By Joseph Sliwkowski, MD, Chief Medical Officer
The cause of the majority of chronic pain remains elusive. Most of the diagnoses are descriptive, e.g. chronic low back pain, fibromyalgia, myofascial pain syndrome and chronic regional pain syndrome. Diagnostic tests are rarely helpful. X-rays and MRI findings of the lumbar spine correlate poorly with who goes on to develop chronic back pain, or even who currently has chronic back pain.
The “root cause” of chronic pain should be found somewhere within the organization of the nervous system: central and peripheral (somatic & autonomic).
I think it makes sense to take a holistic approach to find the mechanism of chronic pain. What if the problem was at the interplay of all the nervous system components?
Connection 1: Autonomic System directly activates Somatic System. The stress response, aka “fight or flight response”, is expressed through our voluntary musculature. The purpose of the stress response is to protect the organism from danger by activating the somatic nervous system. If the stress stimulus is severe or repetitive enough, due to an individual’s unique vulnerability, this activation can remain in the “on” position.
Connection 2: The brain has the “software” to contract or relax any of the 640+ voluntary muscles in the body, allowing us to be flexible and mobile. A maladaptive stress-response can interfere with this capacity.
Connection 3: The Sensory Nerves communicate to the Brain when danger is passed. Skeletal muscles have pressure-sensitive receptors (Golgi tendons and spindle cells) that are part of this feedback loop. Research shows that there is a pressure threshold where these receptors start transmitting pain signals back to the brain.