About Massage for Chronic Pain

Why does it hurt?

For the discussion below, the source for pain excludes disease processes and illnesses. Instead, we look at pain caused by dysfunction in the affected muscles and soft tissue which can be eased or erased with manual therapy that includes muscle energy techniques (MET) and myofascial release.

Temporomandibular Joint (TMJ) Dysfunction is caused by excessive sustained contractions of the muscles that open and close the mouth. TMJ can be initiated by poor posture, stress, whiplash or other physical trauma, grinding of the teeth or maloccluded teeth. Pain in the jaw often radiates to the head, face, neck and shoulders. Myofascial release and massage with MET can reduce pain and muscle spasm.

The most common types of headaches are migraines, tension headaches and cluster headaches. Of these, tension headaches are the most common. With tension headaches, physical, emotional and psychological stresses can cause the muscles in the head, jaw and neck to contract painfully, pinching nerves and bringing on headaches. Again, massage with MET relieves pain, increases circulation in affected muscles and relaxes the whole body.

Many factors contribute to neck and shoulder pain. These include poor posture, injury or trauma, psychological or emotional stress, inactivity, degeneration of the cervical vertebrae, and aging. The neck or shoulder or both may feel tight and stiff or achy or experience sharp pain. The pain can range in severity from nagging nuisance to severe and can either stay localized or radiate to other areas of the body.

So many people experience back pain, especially low back pain whose cause is controversial. We do know, however, that most low back pain results from lack of proper functioning of the spine and soft tissues rather than from disease. Many factors contribute to back pain. These include sedentary lifestyle habits such as extensive periods of sitting or driving and lack of exercise. Other factors include poor posture, obesity, fatigue, emotional stresses, joint dysfunction and muscle imbalances. Low back pain can refer pain into the legs.

And then there are stresses. Depression, anxiety, resentment, fear. These emotional stresses create areas of prolonged muscle contraction with decreased blood flow which leads to muscle fatigue and changes in muscle movement and pain.

The importance of good posture cannot be exaggerated. Poor posture creates a forward head position that pulls strongly on the muscles at the base of the neck. Over time the shoulders become rounded and both neck and shoulders become stiff and lose the full range of motion. Continued sustained contractions in the mid back can lock in the "dowager's hump," dysfunction and instability in the low back.

Sciatica often occurs when one or more contracted muscles of the gluteal region tighten over or around the sciatic nerve. Symptoms include diffuse pain in the buttock with pain, numbing or tingling along the back of the thigh.

A fibromyalgia diagnosis traditionally has been difficult to come by. In 2010 new criteria for a positive diagnosis include an analysis of widespread pain over 19 areas of the body and an assessment of the severity of that pain. Sufferers may experience chronic fatigue, difficulty concentrating and physical symptoms such as tingling or numbness, dizziness, headaches or IBS.

Chronic Headache Pain

Chronic headache pain is one of the most common pain complaints, and covers a wide range of conditions and causes, from occasional, benign tension headaches to debilitating and chronic migraines. In addition to true headaches, neck or upper back pain may also sometimes be interpreted as a headache.

There are several different ways to classify headaches, but let's start by dividing them up into primary and secondary headaches. In primary headaches, the headache itself is the main problem. In secondary headaches, the headache is just one symptom of an underlying problem that can range from caffeine withdrawal to simusitis to high blood pressure or a stroke. Both primary and secondary headaches have the potential to result in chronic pain, so we'll discuss both types here.

It is a myth that chronic headache pain is a part of life and you should just suffer with it. It is still frustrating for me to see how often a client comes in and tells me they have been having headache pain for years without relief. It's true that everyone gets headaches once in a while; however chronic, painful headaches are not normal or acceptable. Once you have an idea of what might be causing your headaches, there are a variety of treatment options available,

Primary Headaches

The most common type of primary headaches are tension headaches, migraine headaches, and cluster headaches. It is very unlikely that these types of headaches are actually dangerous; however, without accurate diagnosis it's hard to be sure that there is not an underlying medical cause that might need treatment.
Tension Headaches usually begin in the back of the head or the neck. The most common description of the pain is that it feels like a or a feeling of pressure. Sometimes you may feel like there is a band pressing across your forehead or eyebrows.
Migraine Headaches are probably the type of headache most likely to be thought of as chronic, and is also among the most debilitating. People with migraines (including me) describe them with words like pounding or throbbing. Migraine headaches are often limited to one side of the head, but not always. Migraines are often made worse by sounds, light and physical activity. Click here for an in-depth discussion of chronic pain related to migraines, and ways to prevent or control migraines.

Cluster Headache Pain Generally comes on quickly and without the warning aura frequently found with migraines. The pain reaches its peak within 15 minutes, and is often described as deeply intense, explosive and nonfluctuating. A minority of people describe an additional sensation of a stabbing sensation in the area just behind the eyebrows. The pain nearly always is limited to one side of the head. Follow this link for a full discussion of cluster headache pain and alternatives for treatment.

There may be cases in which what appear to be migraine headaches are actually symptoms of problems in jaw alignment, specifically the temporomandibular joint (TMJ).

Secondary Headaches

While primary headaches are generally presumed to not be dangerous, secondary headaches by definition have underlying causes that can be very serious. These causes can include, but are not limited to:

High Blood Pressure - particulary when it comes on suddenly.

Infections - such as meningitis caused by bacterial infection.

Tumors - in the brain, including tumors that have spread from another part of the body.

Hypothyroidism - in which the thyroid gland does not produce sufficient thyroid hormone.

Strokes - due to either a ruptured vessel in the brain or a blood clot in the brain.

Chronic Sinus Infections.

Overuse of Over-The-Counter Pain Relievers.

You should always see a doctor if you have any concerns that your headaches may have an serious underlying cause that needs treatment.

Alternative Headache Treatments

As with any type of chronic pain, the emphasis is on management of pain, rather than finding an ultimate cure, and there are a number of treatment alternatives that can help. Combine these treatments with a wellness mindset and lifestyle, and most people can significantly reduce the intensity and frequency of their chronic headache pain.

Caffeine and Headaches

Caffeine is an ingredient in a number of pain medications, but there continues to be a little controversy about its role in chronic headache pain. View a summary of some recent research.

Chronic Arthritis Pain

While many people think of bad backs when they think of chronic pain, chronic arthritis pain is probably the most common cause of pain, and in fact is probably the most common chronic disease for people past the age of 40.
We think of arthritis as something that happens in our "senior years," but over half of people with arthritis are under age 65. You may think of arthritis as a disease of joints in the legs or hands, but many people develop arthritis in the lumbar and cervical spine, resulting in chronic back or neck pain.

Types of Arthritis

Since you've found your way to this blog, you probably already have quite a bit of information on what type of arthritis you have. For those who would like more information, take a look at these pages on osteoarthritis and rheumatoid arthritis pain.
Arthritis Pain Management Options

pain management Since chronic arthritis pain does not have a cure, it become important for you to have a good management system in place. Work with your doctor to find the best balance of traditional and alternative therapies for you.

For that to work, you need a doctor with at least two characteristics:

1) Listens well enough to tailor a plan specific to your needs, and to get feedback about how your current plan is working, and

2) Has an open mind to the role of alternative pain management techniques.

If you've got that, then your way ahead of the game.

Chronic Knee Pain and Arthritis

Your knees are joints that are very prone to the development of osteoarthritis. Read more about the reasons for this, and some recent research on new treatments, at the Arthritis Knee Pain page.

Conventional Arthritis Pain Management

Your doctor will go over the pain medicine options for managing chronic arthritis pain. That should include information on over-the-counter medications and prescription medicines (both narcotic and non-narcotic).
I believe that almost everyone can benefit from some or all of the alternative pain management techniques available for arthritis. Consider alternative techniques if:

*You prefer holistic treatment to medical treatment when possible,

*You are concerned about medication side effects,

*You can't afford prescription medications, or

*You are not getting sufficient relief of your pain.

Alternative Arthritis Pain Management

There are a number of alternative methods for managing arthritis pain that have some demonstrated effectiveness. These include:

*Changes in diet and use of supplements for arthritis pain,

*Exercise programs tailored to the needs of people with arthritis,

*Acupuncture,

*Relaxation training, hypnosis and/or imagery, and

*Psychosocial support

Chronic Pain in Women

Pain in Women
A Unique Perspective

Pain in women is not entirely the same as it is in men; no surprise there. If you are a woman with chronic pain, you also won't be surprised when I tell you that until very recently there has been little or no attempt to understand how women's pain might differ from men's. This area of research is expanding, but there is still a lot to be learned about how to address women's specific pain needs. Let's take a look at what some of the early research is showing.

The Role of Hormones

Research is beginning to show that women experience pain in different ways, and for different reasons, than men (and no, I'm not referring to menstrual pain). One radical difference being researched has to do with the role of hormones on pain perception. Estrogen and testosterone both affect the central nervous system, which is critical in transmitting and receiving pain sensations. Some researchers suggest that this is why women have a much higher incidence of irritable bowel syndrome, osteoarthritis, and headaches.
Hormones may also play a role in other type of pain in women, including inflammatory conditions such as sciatica, endometriosis, and other types of pelvic pain.

Role of the Immune System

yoga, immune system, relaxation
There also appear to be significant differences between the immune systems of men and women. Women tend to have stronger and more alert immune systems. Because of this strength, women's immune systems are more likely to attack themselves, possibly causing those diseases thought to be related to over-reactive immune systems - chronic fatigue syndrome, fibromyalgia, various kinds of pelvic pain, and irritable bowel, all of which come with chronic pain.
Pregnancy and Back Pain

Low back pain is a frequent problem during pregnancy. Our page on Back Pain and Pregnancy give information on how to prevent and treat back pain during pregnancy, and signs that you need to see your doctor.
Fibromyalgia and Chronic Fatigue

Two of these immune system related conditions that have recently received a lot of attention include fibromyalgia and chronic fatigue syndrome (CFS). Pain in women is often associated with these two conditions, which occur in women six times more often than men.
After many years of being dismissed, ignored and misunderstood, there has finally been an increase in attention paid to these diagnoses. There has been more attention from the Center for Disease Control to letting women know about these diseases, and there has likely been more research into finding treatments. Follow this link to find out more about fibromyalgia treatment.

Women and Headaches

Twice as many women have migraines compared to men; the same holds true for other types of headaches. This link will take you to our page on chronic headache pain.
"Female Pain" and Breaking Down Stereotypes

Women for years have not been taken seriously when they complain about chronic pain. With a wife and two daughters, I've seen it happen too often. There is an unfair bias that women maybe "too emotional" or "histrionic," and this is used as a reason to avoid or minimize the seriousness of pain. This is especially true in the case of pelvic pain, which is often very hard to pinpoint and describe. Too often women in pain have discovered that not enough time is taken to sort through the alternatives and come up with a good diagnosis and plan of care.
While more practitioners are becoming aware of concerns and conditions related to pain in women, women still need to be very vigilant about seeking our doctors who have current training and are open to considering all options. It is important to organize your questions and concerns, make a list, and advocate for yourself. Ask you doctor what tests can be done to determine the source of the problem. As long as you are in pain, don't take "I don't know" or "no" as a final answer. There are more tips on working with your doctor on our page on Pain Education.

Medical Treatment for Women's Pain

You may use some combination of over-the-counter pain and prescription medications. Medical treatment should also be combined with alternative treatments to minimize risk of side effects, and to provide balanced overall wellness.
In addition to medication, other medical interventions include injections, including fairly recent use of Botox injections for pain.

Alternative Treatments - Women's Pain

If you are a woman with chronic pain, you can benefit from many of the same alternative treatments I describe throughout this site. Pain in women can specifically be helped by use of:
*Acupuncture

*Massage Therapy

*Progressive Exercise

*Relaxation Training

*Yoga

*Cognitive Therapy for Associated Depression

In addition to those options, here is some information about using TENS (transcutaneous electrical nerve stimulation) to manage pain.

Fibromyalgia Chest Pain, Chronic Chest Pain, Armpit Pain, Underarm Pain

This page is about fibromyalgia chest pain and chronic chest pain. If you have sudden, acute chest pain, please seek emergency medical help to rule out a heart attack.

Your doctor will need to make a diagnosis to determine the best treatment for you, depending upon whether your have costochondritis, fibromyalgia chest pain or another condition.

One of my most prominent areas of chronic chest pain is a deep aching on both sides of the upper chest near the armpits. Yes, armpit pain or underarm pain

I haven't found much helpful info on the Web about armpit or under-arm pain - people like to laugh about it or say "Arm pit pain? I never heard of that... there's nothing there."

But lo and behold, I have a deep aching pain between the ribs near the under arms. One thing that helps me is a hot shower.

Another thing that helps me is the self-pressure technique I will explain here... a hands-on treatment you can do for yourself if you have chest muscle pain, or pectoral pain.

As always consult your doctor or physical therapist if you have any questions at all whether this would be beneficial for your condition.

If you have muscles aching between the ribs, along the pectoral or pectoral minor muscles, sometimes you can get some relief by manually applying pressure between the ribs. Basically, pushing deeply with your thumb on the muscle fibers as they run along the sternum towards the armpit.

Here's how I do the self-pressure massage, on ribs from sternum to under arms:

Lie on the side that is painful, with head and neck properly supported by pillows.
Start with a point near the sternum, aka breastbone. Push to apply pressure with the thumb of the hand that is nearest to the floor.
Using the hand of the arm that is nearest the floor allows you to roll towards the floor with your torso, and use the weight of the body to dig in to the muscle easier.
Use the other hand to stabilize the lower wrist if the lower hand is weak.
Hold this "dug-in thumb"  position for about five seconds then release, then rest for about 15 seconds.
Lather, rinse, repeat!
Move up to a higher rib or down to a lower rib, and start the process again. Begin near the sternum, working your way towards the armpit or side.Make sure you rest for longer periods then you push, in order to let the blood circulation return fully both to your hands and your pectoral muscles.

Observe your neck and jaw to make sure you do not tighten them as you work to loosen other muscles! Experiment to see if inhaling or exhaling at certain points allows you to dig in easier, or to relax the muscles more.