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Modulation – This refers to the adjustment of pain intensity carried out by the nervous system’s antinociceptive system. As everyone knows, the pain of an acute injury often fades within seconds or minutes. Based on tissue healing times, the injury is certainly not “healed” at this point, yet the pain fades allowing the body to return to more normal function. As Whitten, etal, write in their article Treating Chronic Pain: New Knowledge, More Choices (The Permanente Journal/ Fall 2005/ Volume 9 No. 4) this is a perfect example of the Melzack and Wall Gate Theory:

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Conversely, non-nociceptive chronic pain offers an entirely different picture. It begins with changes in what are known as NMDA receptors that lie in the cleft between neurons. When an initial pain stimulus goes on too long, these NMDA receptors become sensitized, which triggers a cascade of events that leads to CNS hypersensitization. This is referred to in the literature as “central windup”. As this process kicks in, NMDA activation alters the balance of neurotransmitters, changes the firing threshold of nerves, and induces synthesis of different gene proteins, among other things. All of this together leads to:

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This requires that we help them understand that they are working from an incorrect model through no fault of their own. It is very important here that you use care in communicating what you believe to be the cause of their pain. Remember, if you always return to explaining their pain via a structural explanation, this is what they will latch on to.

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