The statistics on chronic pain and mental illness in today’s society paint somewhat of a grim picture. We know that one in eight people live with a mental health disorder and that one in five Australians over the age of 45 live with Chronic pain. This number only increases with age, and far from impacting just one aspect of a person’s life, it can also impact quality of life, increase medical expenses and create other economic costs [1-3]. Further to that, chronic pain and mental health issues have long been observed to present together in many cases. Aspects of their relationship are still being investigated in research, such as causal factors and predisposition. Some new theories are emerging, such as the likelihood that inflammation may be a factor in both chronic pain and mental health issues such as major depressive disorder [4].
While solving this puzzle may be a challenge for researchers and scientists, the reality is that in the everyday life of chiropractors and the people under their care, it’s our problem too. A recent case report aptly pointed out that “inflammation has been identified as the mediator of both depression and chronic pain, activating pathways responsible for the transition of acute to chronic pain and sickness to depression [4]. While researchers lock down the mechanisms behind this, we are left with the question, “So, what can we do about it?”
We know that chiropractors care for the nervous system by checking for and adjusting subluxations, and that according to the chiropractic paradigm, this allows the body to function better, working as the self-healing, self-regulating organism that it is meant to be.
A recent case report published in the Asia Pacific Journal of Chiropractic as a part of the ASRF Case Report Project (2022) examined the co-occurrence of chronic pain, ligament instability and depression and charted the progress of the patient as they underwent a course of concentrated chiropractic care.
The Case
A 65-year-old female presented for chiropractic care with the main complaint of chronic depression and chronic pain. At the time of presentation, she was a novice to subluxation-focused chiropractic care. There was no medical history of car accidents, concussions, brain injuries, or whiplash. However, she did have a history of opioid use for pain management, previous use of street drugs, and was currently using marijuana to manage her worsening pain.
Additionally, there was a history of extended mental and emotional stress and abuse. Her struggles with depression had spanned several years, and she was finding it was worsening despite using antidepressant medications. Along with her depression, her chronic pain was also increasing in severity. The patient reported concerns of addiction to white sugar and had hopes of regaining control of her health and mental health in the future.
Her chronic pain was said to radiate from her low and mid-back into her left hip and foot. Her right hip had already been surgically replaced due to pain. Multiple layers of subluxations were present in all regions of the body. Cervical ligament instability of 3.43mm at C4-C5 was found. This, in itself, is a notable finding. Cervical ligament instability often goes undiagnosed and can cause significant irritation within the central nervous system, contributing to higher levels of inflammation. The study’s authors noted that “The American Medical Association has created a standard of diagnosing cervical ligament instability of 3.5mm as a permanent medical disability which causes a 25-28% full body impairment rating for the patient. This standard has existed in the AMA guidelines in the 3rd, 4th, 5th and 6th editions”.
Cervical ligament instability can be the basis for surgical intervention due to the impairment it causes to the central nervous system and a person’s overall quality of life. We are familiar with the risks of surgery and that it is not always a suitable option for many individuals. Approach chiropractic care, as observed in this case, can be an alternative intervention with lower risk for patients with ligament instability in the cervical spine. For the patient in the case at hand, ligament instability was resolved within a concentrated care plan of 41 low-level force spinal chiropractic adjustments, over a 5-day period.
The study’s authors noted that “This case shows a life-changing regeneration of ligamentous and disc tissue, neurological function, and overall quality of life for the patient.” As to the high number of adjustments delivered in the short time-period, this was part of a concentrated care program under the Averio Institute’s functional neurological protocol.
The aims of care were to regenerate the patient’s ligament instability in the mid-cervical spine, with secondary aims of re-establishing normal spinal positioning and structure. These aims were believed to be driven by the improvement of the patient’s neurological function and central nervous system regulation.
Outcomes
Rated on a scale of 1-10, with 10 indicating the best the patient could expect to experience and 1 indicating the worst patient could expect to experience, the patient reported an improvement in quality of sleep from 7/10 to 10/10. She also reported an increase of 2 hours of sleep each night, only requiring 10 minutes to wind down for sleep. She rated her energy during the mornings improved from a 5/10 to an 8/10. Her pain had resolved completely, with significant improvement in the proportion of her thoughts that were negative and her feelings of depression.
The original case report also discussed micronutrient findings, which were taken as part of the intake protocol. This provided insight into the possible underlying substrates of inflammation in this case. The medical history of the individual under care revealed no trauma, car accidents, concussions, falls or whiplash injuries that may have caused the ligament instability. This suggests that there was another starting point for the inflammatory load – such as chemical, emotional or mental stresses. While this perhaps provides a rationale for further investigation into how ligament instability occurs, there is another point in this case. To quote the authors once again “With more than half of the patients presenting to primary care with chronic depression also report some form of pain, finding effective and feasible resolutions is vitally important. [4]”
Once again, a stand-alone case report does not give us room to generalise, and thus further studies are required to explore the causes of inflammation and ligament instability. That said, this case report paints a great picture of dramatic improvements under chiropractic care. And that is something we all would like to see more of.
REFERENCES:
- Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx), (https://vizhub.healthdata.org/gbd-results/, accessed 14 May 2022)
- Australian Institute of Health and Welfare. Chronic Pain in Australia. https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/summary ISBN: 978-1-76054-669.4
- Yong, R. Jasona,*; Mullins, Peter M.b; Bhattacharyya, Neilc.Prevalence of chronic pain among adults in the United States. PAIN 163(2):p e328-e332, February 2022. | DOI: 10.1097/j.pain.0000000000002291
- McIvor C, Postlethwaite R, Kolterman S, Martin A. Depression, ligament Instability and chronic pain improvement concomitant with a course of concentrated Chiropractic Care: A Case Report. Asia-Pac Chiropr J. 2023;3.3 URLnet/Papers-Issue-3-3/#AverioDepressionChronicPain
