is usually a reliable indicator especially if they check off most every box. When does it hurt? Chronic systemic patient presentation will usually say the pain is always present nearly all the time. Mechanical pain is more likely to be episodic based more on certain positions, time of day, and specific activities Does it keep you from sleeping? Chronic systemic presentations always affect restful sleep because when the sympathetic nervous system is always engaged the parasympathetic nervous system is compromised. WHAT What happened? Asking for a specific onset and nature of initial injury is im-portant because they can sometimes suggest a psychogenic component such as PTSD. In which case co-treatment with a mental health professional may be warranted. Other times chronic sys-temic patients are unable to pinpoint one event because the pain has been “going on forever”. What makes it better or worse? Again, typically nothing makes chronic systemic associated musculoskeletal pain better except maybe certain medi-cations when continually or daily con-sumed-sometimes “take off the edge.” Usually any type of activity will worsen the pain after a limited amount of it. What treatments have you tried? It is not uncommon that chronic systemic presentations such as fibromyalgia will have tried “everything” or many treat-ment options. The biggest reason for their lack of success is that there pain is being treated like a purely mechanical problem. WHERE Where is the pain? Even though pain is usually the consequence and not the cause -it’s helpful to know where they are feeling the discomfort. Also, a chronic systemic presentation espe-cially in a long-standing problem will often render the response: “The pain is everywhere” Describe the pain. Lastly, I have the patient describe the pain. Mechanical presentations provide a more distinct description. For example, a sharp back spasm in a distinct quadrant versus a more diffuse presentation in an ongoing chronic problem. Practitioners will find that even if they do not know how to proceed to treat musculoskeletal pain associated with co-morbidities -their clinical results will increase simply because they are not aggravating the patient’s symptoms by applying treatments that amplify the sympathetic nervous system. Do you want to write for Chiropractic and Naturopathic Doctor? Do you have a story to share with your fellow chiropractors and naturopaths? Whether it’s an exciting case study, overview of a new technique, or business tips and tricks (or something completely different), feel free to send an email to our Editor at [email protected] to get the details of how YOU can appear in print and online! #CanadianChiropractor #CanadianNaturopath www.Cndoctor.ca CND_HouseAdwritefor_MayJune21_MLD.indd 1 March/April 2022 Chiropractic and Naturopathic Doctor 7 2021-05-06 9:10 AM
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