Why am I in pain if I’m not injured?!
It’s a familiar story for those living with chronic pain. You tell your primary care provider you’re in a lot of pain. They examine you and conclude that the part of your body that’s hurting is not injured. You leave the office frustrated with a prescription for an antidepressant in hand and an overwhelming feeling of “is this really all in my head?”
During 2021, an estimated 51.6 million U.S. adults (20.9%) experienced chronic pain, and 17.1 million (6.9%) experienced high-impact chronic pain–resulting in substantial health care costs and lost productivity.
Many know that feeling of having a hurt lower back and then watching as that pain seemingly spreads to your upper back and legs. This pain can interfere with your activities of daily living, affect relationships, and sometimes take a toll on mental health.
So, how can a person be in pain — sometimes intense and persistent pain — without anything being “wrong”?
“It’s all in your head.”
The tricky part about chronic pain is that it can’t always be explained by known damage or trauma to the tissue. The key to understanding chronic pain is understanding the differences between central nervous systems (CNS), peripheral nervous system (PNS) and their relationship to trigger points.
Think of your central nervous system (CNS) as a fire alarm. The CNS is designed to send a signal to the brain through the spinal cord when there is damage to body tissue — just like a fire alarm is designed to go off when there is fire.
With chronic pain, imagine your CNS as an over-reactive fire alarm. The nervous system should normally send a pain signal only when there is damage–just as a fire alarm should go off when there is a fire. However, when you are in pain for a long period of time, the muscle cell’s molecular chemistry changes. These cellular changes register as acute trauma to the tissue, triggering the fire alarm. But here’s the problem; there is no fire - or injury - onsite or in the tissue. The fire alarm keeps malfunctioning because of all of the molecular changes, leading to hyper-sensitization of your nervous system.
Many factors can affect your CNS, including injury, stress and trauma. Central sensitization is the reason why many doctors prescribe anti-depressants and cognitive behavioral therapy for those with chronic back pain The theory is that if the stress and trauma are mitigated by balancing chemicals in the mind, the nervous system will slowly regulate itself and not be so sensitive, thus the pain will decrease overtime.
But this is rarely the case.
Peripheral sensitization
Your peripheral nervous system (PNS) includes all of the nerve cells in your body, excluding the nerve cells in your spinal cord and brain (they make up the CNS). The cells in the PNS are often overlooked in chronic pain.
After an injury, the molecular makeup of these nerve cells in the PNS can be altered to make them more likely to fire with less and less stimulation. In other words, the nerve cells in your back can become hypersensitized, meaning that even the slightest touch can make you wince in pain.
And this is all happening outside the CNS!
If central sensitization can be compared to a faulty home fire alarm that goes off for seemingly unimportant reasons, think of peripheral sensitization as starting a fire in your fireplace with a DuraFlame fire starter. The chemical make-up of the DuraFlame is designed to catch fire faster than a normal log. That fire (or pain sensation), caused by the chemically modified wood (or nerve cell), can activate with very little stimulation, causing the fire to start more easily (or increase the severity of the pain sensation). It’s a feedback loop that won’t quit until you undergo some sort of intervention in the muscle itself.
What’s the deal with trigger points?
According to the Integrated Pain Hypothesis, trigger points are formed by an influx of calcium into muscle cells. This influx of calcium causes the muscles to contract, and a nasty feedback loop commences, leading to contracted muscle fibers.
Peripheral sensitization leads to hypersensitivity of neural cells, allowing them to fire at even the smallest stimuli, and a continually contracted muscle, or a trigger point is the perfect stimuli for the PNS to be hypersensitive to. Active myofascial trigger points are one of the major peripheral pain generators for regional and generalized musculoskeletal pain conditions.
By getting rid of the trigger points with dry needling, there is less stimuli that affects the PNS. The hyper-sensitized PNS is less likely to fire if the stimuli (the trigger point in this case) is eliminated. By treating the injured tissue itself, things can improve.
Can dry needling help my chronic musculoskeletal pain?
Yes! And here’s why.
If the sensation of chronic pain was caused only by the CNS, pharmaceuticals would work. Cognitive behavioral therapy would work. But we cannot ignore peripheral hypersensitization.
Epidemiological studies from the United States have shown that trigger points were the primary source of pain in 30% to 85% of patients presenting in a primary care setting or pain clinic. Despite this, there is evidence that myofascial trigger points that cause musculoskeletal pain often go undiagnosed by both physicians and physical therapists, which leads to chronic conditions, like low back pain.
Dry needling causes a local twitch response which can decrease muscle contracture in the muscles. If we decrease the muscle contractures, the hypersensitive PNS has less stimuli to react to leading to a decrease in the pain sensation.
If you have been diagnosed with any of the following, or suspect you might be suffering from one of these diagnoses, seek out a qualified and experienced dry needling provider. The pain is not all in your head.
Fibromyalgia
Myalgic Encephalomyelitis (Chronic Fatigue Syndrome)
Irritable Larynx Syndrome
Chronic Lyme-like syndromes
Irritable bowel syndrome
Tension-type headaches
TMD
Postural Orthostatic Tachycardia Syndrome
Restless Leg Syndrome
Post Trauma Stress Disorder
Myofascial pain syndrome