How Can Osteopathy Help With Chronic Pain, Stress And Inflammation? Part 2
Caryn Seniscal DOMP
Vancouver Osteopathy Centre 2020
Delving deeper into Osteopathic Treatment of Chronic Pain
The Vagus nerve is part of the parasympathetic nervous system (PNS). It is one of the largest nerves in the body, considered both a cranial nerve and a peripheral nerve. It exits the cranium through the jugular foramen and travels down the neck into your chest and abdomen, innervating the entire digestive system. Osteopathic manipulative treatment (OMT) releases soft tissue and joint restrictions in the cranial base and the upper neck to alleviate any compression on the vagus nerve so it can function normally and facilitate good digestion.
New research is discovering that the vagus nerve does more than was originally thought. The autonomic nervous system was developed for defence but it seems we also use it for social engagement. The SNS is sometimes used for ‘play fighting.’ The PNS, specifically the vagus nerve, is associated with facial expression, vocalising, hearing and our ability to comprehend the meaning of speech so we can communicate with others. The vagus nerve and the facial nerve innervate muscles in the middle ear that control the tension on the ossicle bones. If the tension is too high, we have trouble hearing the higher tones in the human voice and can misinterpret the meaning. Conversing can become difficult and make us feel uncomfortable. On the other hand, if we feel safe and relaxed, we can read people’s facial expressions more accurately and our own will be more expressive.
Chronic pain clients often present with hearing sensitivities, altered pressure in the head, lack of prosody (harmonics) in the voice and sometimes a ‘flat affect’ (without much facial expression). They often don’t want to socialise but it may not be just the pain that is causing discomfort or a lack of desire to interact - it could be the vagus nerve not functioning properly, making comprehension and social engaging difficult. (Polyvagal Theory of Stephen Porges) We treat the vagus Nerve.
Quality of Touch
Osteopathy provides healthcare through touch and manipulation of the body and its tissues. The simple act of touching people can be beneficial on so many levels, physiologically and psychologically. It prompts the brain to release oxytocin, sometimes called ‘the hugging hormone.’
The brain releases oxytocin into the bloodstream during physical contact. It lowers blood pressure and helps you feel calm and safe. Oxytocin induces anti-stress-like effects such as lowering cortisol levels and helping one sleep. It increases pain thresholds (which means a reduction in pain), lowers anxiety and promotes tissue growth or regeneration. The quality of the Osteopathic touch enables the body to regain a homeostatic balance and assist its own healing mechanisms.
The fact that our treatment is so gentle and does not trigger a stress response is critical to positive treatment outcomes.
Osteopathic Practitioners are trained in the fine art of palpation. We have a ‘soft touch.’ We can sense alterations in tissue tone and temperature. We develop
“thinking/feeling/sensing/knowing fingers that can feel moment to moment changes” (William Garner Sutherland, DO). The body will ‘pull’ us towards areas of dysfunction and pain. The cranial rhythm is generated in the central nervous system by the production and re-absorption of cerebrospinal fluid (CSF) but the rhythm is manifested throughout the entire body. Osteopathic Practitioners will be drawn to areas where the cranial rhythm cannot be felt. We are “’istening’ to your body’s tissue. We are there to assist your body’s own self-healing mechanism. Sometimes, it hasn’t been able to heal itself and it just needs a little help. If you’ve ever heard of the ‘horse whisperer,’ we are like ‘body whisperers.’ We are present and patient with your body allowing it to come into our hands and show us what it needs so that we can assist the tissue towards a less restricted state. Osteopathy has a ‘handle’ upon many of the subtler components of health.
A wonderful thing about Osteopathic palpation is that we often feel the same things that you’re feeling in your body. There can be a great sense of relief and validation for a person when this happens - especially if you’ve been made to feel like your symptoms were not real. Osteopathic Practitioners listen to your concerns. People often know more about what is going on with them than they may be consciously aware. If a therapist listens attentively, there are often clues and insights that come forth to illuminate and deepen the therapeutic process. Our treatments are usually an hour so there is time to relax. People in chronic pain are often on ‘high stress alert’ and we really want to change this because we don’t want to stimulate the HPA Axis.
“There is nothing more important than the state of your consciousness in this moment”
Eckhart Tolle
The Gut–Brain Axis (GBA) - The Circle Widens
A lesser known nervous system exists in our guts. It is called the ‘enteric nervous system’ or our ‘second brain’ and it communicates with the brain in our head. This is called the Gut-Brain Axis (GBA). Together, our ‘two brains’ determine our overall health. Pain can trigger emotions and those same emotions can trigger symptoms in the gut. Have you ever had a ‘gut-wrenching’ experience?’ Do certain situations make you ‘feel nauseous?’ Have you ever been so stressed you suddenly got some gastric reflux or had ‘the runs?’ The gastrointestinal tract is sensitive to emotion.
Physical or emotional trauma can leave a memory imprint deep inside the body - in a weak spot, a tissue or an organ. East Asian medicine has long believed that there are relationships between emotions and organs. The liver seems most affected by stress and anger. Grief can be stored in the lungs. The stomach often carries anxiety. All of this has the potential to cause an organ to dysfunction and send a distressed signal back to the spinal cord, amplifying the pain pathway. Sometimes, during an osteopathic treatment, parts of these memories or emotions can release but it’s all part of the healing process.
Our body is a system of intelligence where messages travel from brain to organs and vice versa. The communication network includes the central nervous system (brain and spinal cord), the autonomic nervous system (ANS), the Hypothalamic-Pituitary-Adrenal (HPA) Axis and the enteric nervous system. Stress, pain and emotion can intensify organ reactions and affect the GI tract: interfere with peristalsis, alter blood flow and stomach acid levels, cause sphincters to improperly open and close, make inflammation worse, and even make you more susceptible to infection. When the sympathetic nervous system (SNS) is dominant, it can affect the parasympathetic response via the vagus nerve which will affect digestion. Also, the cortisol that is released from the adrenal glands can affect intestinal cells, such as immune cells, epithelial cells, enteric neurons in the walls of the intestines and smooth muscle cells.
The enteric nervous system network of nerves, neurons, and neurotransmitters extend along the entire digestive tract - from the esophagus, through the stomach and intestines to the colon. The same type of neurons and neurotransmitters that are found in the brain and the CNS exist in the gut. These neurons are also under the influence of the gut microbiota (gut bacteria) whose contributing role in brain-gut reciprocal communications has recently been discovered. The concept of a microbiome (community of good and bad gut bacteria) interplaying in the gut-brain axis (GBA) is now emerging. These microbes help us digest food and protect us from infection. It’s astonishing to realise that neurons in the gut walls and the gut bacteria themselves communicate with each other and with our brains, targeting the HPA Axis through neuro-endocrine (hormones) and metabolic pathways.
Dysbiosis (an imbalance of good and bad bacteria) is associated with high stress reactivity, anxiety and fluctuations in mood. Brain-gut and gut-brain dysfunctions can occur with dysbiosis, affecting intestinal motility, secretion and permeability. This can also cause visceral hypersensitivity and cellular alterations prompting the viscera to send distress signals back to the spinal cord. Some people perceive pain more acutely from the GI tract because they are already in chronic pain and experiencing a ‘central sensitization’ in the CNS.
Where does Osteopathy fit in all this?
OMT, Craniosacral Therapy and Visceral Manipulation (see: Our Services) assist in Gut/Brain function. We have many ways to treat the ‘two brains’ by calming the HPA Axis and the ANS, treating the vagus nerve and helping the viscera function normally. Osteopathy offers hope and help. We have treatment modalities to address all of these structures.
There is no doubt that chronic pain is complicated, difficult to treat and from which to recover. We can’t guarantee a cure. There isn’t a formula for treatment in Osteopathy. Each person is a unique individual and each case is different but Osteopathy just might be your best option.
Allopathic medicine would have you be a passive patient but your willingness to participate in your own health and do whatever you can to improve your lifestyle and well-being is essential. You could consider including other therapies such as massage, acupuncture and naturopathy. Dietary changes may be beneficial. Improvements in the gut microbiome could modify the stress response and all functions of the GBA. Doing whatever exercise you can, meditating or just sitting quietly and taking slow, deep breaths assists healing. Spending time in nature has been shown to reduce blood pressure and salivary cortisol levels (ScienceDaily, 6 July 2018). Addressing any unresolved emotional issues and negative thinking which might be impacting the autonomic nervous system would be helpful. Listening to music and/or singing provides an emotional outlet, reduces stress, causes the brain to release endorphins, boosts immunity and stimulates the vagus nerve. The mind and the nervous system are intricately linked. “A thought is an electrochemical event taking place in your nerve cells producing a cascade of physiological changes….Epigenetics is showing that…a change in perception of an individual can change their biology” (Dr. Bruce Lipton. Integr Med (Encinitas). 2017 Dec; 16(6): 44-50).
“The doctor of the future will give no medication but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.”
Thomas a. Edison
Research is ongoing in this field so there are many books and articles to explore. There are already new pain theories emerging.
Osteopathy has a long tradition of tried and true therapeutic tools and resources to help with the complex issues that must be addressed in people with chronic pain. Our ‘wholistic’ methodology is what sets osteopathy apart and makes our treatment highly effective. We treat locally and globally, seamlessly moving from one method of treatment to another, as we intricately address different tissues and systems - with particular focus on the nervous system. It seems the more we learn about the body we see how each system is inter-related and inter-dependant. Osteopathic treatment is three dimensional in many ways. We never lose sight of the whole person, Body, Mind and Spirit.