The world of medical research is not unfamiliar with the pattern: chronic pain and presentations of poor mental health often go together. It’s a well-established comorbidity. This often brings with it a sensible question – which came first? Did the chronic pain trigger the presentation of mental illness, or did the mental illness increase the experience of chronic pain.While we let the world of traditional medical research unravel that ball of yarn, it seems chiropractic has another story emerging through case reports – an emerging pattern whereby the alleviation of chronic pain through subluxation-based care seems to also happen alongside and improvement in poor mental health.
A recent case report published in the Asia-Pacific Chiropractic Journal adds to the growing body of evidence that chiropractic care may improve mental health outcomes through the resolution of chronic pain. [1]
CW: This article speaks about suicidal ideation
Case Details
After seeking help from 14 other health practitioners with no relief, a 49-year-old female presented for chiropractic care with chronic neuropathic pain in her head, neck, face, and shoulders. She also reported struggles with suicidal thoughts, depression, and insomnia. Previously, she had undergone a cervical block procedure and had been a regular practice member (so she was not new to chiropractic care, however the course of the last seven years had interrupted care).
She rated her neuropathic pain between a 5 and 10 out of 10 on a numerical pain scale, and reported it had been this way for approximately seven years. Due to the severity and persistence of the pain, she disclosed that she had contemplated ending her life and was afraid that if she was unable to receive help, she may proceed to do so within the next five years.
The chiropractor noted a range of secondary complaints that the patient was experiencing, likely further reducing her quality of life and ability to cope, including insomnia, fatigue, headaches, low back pain, neck pain, brain fog, poor concentration, and poor digestive function. The patient believed her poor mental health was tied to the chronic nature of her pain and its impact on her daily life.
Multiple levels of subluxation were found throughout the spine and pelvis, as well as reduced range of motion at the cervical and thoracic spine. X-ray findings revealed a reversed cervical lordosis, moderate degenerative disc disease at C5-6 and C6-7, and a mild thoracolumbar scoliosis. Postural abnormalities were noted in the lumbar spinal region with a leg-length deficiency and accompanying lumbar compression.
Other notable findings included hypertension, reduced lung capacity, along with a range of clinical measures that gave insight into how her nervous system was functioning (reduced heart rate variability, and abnormal thermography and surface EMG readings).
The patient’s care plan consisted of two visits per week for 12 weeks, during which a full spinal evaluation and adjusting would occur at each visit, with the aim of optimising neural functioning.After the initial care plan, the schedule was adjusted to weekly sessions, then fortnightly visits for 24 and 48 weeks respectively. Reevaluations were completed every 12 weeks. The patient was adjusted using Diversified, Thompson, and Activator methods.
Additional care recommendations included gentle home exercises targeted at enhancing mobility, and collagen, vitamin D3, omega 3, and magnesium supplements.
The Results for this Person
At the end of the initial care plan, significant improvements were noted in both the objective measures and the patient’s self-reported measures. She reported a decrease in her lower back, knees, and neuropathic pain. She also reported improved sleep quality and comfort, fewer headaches, greater mobility and activity, a more regular menstrual cycle, and improved capacity to handle stress. The patient had observed more positive thinking and stated that her will to live had been restored.
Objective changes included an improvement in her blood pressure, postural, heart rate variability, sEMG, and thermography readings. The patient reported the changes exceeded her expectations and had given her a new lease on life. She was now capable of being active, had returned to regular exercise, and was no longer feeling trapped by pain.This is significant given the level of distress she was under prior to commencement of this care plan.
The chiropractor did not offer specific mental health support, as doing so is beyond the scope of practice in this jurisdiction. The only care offered was nervous system support through checking and adjusting subluxations.
What does this mean for chiropractic?
As always, a case report is insight into how one person responded to care, and we can’t generalise until larger studies are done. With that said, case reports can show us patterns and trends when viewed together.
This case report is not the first to suggest a connection between chronic pain and mental health. [2-4] In broader medical research, the increased likelihood of poor mental health outcomes in individuals with chronic pain is well documented. It makes sense; limiting a person’s ability to enjoy and participate in their everyday life, impairing their sense of autonomy, would begin to impact how a person perceives themselves, their life, and their future. It also makes sense that the improvement of this pain and limitation is likely to reverse poor mental health outcomes.
Additional factors that may have improved the neuropathic pain, and subsequently the mental health outcomes of this patient, include the effect chiropractic adjustments may have on cortisol release and inflammatory mediators. Segmental inhibition of the nociceptive process and inhibition of temporal summation may have also influenced the ongoing pain – i.e. the way spinal segments moved or did not move may have altered input into the brain and thus how the person experienced pain intensity. It is speculative, as it would require larger studies to confirm and isolate the mechanism behind the improvement. However – it makes sense.
Chiropractors have often said that we should be adding years to life and life to years. Cases like these remind us why evaluating and seeking to improve quality of life is of such value to our communities. This case also suggests chiropractic care may offer hope for those who feel like they have tried everything with no improvement.
On one level, it lines up with research indicating that chiropractic care can create changes at the brain level and not just the spinal level. On another, it shows that we do not yet fully understand the impact of what we do.
In this case it may have just created a life-changing difference for a person who had lost hope. That is really something.
References
- Treahy-Geofreda T, Lanoue B, Postlethwaite R, McIvor C. Pain and ideation of self-harm in a 49y female addressed with chiropractic care leading to decreased pain and improved QoL: A case report. Asia-Pac Chiropr J. 2023;4.2.
- 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
- Hughes F. REDUCTION OF CORTISOL LEVELS AND PERCEIVED ANXIETY IN A PATIENT UNDERGOING CHIROPRACTIC MANAGEMENT FOR NECK PAIN AND HEADACHE: A CASE REPORT AND REVIEW OF THE LITERATURE. JCC. 2020;3(1):14-20.
- Russell, David & Glucina, Tanja. (2019). REDUCED ANXIETY SYMPTOMS IN A PATIENT SCREENED WITH THE PHQ4 RECEIVING CHIROPRACTIC CARE: A CASE REPORT AND REVIEW OF THE LITERATURE. 2. 41-48.
