Chronic pain is pain that lasts longer than three months. The mechanism of chronic pain, whether it is spinal or peripheral joint pain is similar; a dysfunction of pain processing cells in the brain

Many people in North Carolina have chronic low back pain, pain lasting more than three months  A random telephone survey of adults in North Carolina by Knauer, S.R., Freburger, J.K., and Carey, T.S. (2010), revealed that 26% had chronic low back pain. A similar study (Freburger, J.K., Holmes, G.M., and Agans, R.P., 2009) found a 10.2% prevalence of chronic low back pain. Katz, J.N. (2006) reported that the cost of low back pain in the United States in 2005 was more than $100 billion..

 Complex regional pain syndrome (CRPS) is a chronic pain condition following nerve injury where an upper or lower extremity becomes  hypersensitive and is characterized by local sympathetic changes such as temperature, sweat, swelling, and muscle irregularities   Chronic low back pain and CRPS both result similar anatomical and physiological changes in the brain

I have found two effective ways to help people in chronic pain. I use these techniques in addition to other effective physical therapy interventions for spine and joint pains

Therapeutic Neuroscience Education(TNE) was developed by Adrian Louw  PT, Phd. CSMT. He found that anxiety and stress facilitates the brain mechanisms that intensify pain signals. Education that the cause of heightened pain is due to brain changes and not to worsening of an injury helps to decrease anxiety and stress and to normalize changes in the brain

Visual mirror feedback (VMF) is very effective for patients with CRPS. The patient covers the painful extremity with a mirror box so that the mirror on the box reflects the opposite extremity. The patient first moves the same joint on the side that doesn’t hurt as the most painful joint on the side that does. The patient sees the reflection of the non- painful joint moving and visualizes that reflection to be the painful joint moving without pain. The patient then moves both joints simultaneously.  This activity causes normalization of the pain processing cells that communicate to the painful extremity and often results in the pain disappearing

A study by Mortimer Mosely in 2006 showed that Guided Motor Imagery, a process that used VMF, was more significantly more effective in resolving CRPS than convention physical therapy and medical management. Most of my CRPS patients have had their pain improve following these two interventions

Here are links to more information