Osteopathy and chronic pain management
What is chronic pain ?
“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in these terms” (IASP).
The term "Sensory" means that we can specify the characteristics of the pain: its location? what to compare it to? its intensity? its evolution over time?
The term "Emotional" means that, by nature, the pain being unpleasant, it can be more or less bearable, painful, distressing.
Pain is a subjective and individual phenomenon, which makes it difficult to communicate.
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Pain acts as a warning signal. Its primary role is to protect the body. Without it, we wouldn’t be aware that a physical injury exists (for example, a fracture). It prompts us to pay attention to the injured area, to recognize danger (for instance, a burn causes an immediate withdrawal reaction to stop the injury), and to seek treatment.
When pain persists, it can also become “memorized.” In situations likely to trigger a previously experienced pain, the spontaneous, reflex reaction is to avoid it.
If acute pain lasts beyond three months, it progresses into chronic pain. This sensation then loses its role as a warning signal: pain is no longer a symptom but becomes a disease.
This category includes certain muscle and joint pain, migraines, and pain associated with nerve damage. The persistence of pain has physical and psychological consequences and leads to changes that contribute to the pain itself: this is what is referred to as pain-disease.
Chronic pain characteristics
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Persistence over time: pain persists well beyond the expected healing time, often more than three to six months.
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Independence from initial stimulus: whereas acute pain is directly linked to an injury or illness, chronic pain may persist even after the initial cause has disappeared, or even without an identifiable cause.
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Emotional modulation: Chronic pain is often associated with mood disorders, such as depression, anxiety and feelings of hopelessness, which can aggravate pain perception.
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Central sensitization: Chronic pain is often linked to a phenomenon of central sensitization, where the nervous system becomes hyper-reactive, amplifying the response to normally innocuous stimuli (such as light touch).
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Functional impairment: Chronic pain sufferers may experience a reduction in their ability to function in daily life, with disruption of sleep, mobility, and social and professional activities.
Factors of pain chronicization
Biological factors :
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Nerve or neuropathic damage: Damage to the nervous system, as in neuropathic pain (e.g. diabetic neuropathy, postherpetic pain), can lead to persistent pain.
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Prolonged inflammation: Chronic inflammatory diseases, such as arthritis or fibromyalgia, can perpetuate pain due to the continuous activation of nociceptors (pain receptors) .
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Neuronal plasticity: lasting changes in pain processing at the level of neural circuits, such as hyperexcitability of spinal cord neurons or loss of natural inhibitory mechanisms, can maintain pain .
Psychological factors:
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​​Stress and anxiety: Chronic stress and anxiety are major factors in the transition to chronic pain. Depression: Depression is frequently associated with chronic pain, not only as a consequence, but also as an aggravating factor. It contributes to a heightened perception of pain and makes pain management more difficult.
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Catastrophism: A tendency to exaggerate the negative consequences of pain can reinforce sensitization pathways in the brain, thereby increasing perceived pain .
Social factors :
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Social isolation: Lack of social support, whether at home or at work, can aggravate chronic pain by increasing stress and anxiety levels.
Economic factors:
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Unemployment or financial problems can create a vicious circle where psychological stress and material difficulties reinforce pain and reduce opportunities for treatment or rehabilitation .
Behavioral factors :
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Physical inactivity: Physical deconditioning is common in patients with chronic pain. Prolonged inactivity can aggravate pain by reducing muscle strength, flexibility and endurance.
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Self-medication: Prolonged use of medications, such as opioids, without comprehensive pain management can lead to dependency and worsen pain through phenomena such as opioid-induced hyperalgesia.
Osteopathy and chronic pain
The benefits of osteopathy in managing chronic pain
Osteopathy is recognized for its effectiveness in managing chronic pain, particularly through non-invasive manual approaches that aim to restore the structural and functional balance of the various body systems. Several scientific studies highlight the beneficial effects of osteopathy, particularly for chronic musculoskeletal pain, such as lower back pain, neck pain, and tension headaches. Research indicates that osteopathic techniques reduce pain and improve patients' quality of life while being safe and without side effects for the patient. This comprehensive approach promotes modulation of nociceptive pathways, relief of sympathetic hyperactivity, and a reduction in central sensitization phenomena—mechanisms now considered to be major factors in the chronicity of pain.
The main chronic pain syndromes managed in osteopathy and manual therapy
Charbel J. Kortbawi, osteopath in Paris, specialist in chronic pain
The chronicity of pain is a multifactorial process that combines biological, psychological, and social dimensions. To control it, a multimodal approach is required: medical treatments, psychological support, and behavioral interventions work together to neutralize the various factors that perpetuate pain.
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Mr. Charbel Kortbawi, an osteopath in Paris 16, specializes in the management of chronic pain. He holds:
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Diploma in “Chronic Pain Management” (Paris-Sorbonne University);
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Diploma in “Pain and Human Motor Function” (Hauts-de-France Polytechnic University);
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Master's degree in neuroscience.
Thanks to his dual expertise in neuroscience and osteopathy, he can effectively support you in managing your pain and help you benefit from the specific contributions of osteopathy.
