Information on Pain Tolerance, Massage Pain, Discomfort during Deep Tissue Massage Sessions

For those who want to go the alternative route to treat their back pain, instead of getting surgery, massage may be the best bet. A new study demonstrates that it is superior to both acupuncture and self-care for this frustrating and debilitating condition. Experts agree that often the best way to manage chronic back pain is to use several therapies at once, and therapeutic massage may be an important part of the package. “This provides some scientific evidence that massage may be useful for people with chronic back pain,” investigator Daniel C. Cherkin, Ph.D.

According to the National Institutes of Health, 70-85% of people experience back pain at some time in their lives, and it is the most frequent cause of limited activity in people under the age of 45.

Research on Massage Therapy

A July 2001 survey conducted by the American Massage Therapy Association found that the number of adults receiving massages from a massage therapist more than doubled since 1997.

Most healthcare providers are recognizing massage therapy as a legitimate aid for lower back pain and an effective adjunct to lower back treatments. Fifty-four percent of healthcare providers say they will encourage their patients to pursue massage therapy in addition to medical treatment.

A study on massage and back pain conducted at the Touch Research Institute at the University of Miami in 2001 found that: “Massage lessened lower back pain, depression and anxiety, and improved sleep. The massage therapy group also showed improved range of motion and their serotonin and dopamine levels were higher.” (International Journal of Neuroscience, 106, 131-145.)

The most effective type of massage therapy for lower back pain is neuromuscular therapy. Neuromuscular therapy is also called trigger point myotherapy. The American Academy of Pain Management recognizes this form of massage therapy as an effective treatment for back pain caused by soft tissue injury (such as a muscle strain).

Neuromuscular Massage Therapy

Neuromuscular therapy consists of alternating levels of concentrated pressure on the areas of muscle spasm. The massage therapy pressure is usually applied with the fingers, knuckles, or elbow. Once applied to a muscle, the pressure should not vary for ten to thirty seconds.

Massage Therapy Can Reduce Muscle Pain

Muscles that are in spasm will be painful to the touch. The pain is caused by ischemic muscle tissue. Ischemia means the muscle is lacking proper blood flow, usually due to the muscle spasm. This in turn creates the following undesirable process:

Because the muscle is not receiving enough blood, the muscle is also not receiving enough oxygen
The lack of oxygen causes the muscle to produce lactic acid
The lactic acid makes the muscle feel sore following physical activity.

After the muscle is relaxed through massage therapy, the lactic acid will be released from the muscle, and the muscle should start receiving enough blood and oxygen.

Neuromuscular therapy will feel painful at first, but the pressure of the massage should alleviate the muscle spasm. At this point, it is extremely important to communicate with the massage therapist regarding the pressure – whether the pressure is too much, too little, getting better, getting worse. The therapist should listen and respond accordingly. Massage therapy pressure should never be overly painful. In fact, most people describe the pressure as “good pain”.

Definition: Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such
damage."[1] It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone".

^[2]

Pain motivates us to withdraw from potentially damaging situations, protect a damaged body part while it heals, and avoid those situations in the future.^[3] Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease.^[4]

Pain is the most common reason for physician consultation in the United States.^[5] It is a major symptom in many medical conditions, and can significantly
interfere with a person’s quality of life and general functioning.^[6] Psychological factors such as social support, hypnotic suggestion, excitement in sport or war, and distraction can significantly modulate pain’s intensity or unpleasantness.^[7][8

 From Wikipedia, the free encyclopedia

My SPECIALTY is “On the Edge” Deep Tissue Massage. Working in your comfort zone is my specialty. I work on a scale of 1 – 10, where 7 is on the edge and 10 is very excruciating pain. Some discomfort is necessary when receiving deep tissue massage to get results. A lot of my clients handle the deep tissue pain or even like the deep tissue pain in order to get the quickest results for their body type. My style of Deep Tissue Massage releases the body’s natural painkillers whereby it stimulates the release of endorphins, the morphine-like substances that the body manufactures, into the brain and nervous system….kind of like a “Runners High” or a parasympathetic state “rest and digest” of mind.

Pain is a relative term. Having the client involved in the process By slowing down the massage strokes during deep work will often solve the pain problem for the client. A little bit of soreness/tenderness can be normal after a rigorous massage, especially if the therapist was working on muscles that aren’t used to being manipulated. DOMS (Delayed Onset Muscle Soreness) is fairly common in people who aren’t used to regular massage. It’s the same feeling you get when you exercise for the first time in a while. DOMS will subside over time and shouldn’t last more than 48 hours. Some relief can be obtained using damp-heat – hot bath or shower, heat pack, steam room/sauna. Of course, any tingling, numbness, or shooting pain is a sign that a nerve is involved and the therapist should stop working that deep.

The Drama of Pain

“Does that hurt.” It really depends on you and your attitudes toward pain. An area hurts in direct relation to its degree of aberration (something that deviates from the normal way or a disorder of the mind.) One needs to ask themselves what is my attitude toward change.

Humans resist change. Somewhere deep down, they feel that somehow they have made it under existing circumstances. What assurances do they have that they’ll continue to make it given a different set of circumstances? Conservatism, the tendency to maintain and protect the status quo, to avoid the unknown, to avoid change, is universal. We call that habit patterns the index of the least effort. The experience of change to the average person often manifests itself as pain.

The force from life or emotional and physical force that is not converted into movement does not simply disappear but is dissipated into the damage done to joints, muscles, and other parts of the body (the brain).

 (Ida Rolf, Rolfing, P. 275- 284 )

Myofascial pain syndrome

Myofascial pain syndrome (MPS), also known as Chronic myofascial pain (LMT), is a condition characterized by chronic and, in some cases, severe pain. It is associated primarily with “trigger points“, localized and sometimes extremely painful lumps or nodules in any of the body’s muscles or connective tissue is known as fascia. Other symptoms include referred pain, restricted movement, and sleep disturbances. ^[1]

Symptoms

Myofascial pain can occur in distinct, isolated areas of the body, and because any muscle or fascia may be affected, this may cause a variety of localized symptoms. More generally speaking, muscular pain is steady, aching, and deep. Depending on the case and location the intensity can range from mild discomfort to excruciating and “lightning-like”.^[2] Knots may be visible or felt beneath the skin. The pain does not resolve on its own, even after typical first-aid self-care such as ice, heat, and rest.^[3]

Causes

The precise cause of MPS is not fully understood and is undergoing research in several medical fields but there are some systemic disorders, such as connective tissue disease, that can cause MPS.^[4] There may be postural, emotional, and behavioral contributing factors.^[5]

Treatment

Massage therapy using Trigger Point release techniques may be effective in short-term pain relief.^[6] Physical therapy involving gentle stretching and exercise is useful for recovering the full range of motion and coordination. Once the trigger points are gone, muscle-strengthening exercise can begin, supporting the long-term health of the local muscle system.^[7]

Three different drug categories are used in the treatment of myofascial pain: anti-depressants (primarily SNRIs), calcium channel blockers such as Pregabalin (Lyrica), and musculoskeletal relaxants such as Baclofen.^{[citation needed]}

Complementary therapy called myofascial release, using gentle fascia manipulation and massage is believed by some to be beneficial and pain-relieving.^[8]

A systematic review concluded that dry needling for the treatment of myofascial pain syndrome in the lower back appeared to be a useful adjunct to standard therapies, but that clear recommendation could not be made because the published studies were small and of low quality.^[9]

Posture evaluation and ergonomics may provide significant relief in the early stages of treatment.^[10] Movement therapies such as the Alexander Technique and Feldenkrais Method may also be helpful.^[11]

MPS versus Fibromyalgia

MPS is often discussed alongside fibromyalgia. However, these two conditions are not the same, and neither is one exclusive of the other; patients may have either condition or both.^[12] The primary difference between the two conditions is the pain pattern. By accepted definition, fibromyalgia is associated with generalized pain, occurring above and below the waist and on both sides of the body. In contrast, MPS pain is localized and may be detected by observing the myofascial trigger points in one or more specific areas.^[13]

Neither MPS nor fibromyalgia is thought to be an inflammatory or degenerative condition, and the best evidence suggests that the problem is one of an altered pain threshold, with more pain reported for a given amount of painful stimuli. This altered pain threshold can be manifest as increased muscle tenderness, especially in certain areas, e.g., the trapezius muscle. These syndromes tend to occur more often in women than in men, and the pain may be associated with fatigue and sleep disturbances.^{[citation needed]}

From Wikipedia, the free encyclopedia

Pain Tolerance: How much can you take?

Pain tolerance is the maximum amount of pain someone can tolerate. Researchers often test for pain tolerance using a similar standard: the cold pressor test (CPT). During a CPT, a person immerses her/his hand in cold water. Researchers note the time when pain is felt and when pain is no longer bearable. This time test gives them a good idea of how much pain the person can tolerate.

And guess what? We all have different tolerance for pain. But why are some people pain resistant and stoics while others are wimps? And are people with a lower pain tolerance are higher risk of drinking or taking drugs

Different levels of tolerance for pain: Why?

Experts do not yet agree on why we have different levels of pain tolerance. However, there are three main possible causes, and perhaps is it a combination of these factors which result in the range of more and less pain-sensitive people.

1. Inborn, genetic differences
2. Psychological differences
3. Cultural differences
4. Gender differences

Genetic pain tolerance – In terms of genes, if you get a certain genetic variation (a Val allele of the val158met polymorphism) from both parents, you get a strong COMT enzyme that metabolizes dopamine, resulting in more pain relief. And if you get a met allele from both parents, your pain sensitivity is high. And if you get one Val allele and one met allele, your pain tolerance is somewhere in between the two ranges.

Pain tolerance and psychology – Additionally, psychology might explain pain tolerance as a result of “mind over matter.” In fact, some people can even control their reaction to pain consciously. People can increase pain tolerance a number of ways. Some examples include stimulating positive emotions to override negative emotions during stressful situations, suppressing pain via distraction, or by training and conditioning, the mind to focus attention elsewhere can help minimize pain.

Social and cultural learning related to pain tolerance – A person’s individual reaction to pain is also subject to cultural influences. Training about how to should respond to pain and discomfort, or what is socially appropriate can influence pain tolerance. And these learned behaviors can transfer to gender differences and how we expect men and women to react to pain. So although research supports the existence of sex differences in pain (men can take more pain for longer than women); social learning may be a stronger influence on pain response than biological mechanisms.

Can low pain tolerance lead to drug use?

Yes and no. Drug dependence and pain perception share common neuro-anatomical and neurophysiological processes. And research has shown that psychoactive drug users experience decreased pain tolerance. In other words, people who take drugs have a low tolerance for pain. But does this mean that if you have a low tolerance for pain that you will turn to drugs or become a drug addict?

No.

If you have a low tolerance for pain, pain killers, and pain medications can really help you. But if you have been prescribed and are taking pain medications as prescribed, your body may become dependent on them, but not your mind. Although it is true that many drug addicts look to drugs to relieve pain (either physical or emotional), not all people who take drugs become addicted to them. If you would like to know the difference, check out the top 10 signs of pain pill addiction here.

Reference sources: The gene for pain tolerance
Gender role expectations of pain
Wiki on pain tolerance
Wiki on cold pressor test

Lateral Dominance, Pain Perception, and Pain Tolerance

Pain tolerance

Pain tolerance is the maximum level of pain that a person is able to tolerate.^[1] Pain tolerance is distinct from pain threshold (the point at which pain begins to be felt).^[2]

Factors affecting pain tolerance

Clinical studies by the journal of Psychosomatic Medicine found that “men had higher pain thresholds and tolerances and lower pain ratings than women”.^[3] The study asked participants to submerge their hands in ice water (the cold pressor pain procedure) and was compensated financially for keeping their hands submerged.^[4] A similar study by the same journal focused on the effects of having individuals perform the ice water procedure while accompanied by another participant. Their results revealed that “Participants in the active support and passive support conditions reported less pain than participants in the alone and interaction conditions, regardless of whether they were paired with a friend or stranger. These data suggest that the presence of an individual who provides passive or active support reduces experimental pain.”^[5]

Effect of exposure to pain

It is widely believed that regular exposure to painful stimuli will increase pain tolerance – i.e. increase the ability of the individual to handle pain by becoming more conditioned to it. However, this is not true – the greater exposure to pain will result in more painful future exposures. Repeated exposure bombards pain synapses with repetitive input, increasing their responsiveness to later stimuli, through a process similar to learning. Therefore, although the individual may learn cognitive methods of coping with pain, these methods may not be sufficient to cope with the boosted response to future painful stimuli.^[6] “An intense barrage of painful stimuli potentiates the cells responsive to pain so that they respond more vigorously to minor stimulation in the future.”^[7]

Because of this, trauma victims (or patients in pain) are given painkillers (such as morphine) as soon as possible – to prevent pain sensitization.^[6]

Kalat suggests that morphine should be taken before surgery;^[6] “People who begin taking morphine before surgery need less of it afterward.”^[8]^[9]

From Wikipedia, the free encyclopedia

Why Does Pain Tolerance Differ Among People?

Pain has been a topic of discussion in a lecture on many occasions, perhaps because pain is something that most experience, but want to avoid. Though most experience some form of pain, incidents vary in intensity and people’s reactions are of different extremes, as well. Why? What causes these differences in pain tolerance? It was determined in class that pain is the result of certain pattern generators in the nervous system, so it is only natural that one looks to the brain to get to the root of pain tolerance. Research has been done that claims the source is genetic, psychological, or even gender-based. But in fact, this student believes that pain tolerance is the result of a combination of at least these three conditions.

The first, and most evidentially-supported, argument—the genetic explanation—revolves around the gene that codes for COMT, an enzyme that metabolizes, or breaks down, the neurotransmitter dopamine. Dopamine delivers signals from one brain cell to another, and so can theoretically proliferate pain signals throughout the nervous system. But, COMT depletes the dopamine supply in the brain, freeing receptors in the brain to which the dopamine was bound so that they are available to bind to endorphins, which lead to pain relief (1,3)

The studies did recently on COMT deal with the common val158met polymorphism, in which methionine is substituted for valine at codon 158, causing a “three- to four-fold reduction in the activity of the COMT enzyme” (3). Two alleles code for the expression of this gene: Val and met, resulting in an instance of codominance. If an individual receives a Val allele from both of his/her parents, the COMT enzyme that is produced is strong, i.e. it readily metabolizes dopamine so that less pain is felt. If an individual receives the met allele from both parents, the COMT enzyme produced is weak; dopamine builds up, suppressing the body’s supply of natural painkillers, or the endogenous opioids (endorphins) so that that individual suffers from low pain tolerance. A heterozygote, receiving the Val allele from one parent and the met allele from another parent, has a pain tolerance that lies somewhere in between that of the homozygotes. In summary, the stronger the COMT, the more receptors that are freed from the grips of dopamine and so the more endorphins that are able to bind to these receptor sites and the more relief from pain that is felt (1, 3, 4).

The lead researcher on the COMT project, Dr. Zubieta, cautions that pain tolerance cannot logically be explained by a single gene, an argument supported by the fact that COMT has other functions in the body; however, COMT must play a very large part in the differences seen in individuals. This statement leads this student to look elsewhere for other explanations of ranges in pain tolerance: psychology.

The psychological research done on this topic operates under the understanding that pain can be manifested in negative emotions, such as anxiety, depression, and anger, to name a few. These researchers argue that these negative emotional responses to pain stimuli can be counterbalanced by positive emotional responses; in one very compelling study, the positive emotional responses were produced by sexual fantasies. The subject was told to immerse his/her arm in ice water until he/she could no longer bear the pain. Then, the subjects were separated into three groups: one group was instructed to envision a neutral fantasy (e.g. walking); another group was instructed to envision a sexual fantasy, and the third group was not given any specific instructions. Then, each group underwent the same submersion task as before. Interestingly, those subjects that were asked to think of a sexual fantasy while experiencing pain “handled pain better and experienced less pain [than the subjects under other conditions]. They also were less anxious and depressed, and less angry.” In general, the subjects under the sexual fantasy condition were able to endure the pain for longer. The pleasant emotions produced by the thought of a sexual fantasy counteract the unpleasant thoughts that are a result of pain. The implications of this are that if a person enduring a painful experience imagines something that evokes in them positive emotions, they are able to cope with the pain better, and actually report experiencing less pain. Conversely, if a person experiences negative sensations from sources other than the painful experience in combination with the painful experience, the subject cannot endure as much pain and reports experiencing more pain than other subjects (2).

Psychology accounts for aspects of tolerance that genetics cannot: “mind over matter.” There is a possibility that two people can tolerate the same amount of pain, but that one voices their felt pain more readily than someone else. This could arguably be because one person is mentally stronger than the other. One person might feel an unbearable amount of pain but stays quiet, does not medicate, goes on with his/her day, etc, while another person, under the same physical stress, manifests his/her pain in moaning, pill-popping, crying, being bed-ridden, etc. Maybe that person that seems stronger has conditioned him-/herself to suppress such manifestations of pain, or maybe he/she has been conditioned by society so that this idea of “mind over matter” is actually cultural (i.e. feeling pain is a sign of weakness, and in some cultures, weakness is looked down upon more severely than in others). This conscious suppression of reactions to pain must then involve the I-function, an aspect of the nervous system in which the genetic explanation would not be involved. But, obviously, this cannot be the only explanation for the wide ranges of pain tolerance seen across humanity. The research is quite convincing but does not take into account the genetic explanation for pain tolerance, just as the genetic explanation does not take into account this theory. So, it leads this student to wonder to what extent pain tolerance is genetic, and to what extent is it psychological? Furthermore, is anything else involved in a person’s tolerance level for pain? And in fact, this student has found some research that suggests gender has something to do with it.

Researchers have found that estrogen can act as a natural painkiller. Higher estrogen levels result in higher pain tolerance, and lower estrogen levels cause effectively lower pain tolerance in subjects. Granted, the study was done only in women, but it is curious that hormones can affect how one deals with pain. Though this student did not find any research that inspected estrogen levels in males or levels of male-specific hormones like testosterone, the studies examined here open yet another door through which pain tolerance may pass. Now, one can question whether these significant changes in pain tolerance are due to estrogen levels specifically, or to hormone levels in general. Furthermore, estrogen levels change with menstruation so that a woman’s pain tolerance would, theoretically, also vacillate with changes in the body. So, though genetics and psychology may play a part, a woman’s pain tolerance is not constant but is subject to manipulations by hormones (3, 5).

It seems that combining the knowledge gained on different theories of pain tolerance—genetic, psychological, and hormonal explanations—leads one to the conclusion that pain tolerance is an intricate neurological output. Not only is one’s basic threshold for pain determined by the presence of certain forms of a gene, but it can be pushed one way or the other by changes in hormone levels and one can conditions him-/herself to live and work through the pain. In conclusion, this student argues that some aspects of pain tolerance are spontaneous and incontrollable; but a large part of it lies within the I-function.

Works Cited

(1) “Gene Controls Pain Threshold”, http://news.bbc.co.uk/1/hi/health/2784869.stm

(2) “Sexual Fantasies Increase Pain Tolerance”, http://www.hopkinsmedicine.org/press/1999/DEC99/991216.HTM

(3) “The Gene for Pain Tolerance”, http://www.bio.davidson.edu/courses/genomics/2003/talbert/pain.html

(4) “Can’t Stand the Pain? Your Genes Might Be to Blame”, http://www.med.umich.edu/opm/newspage/2003/paingene.htm

(5) “Pain and the Brain: Sex, Hormones & Genetics Affect Brain’s Pain Control System, Shaping a Person’s Pain Perception”

http://www.med.umich.edu/opm/newspage/2003/painbrain.htm

By  dmckeever

Pain Tolerance, Dimensions of Pain