Pain is an intricate sensation experienced by every individual at some point in their life. Whether it's from an injury, muscle strain, or a headache, pain can be debilitating and distressing. While treatments like acupuncture, dry needling, massage, massage guns, use of golf ball, TENS, etc, have been known to provide pain relief, the mechanism behind their effectiveness is usually mistaken for structural changes like the release of trigger points, unblocking of nerves, breaking down of knots, etc. One fascinating concept that sheds light on one of the mechanisms of these therapies and pain relief is known as Diffuse Noxious Inhibitory Control (DNIC), also known as conditioned pain modulation (CPM). DNIC is the body's own pain relief mechanism, capable of alleviating pain. In this blog, we will explore how DNIC works and understand its role in various pain-relieving therapies.
Diffuse Noxious Inhibitory Control involves the complex interplay between pain signals in the body and the brain's pain processing centers. It refers to an endogenous pain modulatory pathway which has often been described as "pain inhibits pain". It occurs when the response from a painful stimulus is inhibited by another, often spatially distant, noxious stimulus.
When the body experiences pain, such as a head hit or a shin blow, it sends pain signals through nerve pathways to the brain. In response, the brain initiates pain perception, making the individual acutely aware of the discomfort.
DNIC comes into play when a second, more intense pain stimulus is applied to the body. Surprisingly, this stronger stimulus activates inhibitory mechanisms in the brain, releasing painkillers like endorphins, leading to the suppression of pain signals from both sources. The brain prioritizes the perception of the more significant pain, essentially dulling or blocking the sensation from the initial injury. This phenomenon results in pain relief without a change in the structure of the underlying tissues.
Various traditional and alternative therapies that involve poking, rubbing, pressing, and application of access pressure or temperature (no wonder hot water shower feel good! But, the mechanism behind temperature therapies like hot and cold application go beyond just DNIC) such as acupuncture, dry needling, massage gun, etc have been reported to provide effective pain relief. The brain prioritizes the perception of the more significant pain, essentially dulling or blocking the sensation from the initial injury. DNIC offers a plausible explanation for this seemingly paradoxical effect.
Acupuncture, for example, involves the insertion of thin needles into points on the body, unrelated to the site of pain. This process triggers the body's DNIC response, leading to the release of endorphins and other natural pain-relieving chemicals. Similarly, dry needling and massage can activate DNIC by introducing additional sensory input, thereby reducing pain perception from an initial injury or source. Moreover, it also helps highlight the lack of specificity of these techniques, which are usually used to market these therapies/techniques.
DNIC is an everyday phenomenon that most of us have utilized without even realizing it like pressing your temples for that nasty headache or pressing that one random spot on a sore limb or scratching of an itchy spot. A common scenario occurs when a child accidentally bumps their head against a hard surface. As a parent, instinctively, you may rub or press the affected area gently. Remarkably, this action introduces a more intense sensory stimulus, which activates DNIC. The child often finds relief from the pain of the initial bump due to the brain's inhibitory response.
Another example is when you accidentally hit your shin on a hard object. As you clutch and rub the painful area, you're applying pressure, and the rubbing motion provides a strong sensory input. This activates DNIC, leading to the suppression of pain signals from the injured shin, resulting in pain relief.
Diffuse Noxious Inhibitory Control is a fascinating mechanism that allows the body to naturally alleviate pain by inhibiting pain signals from various sources. This phenomenon plays a crucial role in the effectiveness of pain-relieving treatments, where the therapies trigger DNIC without making any structural or mechanical difference. Understanding DNIC's role in pain relief allows us to receive the benefit of the above-mentioned therapies/ techniques without the unnecessary fear imposed by these on the patients.
As often explained, the cause of pain is multifactorial and so is the solution to it. Even though it might seem like the treatment is working, there might be additional factors like the natural history of the disease, regression to the mean, contextual effects like effects related to the treatment environment, relationship, and perceptual elements, expectations (having high expectations from a technique tends to produce better results) and confirmation bias.
Natural pain relief at its finest, but not fairly consistent, but make sure you can now tune down the elaborate and extensive reasons for how these things help in pain relief to just "it feels good"!
As always, stay informed, be proactive, and keep moving!
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