Editor's note: Dr. John Upledger has asked Tad Wanveer, LMT, CST-D, to share his insights on CranioSacral Therapy. Part 2 of Tad's article, along with a complete list of references, will run in the November issue of Massage Today.

CranioSacral Therapy has proven to be a powerful complement to massage therapy in addressing chronic pain. While massage can effectively address abnormal somatic patterns through the musculoskeletal system, CST approaches somatic disturbances through the craniosacral, fascial and central nervous systems.

Chronic pain can range from mild tissue irritation to intense suffering and disability affecting an individual's entire body, psyche and life. What's more, the perception of pain often persists long after the injured tissue has healed. This can cause compensatory patterns that continue to maintain the sensation of pain, eventually leading to abnormal somatic and visceral changes that frequently mask the primary cause of the chronic pain. "Nineteen percent of American adults, almost one in five, suffer from chronic pain."¹

CranioSacral Therapy can be used to identify and help the body change core patterns contributing to chronic pain. It also effectively addresses its associated symptoms, such as musculoskeletal imbalance, trigger points, myofascial dysfunction, chronic fatigue, immune system dysfunction, autonomic nervous system dysfunction, elevated heart rate, high blood pressure, endocrine system dysfunction, stress, anxiety, hypothalamic dysfunction and sleep difficulties.

Chronic pain has a multitude of causes, including congenital disorders, spinal disorders, musculoskeletal imbalance, compensatory patterns, surgery, scar tissue, disease processes, trauma, infection, overuse, disuse and misuse. "The common denominator of conditions that cause chronic pain is irritation of the nociceptive (pain cell) endings, axons, or processing circuits causing abnormal activity that is interpreted as pain."²

Recent research points to central nervous system adaptation as a common contributor to chronic pain. "Many chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck/shoulder pain, certain types of chronic low back pain, fibromyalgia and others - essentially might be explained by abnormalities in central pain modulation."³

Body tissue often responds to pain through habitual muscle tension, postural distortion, diminished tissue mobility, thickening and congestion of the fascia, decreased blood flow to painful areas, a build-up of metabolic waste products, adverse strain on the peripheral, central and autonomic nervous system tissues, and an overall sense of fatigue.

Persistent peripheral nerve strain due to muscular imbalance, tension, injury or infection might lead to a flood of chronic activity and excessive sensitivity of local nociceptors. This can cause a continual bombardment of signals into the central nervous system. It's as though there is a constant roar of pain information focused on the brain and spinal cord. 

The central nervous system tissue might respond by undergoing any number of adaptive changes. Thickening and inflammation of the membrane layers surrounding the spinal cord and brain might occur, leading to irritation and lack of normal motion of central nervous system tissue, imbalance and restricted mobility of the spinal column, or adverse strain on the peripheral nervous system.

Spinal cord neurons receiving chronic pain signals from the periphery also can undergo long-term change due to the activation of microglial cells (central nervous system immune cells), because abnormally increased sensitivity (sensitization) of the nerve cells might occur. This can maintain a state of overwhelming activity of the pain pathways, thus causing constant pain sensation.

Normally, there is a balance of inhibitory and excitatory stimulation where the pain cell synapses (communicates) with the spinal cord neuron. However, decrease of inhibition at the synapse might occur. When this takes place, the neuron will tend to stay in a state of stimulation. This is another cause of excessive sensitivity and activity of pain pathway and chronic pain sensation.⁴

The spinal cord neurons and glial cells normally produce neurotrophic (vitalizing) elements that are transported to the innervated tissue. A distortion in this supply might occur, leading to tissue devitalization and irritation.⁵ This can lead to a further decrease of normal tissue mobility, which can increase irritation and chronic-pain signals. The nociceptor cells also produce elements secreted by the nerve cell endings (terminal ends) when they're stimulated. These elements create inflammation and heightened sensation of the endings which, in turn, cause the terminal ends to overreact to stimulus and increase the area they receive stimulus from.

This might further create abnormal activity of the pain pathway, which can cause a loop of pain signal dysfunction from the periphery throughout the spinal cord, the autonomic nervous system and the brain. "A very small stimulus which might otherwise be censored out may cause an inappropriately large and indiscriminately wide-ranged neuronal response."⁶