Health Matters

Acupuncture: Relieving Pain Naturally Developed in China beginning some four thousands years ago, acupuncture has been successfully used in providing effective, safe and comfortable treatment for a variety of conditions with little-to-no side effects. Moreover, it has been recognized by the World Health Organization of the United Nations for its therapeutic benefits. One such treatment is for neck and shoulder tension, a prevalent condition in our society with office work and computer use. Signs and symptoms include discomfort with turning one’s head and neck from side to side and trying to touch the ear to the shoulder. Looking at oneself in the mirror, one may notice that one’s shoulders are slowly creeping up and the head is starting to project forward. For those who use laptops, the discomfort can be even worse. As the keyboard is smaller, the shoulders move closer together. With the screen being low, either the chair must be lowered to put the monitor at the right height causing the shoulders to rise and/or keyboard must be kept low causing the head to tilt to see the screen. Sometimes the constant sitting can lead to low back pain which may be temporarily alleviated by slouching, however, once again at the expense of the neck and shoulders. For instance, as the chest drops closer to the seat, the shoulders must be raised yet further. To compensate for the head dropping forward, the muscles in the back and side of the neck which help to extend the head may work overtime and cause compression of the lower cervical vertebral joints. With compression near the diaphragm because of the organs pushing upwards, the muscles in the front of the neck which attach to the upper ribs and the front of the shoulder blade which similarly attach may also tighten to support upper-chest breathing. Over time the tension which began in the upper body may spread to the pelvis and knee. For example, there is a muscle that helps to flex the low back. It actually tightens when it is not used as with sitting in chairs for long periods of time. Additionally, if the seat of the chair is tilted upwards at the front, it may press into the hamstrings causing reduced blood-flow and them to tighten. In fact, when the body is in motion as with walking while the head is projected forward, the hamstrings and lumbar muscles naturally tighten to anchor the pelvis and ribcage. Finally, if certain muscles in the neck and shoulders become taxed, they may develop trigger points which can cause migraine-like headaches. Whether it is muscle tightness or referred pain, acupuncture can be effective in alleviating them and improving range of motion. At The Kingsway Therapeutic Centre this is done by using thin, single-use, disposable needles which can be inserted with little-to-no discomfort or with a low-intensity laser. In the case of needles, they arrive individually wrapped and sterilized. Single-use, rubber finger cots are used while needles are inserted prior to which the area of the skin is disinfected with alcohol swabs. The face cradles of the treatment tables are covered with protectors that are discarded thereafter. Clean sheets are used and the surface area of the table is sanitized with each treatment. * * * * * * * *

Fibromyalgia: Piecing the Puzzle of Pain Affecting an estimated 700 000 Canadians (mostly women), fibromyalgia (FM) is a debilitating condition which undermines one’s quality of life. Unrestful or non-restorative sleep, morning stiffness, fatigue and, of course, pain (generalized and site-specific) – these are the four interrelated, cardinal symptoms FM sufferers endure on an ongoing basis. As with the experience of pain in general, that of FM is very complex, reflecting a person’s sensory experience and evaluation of as well as response to its various qualities and intensities, each of which may vary over time. Nevertheless, it is its overall unrelenting nature, exacerbated by flare-ups, which take their toll on people’s well-being. At least three questions arise from that. What is the source of the pain? Why is it recurring? And how it can be alleviated? The first two will be will be addressed over two articles; the latter,the topic of another. Our bodies communicate information about touch, temperature, sense of movement, injury…and our reactions to our senses via the nervous system. One may think of it as a sort of unending, relay race in which subsequent runners are waiting on the other sides of gates which can be locked or remain open. In this analogy the runners represent the neurons – the basic wiring – while the dowels are the neurotransmitters which help pass on a message. The gates more than less represent receptors for neurotransmitters on subsequent neurons. Key to understanding FM pain is appreciating the concept of central sensitization. Clinically that translates in to experiencing pain in response to non-painful stimuli and/or greater pain than normally experienced, frequently both in relation to pressure. While the initiator of the process of sensitization remains a mystery (though typically seemingly involving some sort of trauma such as a motor vehicle accident, athletic injury or repetitive strain), the sustaining mechanisms are being exposed. One factor involves two specific receptors on certain spinal-cord neurons: NK1 and NMDA receptors. In our example of the relay race, the second is like the gate and the first is the key that opens it. The dowels are two neurotransmitters: substance P (SP) and glutamate, respectively. Both of those messengers are usually found in the same neurons which communicate slow pain; however, under certain circumstances, neurons that transmit information about pressure may also synthesise and release them. With FM, there has been found a higher concentration of SP in fluid which bathes the spinal cord (CSF). By removing a block on the NMDA receptor, it may help to potentiate it, allowing it to respond to glutamate more easily. That may translate into lowered pain thresholds. But what of pressure experienced as pain? That may relate to another substance, nerve growth factor (NGF), which has also been found in higher concentrations in that fluid which bathes the spinal cord. NGF has been associated with changing the neurotransmitters (the messengers) which certain neurons (A-ß) make. Clinical studies have found that this occurs typically in association with inflammation; however, while FM is not really considered to be an inflammatory condition, it may be possible for people to experience a similar pain. Nevertheless, a recent study had found that with FM around some nerves just beneath the skin, there are collagen cuffs which may result in neurogenic inflammation — i.e., inflammation of the nerve. Lastly, one possible but contentious source of pain is muscle tissue for many reasons. While the specific locations of tender points vary from person to person, the American College of Rheumatology in 1991 published a finding that they were frequently found in 18 ‘points.’ From a biomechanical viewpoint, they would coincide with those one would expect from a forward-head-bending posture as noted in the above article. MRS studies have generally found indications of a “metabolic crisis” which may help to explain ongoing muscle tightness (besides overuse), something which would be exacerbated by non-REM sleep. Other studies have found elevated levels of phosphodiesters in the blood, consistent with microtrauma to muscles; however, since growth hormone (which is principally secreted during REM sleep) is needed in the process of muscle regeneration , muscle may take longer to heal. Lastly, disregulation of pain inhibition from the brainstem may lead to a greater sense of muscle pain as more stimuli will reach higher centres where pain is consciously processed.

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