Chiropractic + Naturopathic Doctor • September 2015 • Roundup

A new study from American and Canadian researchers challenges common belief males and females process pain similarly.

The assumption has always been that a common pain circuit exists in both sexes that is altered by circulating hormones like estrogen.

University of Alabama at Birmingham (UAB) researcher Robert Sorge and colleagues from three laboratories in the United States and Canada found this assumption may be false, and that males and females may use very different biological systems to process pain. The key sex difference appears to be in the immune system, and under control of the male hormone, testosterone.

“Realizing that females likely process pain differently than males will allow us to focus on creating alternate pain therapies for each sex,” said Sorge, an assistant professor in the department of psychology in UAB’s College of Arts and Sciences.

It is now known the immune system does more than fight off infection, and actually works in conjunction with the nervous system. For example, experiments have shown that one immune cell, called microglia, is critical for pain processing. When activated by injury like inflammation or nerve damage, it sounds the alarm by changing shape and releasing chemicals that communicate with neurons in the spinal cord to turn up the volume knob of pain.

The findings show this process only occurs naturally in male mice. Interfering with the function of microglia in a variety of ways blocks pain in male mice, but has no effect in female mice. A completely different type of immune cell, called T cells, appears to be responsible for releasing the same chemicals and sending the same signal in female mice.

“Given that women greatly outnumber men as sufferers of chronic pain, one might wonder why it is that this sex difference was not noted until now,” Sorge said. “The reason is that, as in most pain research, the overwhelming majority of the studies of microglia and pain were performed only on male rats and mice.”

The U.S. National Institutes of Health recently unveiled a new policy, similar to one already in force in Canada, to require use of female animals and cell lines in preclinical research.

“The current findings from this paper are an excellent example of the wisdom of this policy,” said Sorge.

The research was published in Nature Neuroscience online, and funded by Canadian Institutes for Health Research, Louise and Alan Edwards Foundation, and the U.S. National Institutes of Health.

Chiropractors are required to spend several years in preparing themselves for international sporting events such as the 2015 Toronto Pan Am and Parapan Am Games. This preparation is comprised of four years of undergraduate studies and four years of chiropractic studies.

The Toronto Pan Am and Parapan Am Games, held across Ontario from July to August 2015, are perceived as one of the most glorious sporting events by medical teams. Elite athletes from all over Latin America, South America, the Caribbean and North America spent several years preparing themselves for the Games. Many of them see participation in the Games as the peak of their sporting careers. In the same respect, local healthcare providers see it as an opportunity to work with elite athletes in a new and exciting environment.

The TO2015 Organizing Committee, in seeking the necessary support to attain a high level of proficiency and care for the Pan Am athletes, has established several performance criteria for health professionals who aim to participate in the Pan Am and Parapan Am Games as part of the host medical team. In order to meet the committee’s criteria and obtain a volunteer position at the Games, health professionals were required to take an online course, attend training sessions onsite, and ensure that they have all the necessary documentation signifying that they are licensed or registered to practice in Ontario.

For those that came from out-of-town, extra steps had to be taken to acquire the necessary funds to support travel, accommodations, food and a temporary licence. Previous experience in working with sports teams is a criterion as well.

The first choice positions were given to health professionals who met the criteria, and therefore ensured their participation in the Pan Am and Parapan Am Games. As one of those chosen to participate in the medical teams, I would like to share some insights from that experience

Our medical team for the Pan Am Games canoe/kayak sprint event, located in St. Catharines, Welland and Henley in Ontario, consisted of medical doctors, chiropractors, physiotherapists, athletic therapists, nurses, paramedics and massage therapists. Working with Pan Am athletes for a short period of time was a complex and demanding process, requiring health-care providers to effectively plan their treatment program, exhibit a high level of commitment, and create a positive and trustful climate between them, the athletes and coaches.

Based on our experience of providing interventions to elite paddlers, two practical tips for chiropractors who work with top-level international athletes are suggested.

First, chiropractors should focus on what they are capable of doing best. As chiropractors, we have a variety of interventions available, and we can adopt various approaches of consultation.

It is recommended that chiropractors develop their own approach based on their individual experience, expertise and professional knowledge.

Second, chiropractors should cooperate regularly with the rest of the professional staff working with the elite athletes. Psychological preparation is one type of preparation in the domain of sport. There are other preparations, such as the physical, technical and tactical, which are probably perceived by the athletes and coaches as more important than the psychological one.

Therefore, chiropractors have to cooperate with other professionals, such as coaches, nurses, physicians, massage therapists, paramedics and physiotherapists, who are working with the elite athletes. Chiropractors have to understand the objectives of each of the other preparations and listen carefully to requests made by the other health professionals to achieve a naturally synthesized training program for the Pan Am athletes.

This cooperation between chiropractors and other professionals should be maintained throughout the entire preparation period, during the Games, and several months after the event.

Communication was key as well. Members of the health-care team, located in St. Catharines, Ont., used Google Translate to communicate with Spanish speaking paddlers.

New friendships and connections were developed througout the duration of the Games. Health professionals from the medical team and elite paddlers exchanged training shirts and jackets as souvenirs, as both wanted something that would allow them to relive the experience after the Game

By Dr. Emily Roback Dr. Emily Roback is a Calgary-based chiropractor with LCP Health, and owner of Iron Mountain Integrative Health. Roback was part of host medical team at the recent 2015 Toronto Pan Am Games. She can be contacted at [email protected]