Reflex pain is a complex condition that involves the body’s pain withdrawal reflex failing to turn off after the event that triggered the pain, so the pain sensations continue. This is a neurological condition known as the withdrawal reflex. It occurs when the body and brain undergo a chain of reactions to remove an affected body part from dangerous situations/stimuli. A typical example is a vehicle crash or accident. During the process, the body’s reflex muscle\s in the injured area tighten to protect the specific body part/s from further damage.

The reflex can feel like a muscle spasm that goes away over time. However, in the case of reflex pain, the signals keep firing. Reflex pain can occur all over the body as the muscles overcompensate to handle the prolonged pain; secondary injuries often develop. An example could be reflex pain in the ankle caused by injury or problems in the hips and back, where the individual tries to avoid moving the ankle in a specific way to prevent and avoid the pain symptoms. Individuals with reflex pain also experience headaches and referred spine and extremity pain. Reflex pain can become a cycle of symptoms that include:

• Unusual tightness
• Stiffness
• Pain
• Contracture – hardening or shortening of the affected muscles, tendons, or other tissues.
• Decreased functional abilities.

Somatic Pain

Somatic pain causes receptors in tissues including the skin, muscles, connective tissues, joints, and skeleton to be activated. Stimuli like force trauma, vibration, extreme temperature, or inflammation/swelling activate these receptors. The pain is often described as:

• Aching
• Gnawing
• Cramping
• Sharp

Somatic pain is often localized to a particular area that is constant and stimulated by movement. There are two types.

• Superficial pain occurs when everyday injuries activate pain receptors in the skin and mucous membranes.
• Deep somatic pain occurs when stimuli activate pain receptors deeper in the body, including the tendons, joints, bones, and muscles. Deep body pain usually feels more like aching.
• Pain can be confined to a local area or radiate to other areas of the body, depending on the extent of the injury.

Somatic pain can come from a variety of different potential causes that include:

• Injury to joints or bones.
• Trauma.
• Fall or collision that damages connective tissues.
• Strained muscles from overuse.
• Bone fracture.
• Arthritis that causes swelling in the joints.
• Diseases that affect connective tissues.
• Bone or skin cancers.

Sometimes these reflexes can stay in the on position and keep the body from achieving full relaxation.

In the nervous system, a body part is stimulated, and the message travels through the spinal cord and into the brain. The information is processed, then sent back through the spinal cord to the level that activates the specific body part. The reflexes transmit faster staying at the same spinal level without having to travel to the brain and back again.

During reflex pain, the body’s muscles are unable to relax, which is necessary for motion/movement. This prolonged contraction generates added pain and causes imbalances that can decrease excitability in the muscles. This can increase the activation of brain receptors that receive pain signals to respond by telling them to shorten and contract.

Therapy

Body misalignment can cause muscles to spasm, causing the nerves to stretch in an awkward way, compress, and get twisted and tangled around other nerves or other tissues. This disrupts communication resulting in pain, illness, and ailments that can lead to other health problems. Chiropractic care can address reflex pain by realigning the spine and improving joint motion and nerve conduction.

Chiropractic restores the body to its full and proper function by activating the natural healing abilities. Manual and mechanical spinal decompression realigns the vertebrae, reducing swelling, blockages, and nerve stress. A comprehensive examination will identify potential dysfunctional areas of the body using palpitations to identify which muscles are involved. Once identified, chiropractic, massage, and physical therapy options can be prescribed to rebalance the body’s muscles, and restore their ability to contract and relax normally.

• Patient education will be provided concerning self-assessment techniques, instruction on how to treat pain, and an anti-inflammatory diet.
• An exercise and stretching program will help maintain the adjustments, keep the body flexible, and strengthen the body.
• Patients are helped to understand how to take control of their pain.

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References

Biurrun-Manresa J, Neziry A, Curatolo M, Arendt-Nielson L, Anderson O. Test-retest reliability of the nociceptive withdrawal reflex and electrical pain thresholds after single and repeated stimulation in patients with chronic low back pain. Eur J Appl Physiol. 2011;111:83-92

Derderian C, Tadi P. Physiology, Withdrawal Response. [Updated 2021 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK544292/

Muir, J M, and H Vernon. “Complex regional pain syndrome and chiropractic.” Journal of manipulative and physiological therapeutics vol. 23,7 (2000): 490-7. doi:10.1067/mmt.2000.108816

Neziri A, Haesler S, Steen P, et al. Generalized expansion of nociceptive reflex receptive fields in chronic pain patients. Pain. 2010;151(3):798-805

Szynkowicz, Peter, and Anthony Petrucci 4th. “Chiropractic Care of a Patient With Complex Regional Pain Syndrome Type 1 (CRPS-1): A Case Report.” Journal of chiropractic medicine vol. 19,2 (2020): 145-151. doi:10.1016/j.jcm.2020.05.001

Yezierski R, Vierck C. Reflex and pain behaviors are not equivalent: Lessons from spinal cord injury. Pain. 2010;151(3):569-577