Most pain is related to injury or tissue damage and the treatment is relatively straightforward in theory: the tissue at fault is searched for and investigated, a cause is found and the treatment is aimed at improving the underlying abnormality. This is the medical model of disease and injury and it works exceptionally well, diagnosing our fractured leg, pneumonia, arthritic joint or heart attack and then treating it so the problem is solved. The difficulty starts with the many pain conditions which dont fit into this model and which are not well diagnosed or treated by medical doctors.

Normal tissue injury pain occurs when the injured area transmits a volley of pain impulses up towards the spinal cord nerves in the back, which take the signals and carry them on towards the brain. The volleys of incoming pain excite the spinal cord nerves strongly and they react by amplifying their reactions to them, giving us higher levels of pain. We then protect the area, it settles and heals and the system settles down to its normal state. However, some conditions do not fit this picture, do not have a precipitating injury or event and do not settle down with time, fitting poorly into the normal picture. These pain syndromes are not well understood or diagnosed.

Complex regional pain syndrome (CRPS), fibromyalgia syndrome (FMS) and chronic widespread pain (CWP) are typical pain syndromes. CRPS can develop in a wrist or ankle after a moderate or minor injury such as a small fracture or a sprain, with the joint rapidly becoming painful, stiff and swollen. A wrist and hand like this has very limited function and needs to be free of immobilisation as soon as possible to start rehabilitation. Early Osteopathy intervention is vital to get the passive and active ranges of movement as soon as possible and educate the patient in what they have to do.

Chronic widespread pain occurs, as the title implies, all over the body, with multiple trigger points in muscle bellies. Trigger points are areas of acute sensitivity to pressure which occur in specific places in muscles and can refer pain away from those sites causing a persistent pain condition. Osteopaths treat trigger point pain with acupuncture, acupressure, stretches and positional advice. Fibromyalgia syndrome occurs mostly in women, and consists of widespread pain, fatigue, hypersensitivity to pressure, poor sleep, feeling unrestored in the morning, brain fog, IBS, reduced physical ability and pain unpredictability.

Anger, depression, anxiety or low mood are common accompaniments to a chronic pain syndrome, necessitating the skills of a clinical psychologist if the patients are to be successfully managed. Patients find sticking to a treatment plan very challenging and exhibit anger, irrational thinking, poor coping, non-assertive communication and negativity. FMS patients often disclose an abuse history either as children or in adult relationships and this can be the dominating feature of their presentation. Isolated Osteo treatment is unlikely to work and the psychologists input is vital.

Psychological therapy in an FMS pain management programme covers education about the condition, validation that it is real, group discussion so they meet others with FMS to reduce isolation, negative and realistic thinking, communication and assertiveness, goal setting and planning, acceptance and mindfulness and pacing to reduce overactivity. Many FMS sufferers communicate very passively with their close relatives and others, leading to frustration and anger that their needs are not being met. A negative bias in thinking is typically present due to the large number of negative experiences connected with the condition.

Medical treatment is not very successful in pain syndromes but drugs such as amitriptyline can be useful with their nerve transmission altering affects. Many FMS sufferers react adversely to drugs and this limits their usefulness, especially if morphine-related chemicals add to lack of mental clarity and fatigue. A graded exercise programme, carefully guided to avoid overdoing, is useful in the longer term as these patients have lost of lot of strength and fitness. Stretching is often reported to be helpful and may be all a person can do if they are having a worsening but overall a structured plan is necessary for a pain syndrome.

Andrew Mitchell, clinical director of the Osteopath Network, writes papers about musculo-skeletal conditions and physiotherapists in London. The Osteopath Network has more than 550 clinics located throughout the UK and offers treatment at weekends and after hours.

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