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Research on Degenerative Disc Disease

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Degenerative disc disease or DDD, is in fact the degeneration of the Intervertebral disc, which refers to the fibrocartilage that lies between adjacent Vertebrae* in the spine and clusters of chondrocytes**, both being suggestive to repair. The main Cause of the development of Degenerative disc disease is aging: As the body ages, the discs in the spine dehydrate or dry out, and lose their ability to act as shock absorbers between the vertebral bodies. The bones and ligaments that make up the spine also become less flexible and thicken. These conditions become more of an issue due to the minimal blood supply to the discs, unlike the muscles; so they lack reparative powers. In this process, fibro-cartilage replaces the gelatinous mucoid material of the nucleus pulposus. Nucleus pulposus is the jelly-like substance in the middle of the spinal disc. Its function is to distribute pressure in all directions within each disc under compressive loads. While this degeneration is a normal process of aging – It is rather a ‘Condition’ than a ‘disease’ – and for some people does not create any physical issues; for others can be accompanied by inflammation, be very painful and hence affecting their life quality dramatically.

This difference is mainly because some people have nerve endings that penetrate more deeply into the outer layers of their discs, producing an area more prone to inflammation and pain. Other factors that can contribute to the development of inflammation and pain, as a result of this condition, are the life styles and the different works that people do. Presumably, people who undertake heavy physical activities and put more pressure on their back, are prone to develop this condition in the earlier stages of their lives, and experience pain as the result. Degenerative disc disease can also lead to other disorders such as: • Narrowing of the canal that houses the spinal cord and nerve roots; known as: ‘Lumbar spinal stenosis’ • Disc slipping forward; known as: ‘Spondylolisthesis’ • Disc slipping backwards; known as: ‘Retrospondylolisthesis’. According to the findings of American Association of Neurological Surgeons (AANS) more than 65 million Americans suffer from lower back pain annually. By the age of fifty, 85 percent of this population will show evidence of disc degeneration; although the vast majority of them show no symptoms related to the condition.

(2) Treatment Options
The first step in the treatment of any chronic or persistent pain is to receive a thorough medical evaluation to determine the cause of the pain. Any techniques necessary for treatment of the condition; will then be based on the diagnosis and the advice of medical professionals. Degenerative disc disease can often be successfully treated with one or a combination of treatments such as Physical Therapy, Chiropractic therapy, Osteopathic or Chiropractic manipulation, or indeed with the use of anti-Inflammatory drugs. Spinal injections could also provide relief from the pain produced. However, if pain from degenerative disc disease is severe, traditional non-operative treatment is often ineffective. In such cases, a suitable surgical operation from a list of surgical treatments available for this condition will be used. The signs that indicate the possible need for surgery include: Weakness or numbness in legs, leg or back pain limiting normal activity, difficulty walking or standing, and medication and physical therapy are ineffective within two to three months of being in use. Use of Hypnosis

Today, the important role the mind plays in chronic pain is clearly recognized in the medical literature. The International Association for the Study of Pain states that: “pain is always subjective, and is defined by the person who experiences it.” It is also known that pain is not only a sensation, like vision or touch, but rather chronic pain is strongly influenced by “the ways in which the brain processes the pain signals.” This of course, refers to the complex physical process initiated when the cause of pain is triggered – in this case, for example when a pressure is applied to the discs – the generated signals, leading to the cortical arousal and the associated hormonal and neural processes, which is then interpreted as ‘pain’. Therefore, our brain can ‘learn’ to manage the sensation of pain. Using the mind, to control chronic pain through effective coping strategies, may be used alone or in conjunction with other pain management therapies. Hypnosis is used to reduce the pain perception in two general ways: Post-hypnotic suggestions; that reduce pain when it is felt, and Self-hypnosis. Many features of Hypnosis are employed in the effective management of pain by Hypnotherapy.

For example, ‘Relaxation of the whole body’, leads to the ease of the muscles and hence the ease of the nerves that signal pain, causing the reduction or sometimes extinction of the signals at the sensory level. Relaxation also helps by reducing the feelings of fear and anxiety; that are common feelings associated with pain. ‘Visualisation’ is the most used and a very effective feature of hypnosis in pain management. For example ‘Visual imagery and distraction’ involved in concentrating on mental pictures of pleasant scenes – part of the relaxation process – and also creating controllable images that represent pain.

‘Dissociation’ is also commonly used in pain management Inductions, this could be in the form of suggesting the subjects to ‘mentally separate themselves from the painful body part’, or ‘imagining the body and mind being separate from each other, and hence the chronic pain being also in the distance from the mind’ or similar suggestions. Hypnosis also facilitates the direct control of pain through the use of different techniques, such as: introducing adjustable ‘pain dial’ or ‘pain switch’ that can control the degree and duration of pain, suggesting the production of ‘Endorphin’, and bathing the aching part of the body in the produced substance, or the use of other imageries such as ‘Glove Anaesthesia’. The degree to which one can tolerate a specific pain, depends on two main characteristics: the site of the pain, and its subjective dimensions – i.e. its intensity and duration. The closer the area of pain gets to the trunk of body – body centre – and the longer and more intense; the less tolerable it becomes.

In the case with degenerative disc disease, as the location of pain is within the trunk of the body, and therefore it is more deeply felt; focusing only on relaxation to reduce or eliminate pain, may not be enough. In such cases, after the initial relaxation and the deepener procedures, the introduction of a more specific technique for pain control, such as “Glove Anaesthesia” or other pain controlling techniques mostly involved with the use of ‘imageries’ are used. These techniques are introduced during the Hypnotherapy with the use of suggestions such as: “.. Recognize and accept pain, relax the muscles around the painful part, and imagine washing away the discomfort by a flowing water that is running over and through the painful area, and washing pain away from the body..” Or: “Imagine entering into the tunnel of pain, this tunnel is yours, you can own and control it… See the light at the end of the tunnel, that light is your target.. it is where you can reach and win over your pain… now, start taking steps towards that light… every step you take, will distance you more and more.. from the pain, and takes you closer and closer.. to being more in control, and achieving freedom from the pain…”

The choice of using any of such techniques, being made by the Hypnotherapists, will be based on the specific needs of the patient with relevance to the quality of pain, and the patient’s personality and characteristics. The flexibility that hypnosis provides in the treatment of any painful condition, is due to the fact that there are no hard lines between the available pain relief techniques that could be used for each type of pain, mainly being: pain developed from Chronic conditions, pain from Surgery, or injury and illnesses. Any technique primarily developed for a specific category; could also be used within the different categories; should the patients’ specific needs trigger such decision being made. Glove Anaesthesia

Glove anaesthesia is an example of the numerous pain relief techniques commonly used in Hypnosis, and although its main use is in surgeries; due to the reasons stated above, it can also be used for other painful conditions including the Degenerative Disc Disease. Prior to the treatment, the patient is asked about his choice of pain relief; i.e. what feeling – heat, coldness or anything else – could produce the sensation of pain reduction or elimination for that individual. Once this has been established, and while the patient is relaxed and in the deepened state of hypnosis, suggestion of numbness production in one of his hands is being made – the one that can easily approach the painful area – This could be either by imagining that hand is being immersed in the hot or cold water, a bowl of ice or any substance that can produce the pain relief sensation. Alternatively, this could be replaced by using ‘Mental anaesthesia’ imagining an injection of numbing anaesthetic into the painful area, or even through pure ‘Imagination’ of the increase or reduction of temperature in the chosen hand. Once the sensation of numbness in that hand has been produced, the subject will be suggested to place the same hand on the painful area, and keep it there until this sensation is transferred into the target area, leading to its numbness, and hence the reduction or elimination of pain.

Because the degeneration of discs is a normal aging process – as it was discussed above, it should be regarded as a condition rather than a disease – it is normally safe for the pain produced as a result of this condition to be completely outside the scope of the patient’s awareness, and except from some rare cases, where the relevant body parts are being abnormally overloaded or abused, the absence of the feeling of pain will generally not lead to an increase in the pathological aspect of this condition. Therefore, with the very good subjects, there is no need to keep a part or an area of pain present. However, in order to avoid a ‘no pain / pain present’ situation resulted from the conflict between the central awareness and the consciousness of the subject, and also considering that pain perception should always have a ‘specified time’ for being turned off; the use of ‘temporary block of pain’ would be more beneficial and safe. (6) Hence suggesting to the subject that for example: “For the next three hours, you will not feel any pain. After that, the pain will ‘gradually’ return – The importance of Control:

The importance of ‘Control’ in pain perception is a well-known phenomenon. Common characteristics influencing pain susceptibility are: – Low motivation, leading to passivity and hence reduction or absence of control over time and energy, – Low self-image, which creates the feeling of vulnerability and lack of control, and – Dependency, such as dependency on others to do daily activities, and the resulting feeling of having no control over one’s life. Hypnosis helps patients to feel, understand and behave in certain ways. This, amongst other benefits, will help patients with the creation or increase of control over their situations, and in understanding and positively changing what pain actually signifies to them. Throughout the different stages of Hypnotherapy: from the initial consultation, where the waking hypnosis and seeding could be developed, through to the actual Induction, where the post hypnotic suggestions of one or more suitable techniques are being made; and also through the introduction and teaching of Self-Hypnosis; this process of ‘increasing patients’ motivation and control’ takes form, and hence the patients become equipped with one of the most important tools in pain management.

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