Marsha Haller, MD, Medical Acupuncture

Dr Haller’s 50 Pound luggage theory of pain


 Imagine you are at the airport checking your bags on the way home from a fabulous vacation.   As you had feared, your suitcase, stuffed to the gills, weighs in at over 50#. This threshold that triggers a predictable response—the agent will not accept your suitcase without a really big surplus baggage fee.   Therefore, you try to remove as much weight from it possible. It doesn’t matter if you take out the rocks, the shoes, books, jewelry or sacred artifacts. Or one of each. A couple of ounces here, a couple of ounces there, and little by little you get it down below the 50# cutoff and you’re good to go.

This is analogous to what happens in pain. A certain amount of input to your nervous system is required for it to trigger the sensation of pain. Maybe your nerves are pinched a little bit near the spine by arthritic changes at the vertebrae. Your back muscles are really tight, which creates a squeeze on the poor nerves that have to run right through them, and the piriformis muscle in you buttock is too tight because you never take the time to stretch. Each of these adds a bit more to the burden of irritation on your sciatic nerve. But if you are tired, or you are on you period, your pain threshold goes down, which means it will take less total pressure on the nerve before it hurts. If you are anxious, depressed or both, that changes the activity at many different sites in the central nervous system to boost unpleasant sensations, and imbue them with particularly alarming meaning. And bingo, you are in pain.   You get the picture.

Usually, many different things are happening simultaneously when you have pain. Just as many individual items add weight to your suitcase of pain, so too there are many ways of lightening the load. You have physical therapy to improve pelvic floor function, and that takes off some “weight”, but alas, you are still in pain. So, you put some heat or patches on your back, and that takes off a pound or two. Nothing is going to make the arthritic changes go away, but if you hug your knees to your chest, that stretches your back, creating more room between the vertebrae for nerves to pass through. Less pinch on nerve roots— by maybe half a pound.   Then you try a little acupuncture, and that reduces the cumulative burden by, lets say, another pound. After that, you put on a mindfulness meditation tape, but repeatedly fall asleep to the man’s boring voice, so in the end it’s only worth a few ounces. Nevertheless, it’s just enough to bring your “suitcase of pain” down below the threshold. The end result of it all is that you feel better. So, don’t scoff at any one intervention because it doesn’t seem powerful enough to be a magic bullet.



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