400- Central Sensitization in Chronic Regional Pain Syndrome Patients

Welcome to the Evidence Based Chiropractor, where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now, here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today's episode is episode number 400 of this podcast. We have some great research to highlight. We are also going to talk about some special things. Considering this is the 400th episode, that means this podcast has been going on for eight years. Believe it or not, I certainly can't believe it. And I want to thank you for tuning in. Whether this is the 400th episode you've listened to or whether it's the first episode you listen to. Thank you so much for tuning into this podcast. I I'm gonna be giving away some special prizes on today's episode. Some swag boxes, some really cool stuff. We're also gonna talk research. Welcome to the 400th episode of the Evidence Based Chiropractor podcast. Before we get started, let me say a few words about Patient pilot by the smart chiropractor. If you would like to generate more reactivations in your practice automatically, head on over to thesmartchiropractor.com and schedule a demo with our team. If you have an email list of more than 300 people that you're not communicating with consistently, you're missing out on opportunity that is just literally slipping through your fingers. We can put that email list into action for you to start generating weekly reactivations. Schedule a demo over@the smart chiropractor.com today. Today's research that we're talking about is a brand new study in pain medicine and it is all around neuropathic pain. Specifically this one is titled Central Sensitization in Chronic Regional Pain Syndrome Patients with Widespread Pain. It is a cross sectional study and there's a lot of great clinical pearls as well. As I'm going to do some extrapolation to what we know of how chiropractic might be able to make a serious impact with these individuals. But before we dive into that, I want to spend a few minutes considering this is our 400th episode and put out something that that is important and what is important it is. I'm going to be at FCA the National next weekend in Orlando. Now what is important about that? If you come up and say, hi, I'm going to have a whole bunch of evidence based chiropractic swag with me so please come find me next Friday afternoon or this coming Friday afternoon, I should say in the expo hall. I will be kicking around. If you come up and say hi, I will be certain to get to give you your selection of evidence based chiropractor swag. I would love to say hi. I'd love to meet the people who are listening to this podcast. That means you additionally have another giveaway. We're gonna stack some giveaways here. If you leave a review on Apple Podcast for this podcast, I'm gonna come in in a week's time and call out a few names of people who leave reviews over the course of the next seven days. Scroll on down, click the number of stars, leave a review. I'm going to call out a few names on the podcast next week. Those names I'm going to ship and deliver swag boxes and believe me, they are worth the couple minutes that it would take to scroll on down and leave feedback. So if this is your first episode listening to, if it's your 50th, if it's your 400th, please leave us some feedback. This is a great way for me to know you're out there and it's a great way if you take some action I am willing to give back in spades. Now with some really great swag that we will ship your way. I'll call out those names next week. So as soon as you finish this episode, scroll on down, leave some stars, leave a feedback. So type a sentence or two and I will see your name. I'm gonna call out a few of those names next week to deliver some awesome boxes too. With all that being said, let's dive into some research on today's episode. Again, I'm gonna drop the link down to this paper in the show notes so you can check it out yourself. But it is titled Central Sensitization in Chronic Regional Pain Syndrome Patients with Widespread Pain and this is a cross sectional study. So CRPS is complex regional pain syndrome and it's characterized by pain that is persistent and disproportionate to what caused it, the initiating event. So somebody falls down, gets hurt. Normally you'd expect that is a simplistic explanation. You'd expect that to heal and the person to feel better. But when the pain becomes far greater than the incident that caused the pain, and it hangs around longer than the normal healing time, that starts to delve into the territory of crps. Now these patients, very commonly you'll find hyperalgesia. Of course they are really sensitized to pain. And that generally results with mechanical stimulus, which is not necessarily. Here's the interesting part. It's not necessarily restricted to the affected area. So this could go like full body pain. Even though the initial incident happened in the low back, it happened in the wrist, and all of a sudden everything hurts. That is very indicative of this. So hypersensitivities beyond the affected area via central sensitization. As I say central sensitization, I think you can already see where we're gonna go with chiropractic. Now, this study did not get into the chiropractic application, but we're going to, based upon what we learn today. So what is central sensitization? It is defined very clearly and cleanly as, quote, increased responsiveness of nociceptive neurons in the central nervous system to the normal or subthreshold afferent input. So that means nociceptive pain neurons are firing off like crazy, and it's increased their response. So it doesn't take much stimulus to get a disproportionate response. That is basically what that means. And for a clinical characteristic of sensitization, you know, it ties right in with chronic regional pain syndrome because it spreads beyond the pain, is beyond the expected anatomical region. And this is something that I know all of us see in practice all of the time, to varying degrees. And the question really becomes, as we dive into this data, how can this be applied to what we're doing and do we make an impact on it? Are we specifically making an impact locally, or do we have the opportunity to extend beyond? And probably, I'm gonna drop some hints here, we're gonna extend beyond, but we'll talk about that as we dive in. So one of the key components here to keep in mind, tying into some previous podcast episodes, is psychological factors can play a big role. They can modulate pain intensity, they can alter the neuronal circuits, and this ties into the corticolimbic system. And this is an important component, psychological factors. Anytime I'm gonna see the word chronic in pain, 9 times out of 10, 99 times out of 100, there is a psychological component. Now, is that psychological component a majority of the challenge, a contributing factor? Correlative or causative? It depends is the answer to that. But it is a factor in some capacity nearly every time we're gonna see chronic pain pain. So in this study, they hypothesized two things. One, widespread pain hypersensitivities and increased temporal summation of pain, as well as enhanced psychological distress in chronic regional pain patients. That was what they hypothesized and much of that came true as we'll talk about. So they found importantly that chronic regional pain syndrome patients with high spatial pain extent, meaning more than 5% of the total body surface of their total surface of their body had pain. Those individuals showed more pronounced temporal summation of pain in the affected area compared to patients with a low spatial pain extent, meaning less than 5% of their total body surface had pain. So let's recap that briefly here. If more than 5% of your body had pain, chances are you had more pronounced temporal summation of pain in the initial area. If you had less widespread pain, chances are you had less temporal summation of pain in the initially affected area. That's what that means. So this study basically found that there was. They've had additional evidence that central sensitization contributes to the pathophysiology of chronic regional pain syndrome patients by mechanical hyperalgesia in remote pain free body regions and increased temporal summation of pain. They also found that with chronic regional pain patients there was an extended pain pattern that showed more pronounced temporal summation of pain in the affected area contributed to wider distribution of pain throughout the body. And this central sensitization is at the heart of it because it is proposed to be basically the primary pathophysiological mechanism in chronic regional pain patients. So that is a big deal. And they also found that reduced pressure pain thresholds in the control area supports previous studies and indicates that a general disturbance in central pain processing might be due to hyper excitable neurons in the central nervous system. Now, where are we going with this? Well, if you tie back to many previous studies we've highlighted on this podcast, may we be able to influence and impact that sensitization with what we do with chiropractic? The answer is yes. May we be able to modulate some of that? The answer is yes, especially when I see pressure pain thresholds. I love seeing that and I love seeing hyperexcitability in the central nervous system. Not because people are dealing with those issues, but because we as chiropractors can make a significant impact in our ability to influence and modulate the function. And through that we can see dramatic changes in pain. So widespread pain hypersensitivity could be induced, they say, through glial activation when we talk about how it impacts the central nervous system as well as cerebral reorganization due to this continuous activation of nociceptive fibers. So when we see pressure pain thresholds lowered, that means less stimulus to cause pain. That also becomes a cascading aspect of central sensitization where we're just ready to fire off. Those neurons are like, man, anything happens, I'm on guard, I'm ready to fire off. We love to see a lot of buffer there where you can tolerate a lot before. Ding, ding, ding, that threshold is hit in pain. And when central sensitization and lower thresholds happen, that means less stimulus is needed. That means there can ultimately be, over time, cerebral reorganization impacts to our brain. And that is really important because you think back a few episodes. We talked about how we can, through chiropractic adjustment, make impacts to biomarkers in the brain. So it doesn't mean it works 100% of the time. It doesn't mean one adjustment's gonna take care of it. But it means we can impact and influence without the necessity for medication with what we do. That is a fantastic option for people that are dealing with chronic regional pain syndrome. And that is what gets really exciting about this study in my world. Now. They also found that pain intensity correlated with psychological factors such as depression, anxiety, catastrophizing this pain. And that is an important thing to keep in mind because as we discussed and have discussed and continue to discuss, the psychological factors involved with chronic pain is a very, very real thing. We look at the opioid epidemic. It is a chronic pain epidemic. We look at the chronic pain epidemic and it is so intertwined with psychological factors. There's just no way to really separate these two things because they are so intertwined and, and medication makes these challenges go off the rails. But when people can either decrease, potentially avoid, or get off of these medications by doing movement based healthcare with what we provide as chiropractors, there is no higher calling, no better thing that we can do. Especially when we look at this. I'll just get real. The opioid Crisis is still 130 deaths every single day and millions upon millions of lives affected. People coming into your practice have the opioid challenges, quite frankly, whether you know it or you're asking those questions so you can get a really great understanding of what's going on with them. But if you're not asking the question or sometimes a patient is embarrassed to discuss it, I can assure you every single day in practice you are seeing patients, some amount of patients that have challenges with opioids, because we just see this so widespread. So the conclusion to this study was that chronic regional pain patients showed widespread pain hypersensitivity and decreased pressure pain thresholds in the controlled area and increased temporal summation of pain in the affected area and more importantly, patients with high spatial pain showed increased temporal summation of pain and body perception disturbances compared with patients with low spatial pain extent. So what does this mean? There's a couple factors here. I'll kind of recap what we discussed and how you can implement it in your practice. In my opinion, number one, anytime we see pressure pain thresholds changed, that is a great opportunity for us to make an impact with chiropractic care. Anytime we see cerebral reorganization, which only takes place over time, and it really is a byproduct, in my opinion, of the sensitization events and the chronicity of the pain, when we can start to peel back that onion, that can make serious impacts in people's ability to live a productive life and ultimately just get back on the road to doing the things that they wanna do. The third component to it here is we see that the greater extent of the pain body surface coverage, the more increase in temporal summation of pain. This is again an opportunity for us to affect not only the region that we are adjusting, but the peripheral nervous system, the central nervous system, the brain, and how the brain processes pain, how that can be influenced and impacted by a chiropractic adjustment. We have hit the tip of the iceberg, but I think there is a lot more that we will continue to learn and continue to get excited. So those were the big messages on today's episode. Before we wrap up, if you are looking to add on an associate, a chiropractic assistant, or a virtual chiropractic assistant over the coming months, now is the time to take action to avoid the feeding frenzy of the fourth quarter. Most chiropractors have their most productive and revenue generating months in the fourth quarter. It's now time to prepare. If you are looking to add on one of those people, you need to add on the right person. That is how you accelerate your progress. Now is the time to do so. And if you would like to make that process as easy as possible and generate the most revenue on the back end as possible, you're going to want to do it right the first time. Hit up Cairo Matchmakers, schedule a complimentary call with the recruiter and see how we can make the process easier, that is. Kairomatchmakers.com Again Chiromatchmakers.com and as I wrap up, if you are going to be at the national by FCA this coming Friday, keep an eye out for me in the Expo Hall. Come say hi, pick up some swag and please leave a rating or review review over the next seven days. I'll call out a few names on next week's podcast where I will send some great swag boxes. Thank you so much. After 400 episodes, I am more excited to do this for the next 400 than I probably was the first 400 to be honest with you. So thank you so much for tuning in and paying attention. It means the world to me. And thank you. Thank you for being a chiropractor. Thank you for tuning in. Have a fantastic week in practice and I will talk to you soon.

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