Chronic Musculoskeletal Pain Clinical Research

Executive Summary

An argument for the use of kinesiology to treat chronic musculoskeletal pain

Introduction

“Chronic pain is defined as an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe; constant or recurring without an anticipated or predictable end; and a duration of greater than 6 months” (Morsby, 2002, p.1262).

In Australia between five and ten per cent of the population suffer significant ongoing pain conditions for which medical science has no complete solution (Pump, 2005). Some types of pain such as lower back pain can be relieved by various treatments but not completely cured because medical science does not fully understand the cause of pain.

Morsby (2002, p.1262) lists defining characteristics of chronic pain.

protective and guarding behaviour,
irritability,
self-focusing,
restlessness,
depression.

Disability may be the result of these person’s search for ways to hold or position their bodies to gain some respite from pain.

Some additional defining characteristics: -

atrophy of the involved muscle group,
problems with sleep,
fear of injury and
altered ability to continue with normal pastimes and family commitments.

The results of these are psychosocial disability.

Kinesiology, the natural therapy used in this research, works with the body’s own innate healing system. It works in harmony with the body to restore balance to neurological and physiological systems therefore restoring health. (Australian Kinesiology Association, leaflet, 2005)

It was hoped that kinesiology would be able to provide a new avenue of treatment for people who had not found any resolution of their chronic musculoskeletal pain or even an opportunity for pain relief to make a difference in their lifestyle.

Purpose of Research

The research was to investigate the effectiveness of kinesiology as a healing therapy:

testing its strengths and weaknesses on participants with serious illness,
most of whom had not responded to conventional treatments.

At the same time, it was hoped to discover if there were any patterns to the type of treatment needed for individual participants, or across the whole cohort.

All participants had musculoskeletal pain of six months or more duration. According to Blyth F.M. el al (2001) “chronic pain impacts upon a large proportion of the adult Australian population” with the concomitant costs on the economic situation of the country.

The social impact not only on those with chronic pain but also on their families can be devastating. Chronic pain is strongly associated with social disadvantage, with many sufferers receiving disability benefits or being unemployed due to health reasons.

Medical treatment of chronic pain.

Weisberg (1999) says that “traditional treatment of chronic pain based solely on biologic factors have proved inadequate for patients with complex pain conditions” p.141. Therefore, treating patients with chronic pain is a challenge for doctors, as they must identify both the cause of pain and read the unspoken messages of each patient.

Often when investigations and tests are unable to provide a physical cause for the pain, patients can be labelled as hysterical or hypochondriacs. But these patients can be time-consuming, frustrating, and emotionally draining for the doctors (Weisberg, 1999).

In some cases, a rigorous search may find some physical damage that may or may not be related to the pain.It has been estimated that clear physiological causes cannot be identified for as many as 85% of patients with chronic low back pain (Deyo, 1988). At the same time Jensen (1994) tested a group of asymptomatic people and found that 64% had at least one abnormal disc and 38% had two or more.

Weisberg goes on to conclude that this continual search for a diagnosis leads to a sense of failure, dissatisfaction, and frustration. Consequently, a confused patient may be told they have to live with the pain, but not how to live with it (Main & Spanswick, 2000. p16).

How is a doctor to formulate a treatment plan without a definitive diagnosis? They may make, knowingly or unknowingly, judgements about the patient and their presenting illness.

Hislop (1987) explains that the emphasis on organic disease is the “natural outcome for a profession selected and propagated by a system noted for its worship of objectivity. Within this rigid framework doctors generally feel more at home, both by reason of their personality as well as by their training” (p.2). For these reasons doctors may fail to consider the individual as a complete entity.

Medications used in chronic pain treatment.

There are several injections used to give pain relief: cortisone and local anaesthetics into joints, between the vertebrae as an epidural block, close to or around a particular nerve, in a disc within the spine and injecting the nerves that go to the arms.

Two more radical treatments are to destroy a nerve by injecting chemicals or by cutting the nerve. This prevents the pain impulses reaching the brain; thus, the pain cannot be felt. There are times when surgery may be considered. (PUMP, 2005).

Below is information from the Pain Understanding and Management Handbook used by Fremantle Hospital that illustrates how a narrow focus on medication for long-term pain can be unhelpful and has a negative impact on a person’s life and general health.

Chronic Pain Medication Trap

Methodology

The criteria used to choose participants for the study is in line with the admission criteria for the Mayo Clinic which involved persons who demonstrated:

1. Chronic pain of sufficient severity to bring about increased dysfunction in daily social, vocational, and/or interpersonal activities.

2. Chronic pain duration of six months or more or clinical indication that pain of a shorter duration will likely manifest into a chronic condition.

3. Adequate motivation to proceed with a rehabilitation approach to management of pain, which often implies awareness, or some level of acceptance that medical or surgical treatments are not a present option.

Most participants had never had kinesiology treatment, with some being sceptical about the methodology. However, all were willing to try anything that might provide pain relief, especially without the use of drugs.

There are direct neurological connections between the limbic brain, sometimes labelled the ‘emotional brain’ and the pathways that control muscle tone and tension (Noback, 1991). Muscular tone is continuously controlled by the subconscious, so by the use of muscle checking a kinesiologist is able to directly access the subconscious system of their patient. This direct interface between the neurological physical body, emotions and thoughts are the ‘tool’ used throughout a kinesiology consultation.

Age recession (or age regression term used in psychology) is used when indicated during treatment for the participant to identify stressful times and events in their life.

Emotions indicated are shared with participants together with a direction, whether an emotion is directed at self, or others are involved in the events above.

Goals were identified at the start of each consultation, either by the participant or by muscle-checking.

Material and Methodology

There were 25 participants in the study, 22 women, aged between 32 to 74 years of age.

All had musculoskeletal pain for a period greater than six months. Some people had been living with pain for between 10 and 20 years.

Most participants had tried various therapies or were undergoing treatment, such as chiropractor, physiotherapy, or massage to get pain relief. Some were permanently on pain killing medication while others were not as they didn’t want the side effects that came with their use.

All participants were asked not to change their treatment regime for the period of kinesiology research, as it could bias the results. However, due to the reduction in pain, increase in range of motion, decrease in disability or all of these, some participants reduced or stopped taking painkillers and other treatment as they deemed them unnecessary.

Up to six consultations were available, however some participants required less to produce a successful outcome. The number of consultations are analysed in the results section.

At the first consultation a full history was taken: a self-assessment of pain levels (scale of 1 to 10), disability and impact on lifestyle was recorded on a pain assessment sheet.

This type of subjective assessment has been used before in medical research and trials. Mannion, Duorak, Tairnela & Muntener (2001) did research on training programmes for people with chronic low-back pain. For their pre and post therapy assessment they used self-rated pain intensity, pain frequency and disability. Self-reports on frequency and severity of pain were also used by Borders, Xu, Heavner & Krise (2005).

Therefore, the pre and post treatment assessment of pain levels, disability and impact on life is an accepted method used in research into chronic pain. A full history of the pain, defining characteristics and past treatments was also recorded. Details of each consultation were recorded on a treatment sheet, recording each correction together with any emotion involved.

Kinesiology is a ‘hands on’ natural therapy so no medications were used. In this research Schuessler tissue salts and Bach flower essences were used by some participants.

RESULTS

Treatment Outcomes

The final outcome of the kinesiology treatment has been divided into six categories. The information for these results has been obtained from conversations with participants. At the beginning of each consultation and the end of the final consultation every participant gave feedback on their progress in respect to pain and general well being. Very few participants were able to give precise percentage changes, therefore information for this section is subjective in nature.

The categories used to evaluate the treatment are:

No change in physical symptoms, pain levels – therefore no benefit from treatment.
Some improvement in pain, body or spirit.
Noticeable improvement in pain/sleeping/lifestyle/inner feeling and the ability to use self-management techniques.
Good improvement in pain together with some regain of lifestyle, few restrictions and improved health. The ability to use self-management techniques.
Almost complete reduction in pain with some residual symptoms, full return of lifestyle, normal sleep patterns, no restriction and improved health. The ability to use self-management techniques.
Complete absence of pain and return to full lifestyle. The ability to use self-management techniques.

Figure 1

The modal outcome for kinesiology treatment in this research study was five. This was the most frequent outcome from the study. Chronic pain suffers in this category regained their normal lifestyle and were not hampered by restless sleep but still had some residual pain either constant or intermittent.

The mean outcome from treatment was 4.08 with a standard deviation of 1.65.

Therefore 68% of people would probably have an outcome of 2.43 – 5.73.

This data indicates that two-thirds of people having kinesiology treatment for their pain would probably have an outcome of between category 2 and 5, showing a reasonable change in their condition, but not a total removal of pain.

Another appropriate statistic would be that 72% of participants are category four, five or six, which means they gained substantial relief from kinesiology treatment.

The number and frequency of consultations was determined by muscle monitoring. Therefore, the clients’ subconscious directed treatment and also decided when treatment was complete.

Figure 2 below shows the number of consultations needed by each participant. Three people who failed to complete the research are not included in this graph.

Figure 2

The mean number of consultations needed for a complete kinesiology treatment for chronic pain is 4.45 and the standard deviation of treatment is 1.03 consultations.

Therefore 68% of people would probably require 3.42 – 5.48 consultations.

Therefore 95% of people would most likely require 2.39 – 6.51 consultations.

This could be described as, two-thirds of people in chronic pain would probably require from four to six consultations, whereas 95% of people with chronic pain would most likely require three to seven consultations.

One aspect of treatment that needs to be considered is the relationship between the number of consultations and the outcome of the treatment. It would be logical to assume that if a person had more consultations, they would receive more benefit.

The chart below shows the number of consultations graphed against the physical and emotional outcome, as grouped into categories above, for those participants who completed the research study.

Additional Relationships

This statistic proves that for this research study there is no relationship between the number of consultations that a person undergoes and the outcome of their treatment.

However, it may be more productive to look at different comparisons between data, as the cohort in this research was so diverse. All the people taking part in this research were suffering with chronic pain, the duration ranging from six months to twenty-five years. Therefore, the statistic investigated next was the correlation between chronicity and the treatment outcome.

This research also showed there is no correlation, or an extremely weak correlation, between the number of years that a person had been in pain and the outcome of their treatment.

This research also showed there is no correlation between the number of consultations needed and the number of years that the participant had been suffering with chronic pain.

This shows the total percentage of anger, wrath and rage is 41% showing that this emotion does account for much of the accepted emotional stress suffered by chronic pain patients. The second most expressed emotion is depression.

In kinesiology treatment the Five Element Emotion Chart is used providing people with a wider range of emotions. Figure 8 below illustrates the advantage of the kinesiological treatment of emotions as

Kinesiology treatment can encompass a larger range of emotions than traditional treatments. This suggests that the subconscious mind has a broad range of emotions that need to be addressed to give relief to chronic pain sufferers.

Age recession may be used during a kinesiology consultation. But are the number of times that age recession was used significant? It was found that all of the participants had at least one age recession.

The minimum number of age recessions is one and the maximum is four.

There are two average (mean) values that can be considered within this age recession data.

From the chart above the average is 2.43 age recessions over the whole treatment period, with a standard deviation of 0.92 age recessions. This can be more simply explained, as 68% of people, or approximately two-thirds, with chronic pain would have between one and four age recessions over the duration of their treatment.

The average for this data can be viewed in a different manner. This is to calculate the average number of age recessions per consultation. The average number of age recessions per consultation is 0.6, illustrating that for some goals or some balances there is no need for the person to access another time in their life.

Recommendations

It is hoped that this research into kinesiology, a natural therapy, will prompt more investigations and proof of the efficacy of complimentary therapies to encourage their use by the general public and to give doctors the confidence to refer patients for treatment.

The Melzack & Wall theory of pain recognized the psychological aspect involved in pain perception. There are signals not only ascending but descending from the brain to the peripheral site of the injury. These descending signals allow for the modulation of pain perception due to motivational and cognitive factors.

Descending modulation involves the emotional parts of the brain proving that attention needs to be given to stress and emotions caused by past events and life experiences.

Conclusion

Chronic pain is a growing problem in Australian both in economic and social terms, causing long-term disability and emotional distress.

The purpose of this research was to demonstrate that kinesiology may be effective in treating chronic musculoskeletal pain, particularly in people who have not been able to get relief from conventional treatment or did not want to use medications.

Overall results are promising with 72% of the cohort gaining substantial improvement in their lifestyle. 16% of participants had full elimination of pain and a further 32% were in the category ‘almost complete reduction in pain with some residual symptoms, full return of lifestyle, normal sleep patterns, no restriction and improved health.’

They also have the ability to use self-management techniques to prevent a relapse in their condition. These are the results at the completion of their treatment. There is no data available on the long-term benefits, although the self-management techniques are at their disposal, should symptoms recur.

There are several important findings to summarize here:

The importance of movement,
The issue of self-responsibility and
The duration of treatment.

Firstly, the research showed that physical movement was a key issue with some of the cohort – particularly those people who had developed physical disabilities due to their pain. This was demonstrated, several times, by the use of Brain Gym activities that gave almost immediate relief from pain.

In relation to self-responsibility there are two issues that the research study brought to light. There can be an expectation from patients that a practitioner will provide treatment which reduces or removes pain without the patient themselves doing anything except come to treatment. Illustrations of this were those participants who did not do the homework chosen by muscle monitoring as a result of which they gained little or no benefit from the kinesiology treatment.

The other type of self-responsibility was a psychological response when there is an expectation that family and friends will constantly care for them or will endlessly listen to their complaints of ‘poor me’. If people cannot be encouraged to change their thinking by psychological intervention or, as the example in this study, the use of positive statements, they are unlikely to see any improvement in their condition. By its very nature kinesiology is a self-development process where patients can gain insight into the way they live their lives and their subconscious reactions to their environment.

It may seem logical for those people suffering more complex chronic pain and/or more severe disabilities to need a prolonged period of treatment. However, this research clearly demonstrated there were no links between severity and the number of consultations or the outcome. Perhaps the previous paragraph on self-responsibility may provide a clue to this finding?

There are many areas that the research has highlighted but only in the context of treatment, such as the way that emotions are released, how many of the corrections actually work and why is it important in chronic pain treatment to use age recession? This was not the focus of this study, but it is hoped that more research will be done in the future.

Therefore, to recap the advantages of kinesiology treatment is that it can: help chronic pain suffers who have been unable to gain relief from other types of treatment; provide access to and release a wide range of emotions; enable patients to undergo treatment at earlier times in their lives and finally to have a variety of corrections, such as energy therapy and Brain Gym, not available elsewhere.

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