Positive brain changes from chiropractic care?

Chronic pain (pain lasting longer than three months) causes changes in the brain. A new study shows that adjusting people with chronic neck pain has some effect on these areas of their brains. A control group doing neck motion exercises showed no changes.

The researchers looked at somatosensory evoked potentials (SSEP) from the median nerve (the nerve that goes through the carpal tunnel). SSEP’s are a measure of the brain activity from a particular area. In areas with chronic pain, the brain tends to be overactive. So less SSEP’s is good.

In the group that got neck adjustments, they had lower measured SSEP activity. The group that did range-of-motion exercises showed no change. They only looked at these patients after one treatment. The effect lasted about 20 minutes.

This is great news for chiropractors everywhere. No more three times per week treatment schedules – we need to see you every 20 minutes (at least during office hours). : – P

This study adds to our understanding of how adjustments, or spinal manipulation (the technical term), work. However, many questions still need to be answered.

What’s really going on here?

Ok, so we know that we don’t know for sure, blah, blah, disclaimer, disclaimer. What’s really going on here? (Editors note: The following is opinion – a good one, though.)

I think it boils down to (mostly) motion. What we are trying to do when adjusting a neck or back is get a joint that has dysfunctional movement, to move normally. Joints that are not moving normally cause problems. We have studies showing that joints start to degenerate quickly when they are not allowed to move.

The lack of normal motion causes different information to be sent to the brain (for nerds only: less mechanoreceptor input, stopping the spinal gating theory from helping out). This contributes to changes in our movement patterns and keeps the pain around longer, even without anything still broken, or torn or obviously inflamed.

Increasing the motion with a spinal adjustment (or manipulation for those terminology sticklers), reverses these changes. After one treatment the changes only lasted for 20 minutes.

I don’t think this means we need to treat patients 72 times per day. After an adjustment, you get lots of extra motion for about 20 minutes or so. This is partly related to some muscular reflex relaxation and the gas bubble that pops (that’s what makes the “crack”).

To provide meaningful change, we need to keep this motion normal. Having a course of treatments along with some specific exercises and postural advice can accomplish this.

How many treatments do you need? It really depends a lot on your spine and how well you do your home-exercises, etc. It could be 4-6 or 12 or 20.

As we saw in this study, changes were made in one treatment. If you need spinal manipulation you should see some change, not perfect or permanent – but some definite relief within 4 treatments.

Your Brain on Placebo

A new study from one of my favorite periodicals, PAIN, has shed some light on the placebo effect. I know many of you look with some suspicion on this whole thing. You think placebo is something that crazy, or at least gullible, people make up – certainly not something that applies to a sane, intelligent person like you.

Some researchers have wondered if you might be right. They have theorized that the placebo effect is due to patients remembering an effect from the fake treatment, when in reality nothing happened.

To test this idea, they gave patients a painful stimulation twice. (Don’t ask how they inflicted the pain. But know you don’t want to participate in this kind of research.) The first time they told them they were giving them a painful stimulus. The second time they said they were doing the same thing, but had given them some medicine that decreased pain in many people.

During both of these events, they used functional MRI (f MRI) to look at how active the parts of the brain were that process pain. When they thought they were being treated, not only did they report less pain, but the areas of the brain that process pain were substantially less active.

Hmmm…….maybe there is something to this placebo thingy?

So, throw out the Vicadin and replace them with sugar pills?!! Unfortunately, even as much as your insurance company would love the savings, that’s not the lesson from this study. The take home from this study is that, while what’s going on in your head may not be the cause of your pain, it has a definite effect on how you actually feel.

Where is my pain?

Where does it hurt and what does it feel like? Simple questions, but not simple answers.

Trying to communicate back pain can be as excruciating as the condition. When I ask this question, as I must, patients furl their brow, gaze in all corners of the room and then with a look of frustration and embarrassment finally say: “I don’t know, it just hurts!”

How can something so simple be so hard!

Our brains have a lot going on. (Yes, even that goofball in the next cubicle.) Since the brain can’t deal with everything, it must make priorities. Unfortunately, your back is not high on the list.

Your brain sets aside a portion – actual physical real-estate – of its sensory area for every part of your body. This is called the somatosensory homunculus, or just homunculus to it’s friends. See the diagram below.

From this chart we can see that your thumb has about as much representation as your entire back, chest and abdomen. No wonder it’s hard to tell what’s going on in your back!