Pain is an intricate and multifaceted sensation which serves as a crucial alarm system signalling potential harm to the body. However, the perception of pain is not solely dictated by the severity of tissue damage. Rather, it is profoundly influenced by a myriad of factors, including proprioception and descending inhibition (which we will explore further in this article). Understanding the interplay between these components offers valuable insights into mechanisms that can alter the way you experience pain (‘pain modulation mechanisms’), and opens avenues for therapeutic interventions.
Proprioception and Pain
Proprioception, often referred to as the “sixth sense,” encompasses the body’s ability to sense its position, movement, and orientation in space. This sensory information is conveyed through mechanoreceptors embedded within muscles, tendons, joints, and ligaments. Through intricate neural pathways, proprioceptive signals are relayed to the central nervous system, providing essential feedback for motor control and coordination.1
The relationship between proprioception and pain is complex and bidirectional. Dysfunction in proprioceptive signalling has been implicated in various pain conditions, including chronic low back pain, osteoarthritis, and neuropathic pain syndromes. For instance, altered proprioceptive feedback due to joint injury or degeneration can lead to maladaptive movement patterns, contributing to pain amplification and functional impairment.
Conversely, pain itself can disrupt proprioceptive processing, leading to further motor dysfunction and sensory disturbances. The phenomenon of “pain inhibition of motor control” highlights how nociceptive or “noxious” input can impair muscle activation patterns and alter joint mechanics, perpetuating a vicious cycle of pain and motor dysfunction.2
Descending Inhibition
Descending inhibition, a crucial mechanism of pain modulation, refers to the suppression of nociceptive (noxious) signals at the spinal cord level by higher brain centres. This process involves the release of endogenous pain-inhibitory neurotransmitters, such as endorphins, enkephalins, and serotonin, which act on pain pathways to dampen nociceptive transmission.3
Interplay Between Proprioception, Pain, and Descending Inhibition
Emerging evidence suggests a dynamic interplay between proprioceptive feedback, pain processing, and descending inhibition. Proprioceptive inputs have been shown to influence descending pain modulation pathways, with proprioceptive stimulation eliciting analgesic effects through the activation of endogenous pain-inhibitory mechanisms.
Conversely, pain-induced disruptions in proprioceptive processing may impair descending inhibition, leading to exaggerated pain responses and maladaptive neuroplastic changes within the central nervous system. Dysfunction in descending inhibitory pathways has been implicated in chronic pain conditions characterised by abnormal pain sensitisation and diminished pain modulation capabilities.3
Therapeutic Implications
Understanding the intricate interplay between proprioception, pain, and descending inhibition holds significant implications for the development of novel pain management strategies. Therapeutic approaches targeting proprioceptive enhancement, such as sensorimotor training and proprioceptive feedback interventions, such as chiropractic manual therapy or low force manipulations, may help restore normal sensory-motor function and alleviate pain in individuals with proprioceptive deficits. Chiropractors spend a lot of time studying this and understanding how recent research on this topic can guide treatment choices for people with chronic pain or pain conditions.
Moreover, other interventions aimed at enhancing descending pain modulation, such as mindfulness-based practices, cognitive-behavioural therapy, and non-invasive brain stimulation techniques, offer promising avenues for enhancing endogenous pain-inhibitory mechanisms and attenuating pain perception.4
Conclusion
Proprioception, pain, and descending inhibition represent integral components of the body’s pain processing system, intricately intertwined in a complex network of neural interactions. By clarifying the mechanisms underlying their interplay, researchers and practitioners can uncover novel therapeutic targets for the management of chronic pain conditions, ultimately improving the quality of life for individuals suffering from persistent pain.
If you are interested discussing the treatment of pain, our chiropractors would love to help. For more information, call us on (07) 5580 5655 or to make a booking online visit https://spinesportfeet.com.au/booking/
References:
1. https://www.griffinot.com/what-is-proprioception/
2. Meier ML, Vrana A, Schweinhardt P. Low Back Pain: The Potential Contribution of Supraspinal Motor Control and Proprioception. Neuroscientist. 2019 Dec;25(6):583-596. doi: 10.1177/1073858418809074. Epub 2018 Nov 2. PMID: 30387689; PMCID: PMC6900582.
3. Pain Facilitation and Inhibition – Physiopedia (physio-pedia.com)
4. Pak SC, Micalos PS, Maria SJ, Lord B. Nonpharmacological interventions for pain management in paramedicine and the emergency setting: a review of the literature. Evid Based Complement Alternat Med. 2015;2015:873039. doi: 10.1155/2015/873039. Epub 2015 Mar 31. PMID: 25918548; PMCID: PMC4396997.
