Chiropractors have a number of ways to work out problems in your joints and soft tissue:

• High-velocity low-amplitude spinal manipulation therapy (HVLA SMT). This is the “adjustment” most associated with chiropractic care. The chiropractor pushes a joint, usually in your spine, beyond its normal range of motion with one or more quick, forceful thrusts.
• Joint mobilization. Here, the joint is worked gently through its natural range of motion, looking for places where movement is restricted.
• Stretching and massage.
• Heat and/or cold therapy.
• Transcutaneous electrical nerve stimulation (TENS). This device delivers a mild electrical pulse to stimulate your muscles and nerves.
• Ultrasound. Sound waves can help relieve pain and swelling in joints and soft tissue.
• Low-level laser. A type of laser that doesn’t generate heat can also bring down swelling.

When you live with pain, it can affect every single part of your life and compromise your quality of life. But in order to know how to best approach pain and its treatment, it is important to first understand what pain is, what causes it, how pain works, and what purpose it serves.

Is Pain Universal to All Animals?

Pain might be the one sensation that is common to all animals. There are enough similarities in the common vertebrate physiology to suggest that, even though we aren’t sure about exactly how different species feel pain, we know that they do feel it.

Moreover, scientists claim that invertebrates too have the physiological capability to detect and react to harmful stimuli. Their reactions of withdrawing and escaping seem to confirm this theory.

Pain is one of the most universal sensory experiences, even if it does not present in emotional and psychological factors for all species.

Understanding Pain as a Protective Mechanism

it is safe to say that it’s one of the oldest evolutionary protective mechanisms in nature and that it predates the human race.

Pain is the body’s reaction to the so-called noxious stimuli – stimuli from some sort of damaging experience. In that sense, pain is actually an adaptive trait – the evolutionary result of natural selection.  The pain message tells us when we need to escape or withdraw from a damaging influence. This response helps us avoid more extensive potential tissue damage. It also reminds us to be careful with the affected area until our injury heals.

How Do We Feel Pain and What Is the Message Pain Sends?

Pain takes place almost entirely in the nervous system. It starts with an unpleasant stimulus, be it an injury or an internal inflammation. The pain receptors at the end of nerve fibres detect that stimulus. 

On the other end of this pain pathway is the spinal cord. When the stimulus triggers the pain receptor, it sends electrical signals up the neuron to the spinal cord. From there, the pain message is further relayed to the part of the brain called the thalamus. The thalamus sorts the pain signals and directs them to other parts of the brain – namely, the parts in charge of emotions, physical sensations, and thinking.

Pain perception is exactly that – perception. Pain is a construct in the central nervous system, or, more precisely, the brain and spinal cord. The pain stimulus is real, and pain is too, but perhaps not in the way you sometimes think of it.

The pain messages are quite literally a warning bell from the brain. It is the alarm signal the brain uses to tell you that your body is in danger. People who are born with a congenital disorder that prevents them from feeling pain or transmitting pain messages rarely live past the age of twenty-five.

The Difference Between Chronic Pain and Acute Pain

When we talk about acute and chronic pain, it pertains to the duration of the sensation.

Acute pain is temporary. It is caused by pain messages the moment the injury or inflammation is happening and goes away once the tissue has healed. Typically, pain that lasts under 6 months is considered acute pain.

Chronic pain, or persistent pain, can be present due to persistent tissue damage or inflammation. However, sometimes it lingers even after the damage has healed. In some cases, the pain is not a symptom but rather part of a pain disorder.

Chronic pain usually occurs when some part of the nervous system – like the receptors, the neurons, or the spinal cord – become easily activated or fail to function properly due to an injury.

Chronic pain often persists even when there is no visible damage, an occurrence called nociplastic pain.

The Characteristics of Pain

Pain is a subjective feeling. There is some indication that MRI scans of the brain might reveal the objective intensity of pain, though not common practice yet.

pain is mostly measured through self-assessment. Accuracy is important so that the patient can get the best diagnostics and treatment. In order to get the clearest possible picture, it is important to determine several characteristics of pain:

• Intensity (from mild to severe pain, usually on a scale of 1 to 10)
• Location
• Duration
• Alleviating and aggravating factors 
• The descriptive quality of the pain – whether it’s a sharp pain, a stabbing sensation, throbbing, pressure, cramps, or some other feeling.

Types of Pain

depends on where the pain originates, as well as what types of nerves transmit the pain signals from the pain receptor to the brain.

Nociceptive pain

Nociceptive pain is pain from injury. It is the pain that occurs due to tissue damage or the possibility thereof. Arthritis pains are nociceptive. There are many reports of successfully using red light therapy for arthritis pain.

This type of pain gets its name from nociceptors – the pain receptors that register noxious stimuli. The stimulus in question can be heat, cold, chemical, or a physical force. These peripheral nerve endings then send the pain signal about the injury to the spinal cord and the brain.

Once the damage has occurred, it is usually followed by inflammation in the injured area. Inflammation is a useful body response that promotes healing. However, it can be extremely painful and even a gentle touch can cause intense inflammatory nociceptive pain.

Neuropathic pain

This type of pain arises from injury or damage to nerve cells or nerve tissue. Nerve pain is usually perceived as shooting or stabbing and it can be triggered even by a very light touch.

Persistent pain from damage to the nerves can easily become chronic pain so it is crucial to treat it in an adequate and timely manner.

Algopathic Pain

Algopathic pain is the kind of pain that occurs in conditions and disorders which cause long-term pain all over the body, such as fibromyalgia. In these conditions, the pain is the main problem, rather than a symptom of some underlying damage.

Visceral and Somatic pain

Depending on where it occurs, pain can be somatic or visceral.

Somatic pain is usually associated with the skin, muscles, bones, tendons, and joints. It is also the most common type of cancer pain.

Visceral pain is the aching pain that affects the internal organs.

All of the different types of pain can be either visceral or somatic.

Living With Pain and Pain Management

Living with pain is not only physically challenging but also mentally and emotionally draining. Chronic pain in particular can be a very trying emotional experience for patients and it is often accompanied by stress so great it can lead to depression and anxiety. That is why the treatment of pain may require a multidisciplinary approach.

Treatment of pain at our office includes Chiropractic treatment with physical therapy, but also significant lifestyle changes, like a diet change, reduction in stress, and increased physical activity. Additional treatments such as massages or non-pharmacological pain management tools are also be helpful.

One of the most effective ways to help your body manage both acute and chronic pain is red light therapy. Therapy using red and near-infrared light stimulates the body’s natural healing mechanisms which help reduce and, ultimately, get rid of the pain for good. 

Pain has sensory and emotional components and is often classified as acute or chronic. Acute pain is frequently associated with anxiety and hyperactivity of the sympathetic nervous system (eg, tachycardia, increased respiratory rate and blood pressure, diaphoresis, dilated pupils). Chronic pain does not involve sympathetic hyperactivity but may be associated with vegetative signs (e.g., fatigue, loss of libido, loss of appetite) and depressed mood. People vary considerably in their tolerance for pain.

Acute pain, which usually occurs in response to tissue injury, results from activation of peripheral pain receptors and their specific A delta and C sensory nerve fibers (nociceptors).

Chronic pain related to ongoing tissue injury is presumably caused by persistent activation of these fibers. However, the severity of tissue injury does not always predict the severity of chronic or acute pain. Chronic pain may also result from ongoing damage to or dysfunction of the peripheral or central nervous system (which causes neuropathic pain).

Nociceptive pain (pain caused by tissue injury) may be somatic or visceral. Somatic pain receptors are located in skin, subcutaneous tissues, fascia, other connective tissues, periosteum, endosteum, and joint capsules. Stimulation of these receptors usually produces sharp or dull localized pain, but burning is not uncommon if the skin or subcutaneous tissues are involved. Visceral pain receptors are located in most viscera and the surrounding connective tissue. Visceral pain due to obstruction of a hollow organ is poorly localized, deep, and sometimes cramping and may be referred to remote cutaneous sites. Visceral pain due to injury of organ capsules or other deep connective tissues may be more localized and sharp.

Psychologic factors modulate pain intensity to a highly variable degree. Thoughts and emotions have an important role in the perception of pain. Many patients who have chronic pain also have psychologic distress, especially depression and anxiety. Because certain syndromes characterized as psychiatric disorders (e.g., some somatic symptom disorders) are defined by self-reported pain, patients with poorly explained pain are often mischaracterized as having a psychiatric disorder and are thus deprived of appropriate care.

Pain impairs multiple cognitive domains including attention, memory, concentration, and content of thought, possibly by demanding cognitive resources.

Many pain syndromes are multifactorial. For example, chronic low back pain and most cancer pain syndromes have a prominent nociceptive component but may also involve neuropathic pain (due to nerve damage).

Pain transmission and modulation

Pain fibers enter the spinal cord at the dorsal root ganglia and synapse in the dorsal horn. From there, fibers cross to the other side and travel up the lateral columns to the thalamus and then to the cerebral cortex.

Repetitive stimulation (e.g., from a prolonged painful condition) can sensitize neurons in the dorsal horn of the spinal cord so that a lesser peripheral stimulus causes pain (wind-up phenomenon). Peripheral nerves and nerves at other levels of the central nervous system (CNS) may also be sensitized, producing long-term synaptic changes in cortical receptive fields (remodeling) that maintain exaggerated pain perception. This process of chronic afferent input causing increased sensitivity (lower thresholds) and remodeling of central nociceptive pathways and receptors is termed central sensitization. It explains why the following occur:

• Allodynia (pain response to a nonpainful stimulus)
• Hyperalgesia (excessive pain response to a normal pain stimulus)

Substances released when tissue is injured, including those involved in the inflammatory cascade, can sensitize peripheral nociceptors. These substances include vasoactive peptides (e.g., calcitonin gene-related protein, substance P, neurokinin A) and other mediators (eg, prostaglandin E2, serotonin, bradykinin, epinephrine).

The pain signal is modulated at multiple points in both segmental and descending pathways by many neurochemical mediators, including endorphins (e.g., enkephalin) and monoamines (eg, serotonin, norepinephrine). These mediators interact in poorly understood ways to increase, sustain, shorten, or reduce the perception of and response to pain. They mediate the potential benefit of CNS-active drugs (eg, opioids, antidepressants, antiseizure drugs, membrane stabilizers) that interact with specific receptors and neurochemicals in the treatment of chronic pain.

Psychologic factors are important pain modulators. They affect how patients speak about pain (e.g., in a stoic, irritable, or complaining way) and how they behave in response to it (e.g., whether they grimace), but they also generate neural output that modulates neurotransmission along pain pathways. Psychologic reaction to protracted pain interacts with other CNS factors to induce long-term changes in pain perception.

In initial consultation, questions to gain insights into the possible causes of the pain are asked and request for different tests to pin down a joint pain diagnosis may be ordered.

Patient might need one or more of the following tests:

• An x-ray of the affected joint(s)
• Blood tests to detect autoimmune disorders 
• Joint aspiration to check for crystals, white blood cell count, and infection 
• Complete blood cell count 
• C-reactive protein and/or sedimentation rate blood tests to check for inflammation

The diagnostic process for joint pain can take a while if the cause is difficult to identify.   you will be given strategies for pain management during the process.

For acute joint pain with a clear cause, such as overuse, rest (avoiding activities that cause pain or swelling), and simple at-home care are enough may be recommended to reduce soreness and improve joint pain. recommend hot and/or cold therapy, warm baths, compressive or supportive aids, specific types of stretching and exercise, over-the-counter anti-inflammatories, and other types of supportive care for mild sprains and other forms of acute joint pain may be recommended.  

Other conditions causing joint pain might require pain management, antibiotics, or even surgery. Chiropractic care including physical therapy will be initialed. Tips on preventing joint pain in the future.

Chiropractic care plan is initiated for Chronic joint pain. This will set the patient on a path of relief.

There are different autoimmune blood tests that aid in the diagnosis of autoimmune diseases as related to joint pain. Autoimmune diseases are those in which the immune system attacks normal cells and tissues with inflammation.

Some of the most common autoimmune diseases include:

Some of these tests detect signs of inflammation or increases in proteins (like ferritin) that are hallmarks of autoimmunity. Other detect substances called autoantibodies that direct the immune assault. There is no single test that can diagnose the over 80 types of autoimmune diseases.

C-Reactive Protein (CRP)

The C-reactive protein (CRP) test is used to measure the level of a protein that is produced by the liver and released into the bloodstream in response to inflammation.

Increased CRP levels can provide evidence of inflammation that commonly occurs with autoimmune diseases as well as infections, cancer, and other diseases.² The CRP is important because the absence of inflammation could exclude autoimmunity as a cause.

Interpretation of CRP levels is as follows:

• Less than 0.3 mg/dL: This is considered normal for most healthy adults.
• 0.3 to 1.0 mg/dL: Mild elevation can be seen with obesity, pregnancy, depression, diabetes, common cold, gingivitis, periodontitis, sedentary lifestyle, smoking, and genetic polymorphisms.
• 1.0 to 10.0 mg/dL: Moderate elevation indicates systemic inflammation, such as occurs with autoimmune diseases and diseases like cancer, heart attack, pancreatitis, and bronchitis.
• More than 10.0 mg/dL: Marked elevation generally signals an acute infection, systemic vasculitis, or major trauma.
• More than 50.0 mg/dL: Severe elevation may be caused by severe bacterial infections or sepsis.

Erythrocyte Sedimentation Rate (ESR)

The erythrocyte sedimentation rate (ESR) test measures how quickly erythrocytes (red blood cells) collect at the bottom of a test tube. Normally, RBCs settle slowly. A faster-than-normal rate generally indicates inflammation in the body.

The normal range for ESR measured in millimeters per hour (mm/hr) is:³

• Infants: 0 to 2 mm/hr
• Children: 0 to 10 mm/hr
• Males under 50: 0 to 15 mm/hr
• Males over 50: 0 to 20 mm/hr
• Females under 50: 0 to 20 mm/hr
• Females over 50: 0 to 30 mm/hr

As with the CRP test, a high ESR could indicate an autoimmune disease or other inflammatory conditions. On the flip side, a normal ESR may be an indication that autoimmunity is not involved.

Antinuclear Antibodies (ANA)

Antibodies are proteins your immune system produces to fight foreign agents like viruses and bacteria. On the flip side, autoantibodies are proteins produced by the immune system that inappropriately attack healthy cells.

Antinuclear antibody (ANA) is one type of autoantibody that attacks the nucleus (center) of cells.⁴

The ANA test is primarily used to diagnose lupus but may also indicate other autoimmune diseases like rheumatoid arthritis, scleroderma, or Sjögren’s syndrome.   An ANA result is negative or positive based on the concentration of the autoantibodies in a sample of blood  

ANA Accuracy in Diagnosing Lupus

About 95% of people with lupus have a positive ANA test result. Other indicators are including a butterfly-shaped rash on the cheeks and nose, hair loss, mouth or nose sores, and fingers that turn white or blue when cold or stressed (Raynaud’s syndrome).⁵

Ferritin

Ferritin is a protein produced by the liver that the body uses to store iron inside of cells until it is ready to be used. High ferritin levels (hyperferritinemia) can be a sign of inflammatory diseases, infections, or cancer. It may also be a sign of autoimmune disease.⁷

• Adult males: 20 to 250 ng/mL
• Adult females 19 to 39 years: 10 to 120 ng/mL
• Adult females 40 years and over: 12 to 263 ng/mL

Anything over these values may be suggestive of an autoimmune disease.

Anti-Cyclic Citrullinated Peptide (Anti-CCP) Antibodies

Anti-cyclic citrullinated peptide (anti-CCP) antibodies are another type of autoantibody associated with rheumatoid arthritis. While specific to rheumatoid arthritis, the anti-CCP test is not a particularly sensitive one.

With a sensitivity of roughly 70%, the test will return a false-negative result in three of every 10 tests. On the other hand, it has a specificity of 96%, meaning that a positive result is almost always diagnostic of rheumatoid arthritis.⁹

Anti-CCP results are described as negative or positive based on international units per milliliter of blood (IU/mL):¹⁰

• Negative: Less than 20 IU/mL
• Positive: 20 IU/mL and over

The interpretation can vary from one lab to the next.⁹

Rheumatoid Factor (RF)

The rheumatoid factor (RF) test detects an autoantibody closely linked to rheumatoid arthritis. The RF autoantibody can also be found with other autoimmune diseases like juvenile arthritis and lupus as well as tuberculosis and certain cancers like leukemia.

RF results are described as negative or positive based either on the titer or IU/mL values:¹¹

• Negative (titer): Less than 1:80
• Positive (titer): 1:80 or over
• Negative (value): Less than 15 IU/mL
• Positive (value): 15 IU/mL or over

Despite the RF test’s usefulness in diagnosing rheumatoid arthritis, around 20% of people with the disease have little or no RF in their blood.¹²

Even so, your healthcare provider may be able to diagnose rheumatoid arthritis by comparing the RF and anti-CCP test results, as follows:¹⁰

• Positive anti-CCP and positive RF: You likely have rheumatoid arthritis.
• Positive anti-CCP and negative RF: You may be in the early stages of rheumatoid arthritis or will develop it in the future.
• Negative anti-CCP and negative RF: You are unlikely to have rheumatoid arthritis.

Immunoglobulin A (IgA)

Antibodies are also known as immunoglobulins. There are three main types: immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM). Of the three, IgA—or specifically the lack of IgA—may indicate an autoimmune disease.

Normal IgA values measured by milligrams per deciliter of blood (mg/dL) vary by a person’s age:

• 0-5 months: 7-37 mg/dL
• 5-9 months: 16-50 mg/dL
• 9-15 months: 27-66 mg/dL
• 15-24 months: 36-79 mg/dL
• 2-4 years: 27-246 mg/dL
• 4-7 years: 29-256 mg/dL
• 7-10 years: 34-274 mg/dL
• 10-13 years: 42-295 mg/dL
• 13-16 years: 52-319 mg/dL
• 16-18 years: 60-337 mg/dL
• Over 18 years: 61-356 mg/dL

Several other, more routine tests can detect inflammation, but abnormal levels in these tests may not necessarily be a sign of autoimmune disease, including:

• Fibrinogen: 200 to 400 mg/dL
• Haptoglobin: 410 to 1,650 mg/L
• Albumin: 3.4 to 5.4 g/dL

Less Common Autoimmune Tests

  Some specific antibody tests may recommend include:

• Anti-double-stranded DNA (lupus)
• Extractable nuclear antigen (lupus, Sjogren’s systemic sclerosis, inflammatory myositis, mixed connective tissue disease)
• Anti-signal recognition particle tests (inflammatory myositis)
• Anti-neutrophil cytoplasmic antibody (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, inflammatory bowel disease)
• Complement complexes (lupus)
• Cryoglobulins (Raynaud’s syndrome)
• Lupus anticoagulant, anti-cardiolipin, or anti-phospholipid autoantibodies (lupus, antiphospholipid syndrome)