JACK RIEKE, DC, ART
Today's article was written by Dr. Jack P Rieke, DC, ART. Dr. Rieke was inspired by Chiropractic at a young age when his mother suffered from severe and chronic pain. After seeing 13 specialists and undergoing countless failed procedures, Dr. Rieke’s mother finally experienced effective and lasting relief by visiting a Chiropractor. After becoming a patient himself, Dr. Rieke recognized the immense impact this practice makes on the lives of many and he knew right away that he must pursue a career of service to others. In 2015, he graduated with a bachelors in science of kinesiology from the University of Illinois Chicago and then matriculated at National Chiropractic College where he graduated with honors in 2018. Dr. Rieke is dedicated to the comprehensive practice of Chiropractic and alternative medicine. He enjoys reading, writing, and lifting weights. He is a passionate family man and his favorite author is Dale Carnegie.
What is Pain and Where is it Coming From?
How can something be so prevalent yet incredibly neglected? It seems we are so focused on finding ends without exploring the means. Often times, the best answer will be found in observation of the process. This is how we must address pain. Recommendations for pain medications are made without regard for the source of pain. Diminishing pain via pharmaceuticals must mean we are healed, right? I’ll say this much: you can take cocaine to stop a tooth ache, but it won’t get rid of an infected and decaying molar.
Nevertheless, pain transmission throughout the body is a multifactorial process. The severity of pain varies among individuals, but the physiology remains the same. To understand this, we must discern between lower and higher brain centers of pain transmission. Pain is only pain if the signal, pinching for example, reaches the higher brain center (thalamus) and emotional center (limbic system). The signal traveling throughout the body before this point is referred to as nociception – nocere or noxious meaning ‘harmful’ and -ception meaning ‘receptor.’ These receptors carry noxious information along specific nerves up the spinal cord and to the brainstem, but they don’t always result in pain. Different people have different neurologic thresholds. I’m sure you have heard someone say “well, I have a high pain tolerance.” This is the reason. What causes these nociceptors to fire? It could be a very intense signal – think about a punch from a 3-year-old vs that of heavy weight champion, Deontae Wilder – both punches, but you get the point. Nociceptors can also fire due to inflammation in the area, which sensitizes the nerves; therefore, someone that is very inflamed may feel pain from a minor bump that would usually be no big deal.
Dr. Bernard Feinstein published research in 1954 that better demonstrates this phenomenon. In his research, he injected hypertonic saline (a salt ion solution) into certain muscles to stimulate pain in people. This research showed us a few things. First, it demonstrated that certain structures consistently create and refer pain in a predictable pattern. For example, injecting the muscles on the front of the neck (the SCM) created a line of pain around the ear and up the back and side of the head towards the eye. You may have seen these “pain referral pattern” charts that exist today from Feinstein’s work. Nevertheless, the same solution and dose did not create any response in some subjects, while another set of subjects experienced an array of internal symptoms, such as sweating, slowed heart rate, reduced blood pressure, nausea, or paleness. It’s amazing to me how a physical stimulus can cause nausea. Why does this matter? If I have a patient present with nausea and faintness, but he/she took a bad collision in soccer yesterday, should I immediately recommend Pepto-Bismol? No because I need to first assess and narrow down the sources. Then perhaps I could recommend an herbal or pepto if I rule out causes other than the gut.
Let’s jump back for a moment to the idea of referred pain. We now have a large map of the body showing how injury to certain areas can cause pain in another. More often than not, pain isn’t caused by the anatomical structure located just beneath it. Why then, do we always chalk up joint pain as arthritis? In my practice, I am constantly asking myself “what is the pain generator?” MRI and Ultrasound studies demonstrate that arthritis isn’t an accurate predictor of pain. A study by Girish 2011 demonstrates with ultrasound imaging that 96% of those with degenerative shoulders did not have pain. A study by Register et al 2012 demonstrates with MR imaging that 73% of pain free subjects had hip abnormalities and 69% had labral tears. I don’t want to mislead you, arthritis can cause nociceptors to fire and ultimately cause pain, but don’t be fooled by your radiology report that your knee needs to be replaced right away because arthritis is present. In many people, the correct term is actually arthrosis – meaning that degenerative changes are present but not inflammatory.
Stay tuned for follow-up article about the cycle of chronic soft tissue injury and how Chiropractors like Dr. Sipe and I manage them effectively.