Don, now a doctor, decided to see a massage therapist recommended by a friend. When he came to see me, he still suffered from back pain that kept him from running, bicycling, and swimming. He was initially skeptical.

I used massage to remove the blood stagnation¾improving circulation and reducing tension in stiff muscles. Then after locating the points needed for therapy, I pressed the acupoints used since ancient times to relieve pain. I also located and pressed acupoints that I discovered during my exam. After a course of treatments, the bad pain was gone and he resumed swimming. After working with me for six months, his problem was completely resolved. Three years later Don wrote about his recovery from chronic back pain with acupressure massage, “(It) completely controlled not only that problem, but chronic shoulder stiffness and pain.”

Though pain may be a mystery to many, it is no mystery why people seek massage therapy. Massage has many benefits, no risks, and is complementary to medical therapy. Massage clients report long-term benefits of more energy, greater strength, and flexibility.

The way you think about pain can hurt you. When in pain, imagine your body is talking or your life force is sending you a message, seeking a helping hand. Massage therapists erase pain by rubbing it out. Acupressure therapists relieve pain by applying pressure to acupoints. Remember, you do not have to suffer from pain.

Formula for Failure

Published in the California Journal of Oriental Medicine, Fall 2004
Non-steroidal anti-inflammatory drugs (NSAIDs) relieve pain most effectively the first time they are taken, however, when taken daily they lose their effectiveness. Increasing the dosage or changing to stronger pain pills may bring temporary relief, but soon even these strategies fail to be effective. In such cases even acupuncture fails to give lasting relief for this pain. Few sufferers realize that this formula for failure they are experiencing known as rebound pain, results from their use of NSAIDs (aspirin, ibuprofen, naproxen and acetaminophen). The cause of rebound pain will be explained in the following article.

In order to discuss rebound pain, a fundamental understanding of tissue repair is helpful. Western medicine identifies three healing stages for injuries great and small (note 1). When these three stages of healing proceed naturally, healing progresses quickly. However, when healing is disrupted, problems abound: specifically, poor circulation of blood and lymph, as well as chronic pain and its associated disability. During tissue repair, fresh blood brings nutrients and oxygen to provide material for healing and the lymph removes the byproducts of tissue repair. As pain becomes chronic, it is often accompanied by stiffness and reduced range of motion. The use of pain pills to relieve chronic pain often backfires. The resulting rebound pain causes or plays a role in several chronic pain syndromes such as fibromyalgia, chronic muscle pain syndrome, and chronic fatigue syndrome.

The Three Stages of Healing

The three stages of healing are:

  1. Inflammation
  2. Cell proliferation
  3. Remodeling

Scar tissue normally forms during the first two stages of healing.

1) During the initial inflammatory stage, which lasts three to five days, prostaglandins initiate multiple tasks: to stimulate the immune system, to buildup platelets around the lesion, and to attract white blood cells that protect against infections and clean up the damaged tissue. Specialized cells called fibroblasts produce disorganized fibrous (scar) tissue.

2) During the second stage, which lasts four to six weeks, cells proliferate to replace the damaged cells and scar tissue becomes organized. Physical activity eliminates unnecessary scar tissue that has inadvertently adhered to neighboring tissue.

3) During the remodeling stage, lasting about six months or more, the repaired tissue remodels itself. Interestingly forensic anthropologists and archeologists observe changes in bone structure, for example, to determine the types of work a person performed based on the fact that remodeling is an automatic process accompanying use. During the third stage of healing this process can restore damaged tissue so it is stronger than it was before the injury. If remodeling doesn’t occur, it leads to weakened tissue prone to reinjury.

Injuries are an opportunity to become stronger. When the three stages proceed normally, tissue becomes stronger and less prone to injury. This principle is used by performance athletes. Likewise, pain is rare if the damage heals quickly and thoroughly, without abnormal adhesions.

What Is Scar Tissue?

The fibrous connective tissue produced during the initial inflammatory stage serves to temporarily replace damaged tissue during the first stage of healing. Scar tissue lacks oil glands and elasticity. By contrast, healthy tissue is elastic and lubricated, which protects it against irritation. It is the nature of scar tissue to contract over time and become sensitive as pain nerves enter the aging scar tissue. (note 2) This sensitivity prolongs the period of inflammation and results in the formation of excessive scar tissue. Muscles become fibrous as a result of chronic inflammation. Scar tissue reduces and blocks the circulation of fresh blood, carrying nutrients and oxygen, and the flow of lymph, which carries away toxins. This vicious cycle of continued scar formation can thus increase pain, reduce circulation, and restrict movement.

As pain nerves penetrate scar tissue, it becomes hypersensitive to stimulation. This makes it easy to find during massage because the pain response indicates the scar tissue with its hypersensitive nerves. An acupuncturist can also feel the presence of recent and old scar tissue by feeling the resistance to the needle. Healthy tissue offers no resistance and feels like it is soft and lubricated.

Other Causes of Scar Tissue

From my clinical experience, there are many causes of fibrous, sclerotic tissue in the musculo-skeletal system. In-depth discussions with patients about the history of their pain have revealed treatments with trendy therapies such as icing, cortisone injections, and NSAIDs, all of which alter and inhibit healing by blocking prostaglandin production. Prostaglandins are produced during the first stage of healing to protect and repair the damaged tissue. They protect by delivering a pain message and by sensitizing the area or injury to keep from further injury. They initiate a host of repair activities that are required during the healing process.

Intentional scarring therapy (sclerotherapy) is sometimes used to treat chronic pain. This involves local injections, especially of the steroid anti-inflammatory cortisone; the more cortisone administered, the more scarring of subcutaneous tissue. Patients who have received cortisone shots often report more painful acupuncture-needle insertions at the injury site. Relief for them will also require more acupuncture treatments than if cortisone was not used. Cortisone injections have also been shown to dematerialize bone and cause soft tissue to become fragile.  (note 3)

One of the therapeutic actions of cortisone is tissue necrosis. Injections at the site of inflammation kills the inflamed tissue sending out pain signals.  My interviews with surgeons indicate scar tissue present at the site of cortisone injections. Basically, washing inflamed tissue with cortisone kills it, and it is replaced by scar tissue. At first this brings quick relief, but in about three months pain nerves enter the aging scar tissue as it shrinks. This vicious cycle spreads to surrounding tissue, resulting in reduced mobility and the return of more intense and intractable pain.

Unintentional scarring can also result from the application of cold to relieve pain. My interviews with patients having a history of athletic injuries often revealed a pattern of stiff and painful tissue in areas where icing was used to relieve pain after athletic events. The more often icing was used, the more resulting tissue stiffness was discovered and the more subsequent treatments with needle moxa were required to restore the circulation of blood and lymph.

Although no statistics are available, a survey of the history of medicine from around the world suggests that traditionally, though pain was an uncomfortable problem, chronic pain was rare. (note 4) Prior to the 20th century, the method of treating pain was dramatically different. In the past, chronic pain was treated with counterirritants (irritation applied to the surface of the body to counteract pain and disease), such as mustard and medicinal plasters. Since the discovery of aspirin and the increased use of anti-inflammatories, there has been an increased incidence of chronic pain. Chronic pain is reported to be most common in countries where anti-inflammatories are used extensively. In Third World countries where time-honored means of treating pain are employed, chronic pain is rare. (note 5)

Many recent studies have associated NSAIDs with chronic pain, especially degeneration of joint cartilage. (note 6) Basically the inhibiting effect of NSAIDs that applies to muscle healing also applies to cartilage repair. The use of anti-inflammatories heightens the incidence of chronic pain. Treating pain while disrupting the healing process results in a build up of painful scar tissue, which can also interfere with the functioning of muscles by scarring proprioceptors.

Proprioception & Tension Receptors

The simple act of walking upright is actually not so simple; it is still a challenge for robot designers. When our body’s ability to sense its position and orientation – known as proprioception – becomes impaired, our ability to move quickly and accurately degrades and our athletic performance suffers. One facet of proprioception is the product of our muscles’ tension receptors, dysfunction of which can also cause chronic pain. Knowing how to locate and heal tension receptors using massage and acupuncture can quickly and permanently reverse years of chronic pain where other attempts to heal brought only temporary relief.

If the muscles become scarred and fibrous, tension receptors in the muscle belly do not readily change shape with the muscle, resulting in delayed or absent responses. When this happens, the brain fails to register the degree of muscle contraction. Consequently, the brain’s signal to contract is increased, causing spasms and/or continuous muscle tension.

When a muscle is either tense or constantly tight it may have fibrous, stiff, and frozen tension receptors. Even when the patient believes they are relaxed, the muscle is tight. It is tight when they go to sleep and tight when they wake up. Deep-tissue massage and acupressure on the origin, insertion, or belly of the muscle can forcefully change the shape of the tension receptor and the muscle will relax temporarily, but constant tightness will return because the tension receptor has not changed. Massage and meditation will fail to relax this type of muscle. Stretching can temporarily reset the tension level, but tension will return. Therefore, the use of massage, acupuncture and moxibustion can correct the chronic tension that often accompanies chronic pain.

Rebound Pain

Rebound pain is paradoxically caused by NSAIDs. NSAIDs stop the first stage of healing by blocking the production of prostaglandins. Bradykinin is one type of prostaglandin that increases pain sensitivity by ten times and speeds healing by five times. (note 7) In other words NSAIDs inhibit healing and the subsequent stages of healing are thus compromised. Rebound pain begins after 4-8 days of continual NSAID usage and slowly increases until it becomes the major component of chronic pain. It is a type of withdrawal pain and may be diagnosed as fibromyalgia (FMS), fibrositis, chronic muscle pain syndrome, psychogenic rheumatism, tension myalgias, and chronic fatigue syndrome (CFS). It is my belief that FMS is fibrosis of the soft tissue often complicated by rebound pain.

Rebound pain probably develops because NSAIDs mask small pain signals that cause us to squirm and wiggle or adjust how we sit and stand. These adjustments to our posture stop tissue damage from the pressure applied to joints and muscles when we sit or stand still. When people stop using pain pills, they temporarily feel their body trying to heal this damage in their joints and muscles. Some patients tell me they cannot stop using the drugs they take because their pain is so bad, but when they do stop, they often have a remarkable reduction in their pain.

A Formula for Success

Acupuncture can initiate a healing process with puncture wounds where healing had been incomplete or interrupted by NSAIDs, cortizone or icing. It is interesting to note that regeneration, the ability to regrow limbs for example, which happens in lower life forms is absent in higher life forms with one exception, the healing of puncture wounds. Local treatments at sites of sensitivity called ahshi points stimulate or restimulate healing as described in the three stages of healing. Therefore, when a patient suffers from chronic pain which doesn’t respond to acupuncture treatments, ask them to reduce and eventually stop pain pills.

Explain to your patients how NSAIDs, cortizone or icing all interfere with healing, which impede the effectiveness of therapeutic approaches such as acupuncture, acupressure, and massage. Acupuncture, however, can be used as a complementary method to quickly end rebound pain when NSAIDs are discontinued. Ear acupuncture is commonly used in detox programs and can restore the body’s natural pain relievers, endorphins. Local treatment with needle moxa therapy on scarred fibrous tissue eliminates the cause of chronic pain. (See “Treating Chronic Pain with Meridian Dredging“ by Michael Turk in CJOM 14.2, Summer 2003)

Notes

1a) Wells, D. “Injury: Three Stages of Healing” in CJOM 14.1 winter 2003

1b) www.issaquahfamilychiropractic.com/sti.htm

1c) The Encyclopedia Britannica CDROM refers to four stages of healing. The first stage is divided in two: one lasts for one day and the second part the typical 3-5 days.

2a) Singh, Vijay, MD “Pathophysiology of the Disc” in Interventional Pain Management

2b) Encyclopedia Britannica CDROM

3) Diwan, P., “Influence of Zinc Sulfate on Steroid Depressed Wound Healing,” Kulkarni, D. InsJPharmac., 11(4), 257-264 (1979)

4) The following statistics indicate the trend toward high rates of chronic pain in the USA

1973   “Although accurate statistics are not available, data from a variety of sources suggest that chronic pain states cost the American people between 10 and 25 billions of dollars annually” (The Puzzle of Pain by Ronald Melzack 1973).

1973    The first world conference on pain estimated 10 million Americans suffer from chronic pain. (The Conquest of Pain by Samuel Mines 1973).

1980    40 million Americans suffer; it is the third leading cause of disability (Pain Control, the Bethesda Program by Bruce Smoller, M.D. & Brian Schulman, M.D. 1980).

1983            “Authorities figures prepared for the year 1983 estimated that 90 million Americans suffered from chronic pain, that 60 million Americans were either partially or totally disabled… (The Culture of Pain by David Morris 1991).

5) Dr. Brand lived and worked in India for many years. He reports that chronic pain was rare p185-190. Brand, P. The Gift of Pain 1997 Zondervan

“Frantic attempts to silence pain signals may actually have a paradoxical effect.”

“My esteem for pain runs so counter to the common attitude that I sometimes feel like a subversive, especially in modern Western countries.  On my travels I have observed an ironic law of reversal at work: as a society gains the ability to limit suffering, it loses the ability to cope with what suffering remains.  (It is the philosophers, theologians, and writers of the affluent West, not the Third World, who worry obsessively about ‘the problem of pain,’ and point an accusing finger at God.)”

6a) Werbach, M. Nutritional Influences on Illness. Third Line Press, California, (468, 469, 590), 1987

6b) see bibliography at www.unitedmedicalnetwork.com/umnrationale_joint.asp

6c) Lopes Vaz AL. Double-blind, clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulphate in the management of osteoarthrosis of the knee in out-patients. Curr Med Res Opin 1982;8:145-9.

6d) Dingle JT., Cartilage maintenance in osteoarthritis: interaction of cytokines, NSAID and prostaglandins in articular cartilage damage and repair. J Rheumatol Suppl. 1991 Mar;28:30-7.

7) From a private communication with Dr. Bruce Pomerantz who has been studying the role of Bradykinin in healing.

8) Turk, M. “Treating Chronic Pain with Meridian Dredging” in CJOM 14.2, Summer 2003

Further Reading

1) Chang, Yeung, Chung Through-and-through & Collective Loci Acupuncture 1976, Medical Interflow Publishing House

2) Chen Xingseng “Comparative Study on Acupuncture Needling Methods for Sciatica: Routine Needling Vs. Point-to-point and Deep Puncture” in American Journal of Acupuncture Vol. 26 No.1 1998.

3) Lowenkopf, Anne N. Osteopuncture 1976 Medical Arts Press

4) Brand, Paul, The Gift of Pain 1997 Zondervan

5) Turk, Michael Pain’s Healing Secret 2001 Chico, CA: Acu Press

Pain’s Healing Secret

 Sign Up for Newsletter on Natural Healing