Anyone living with chronic pain knows how debilitating it can be. It’s defined as pain that lasts for more than three months, or in many cases, beyond normal healing time. If you, or someone you know is living with chronic pain, here are some things you need to know…
Pain is a very real, and often a very unpleasant, personal experience. Pain is as real as any other sensory experience such as fear, hunger, thirst, and fatigue. While the experience of pain is very real for the person experiencing the pain, pain is not necessarily an accurate reflection of the damage at the level of the tissues.
‘All pain, no matter where or how it is felt, is produced by the brain.’
There are many factors that influence how much pain a person may experience. Any information that you and your brain sense as a threat may influence pain. Factors such as damage to the tissues, beliefs about pain, fear of movement, poor coping, physical inactivity, and emotional factors can all play a part in how much pain you may experience.
‘Personal beliefs and environmental factors can make a big difference to how we experience pain and how likely it is that pain will persist.’
Pain is the brain and body’s alarm system. It’s designed to protect us from doing damage. For example, having pain when bending and lifting a heavy load. When you have had pain for a long time your system becomes over-protective. For example, having an increase in pain while bending and lifting a smaller amount.
It’s a protector when we have damage to the tissues, or the brain senses the threat of damage to the tissues. Pain then motivates us to protect from further damage e.g. limping on our sprained ankle. If the brain decides there is something more important than protecting a body part, then it may make the decision not to produce pain e.g. feeling no pain during a shark attack.
‘Pain can occur in a body part that is not damaged. Damage can occur in a body part that is not painful.’
Acute pain (lasting less than 3 months) is helpful as it encourages us to protect the area following injury. This prevents further tissue damage and allows time for the injured tissues to heal e.g. making it painful to walk following a sprained ankle.
Persistent pain (lasting greater than 3 months or the expected healing time) is unhelpful as there’s no longer the need to protect the injured area, yet the pain persists. For example, having constant low back pain for the last 10 years.
‘Persistent pain is less to do with injury in our bodies and more to do with our central nervous system.’
Pain is an output of the brain, not an input to the brain. The brain decides on how much pain or protection is required. Factors not related to tissue damage (e.g. pain beliefs, fear of movement) tend to become more and more relevant the longer pain persists.
‘Remember, every pain problem, acute or chronic (persistent), has a thinking, reasoning and emotional brain attached to it.’
Pain does not show on scans. Both people with and without pain will have signs of tissue damage on a scan. These are often ‘normal age-related changes’ and are not the full explanation as to why a person may be experiencing pain
‘There is a high prevalence of ‘abnormal’ findings on MRI (of the low back) in pain –free populations.’
Making sense of pain is the first step in moving forward. This starts from understanding that pain does not equal damage. It’s safe to move and you don’t have to be completely pain-free to start being active again. From this understanding you can begin to overcome a fear of pain and movement and gradually return to the things in life that you enjoy.
‘The way you think about pain is very important. If you understand your pain more, then you feel more in control, make better decisions and experience less pain’
Getting moving again is the second step in moving forward. Similarly to the use of topical pain relief products, exercise plays an important part in feeling stronger, more in control, less scared of moving, more endurance, more confident, and less pain.
There does not appear to be one form of exercise that is greatly superior to another for most forms of persistent pain. The exercise that you enjoy and associate with achieving your goals will help you stick with it.
‘With increased activity and increased confidence, people experience less pain, which in turn leads to further positive changes’
Goal setting is very important for sufferers of persistent pain. The focus of goal setting should be towards improving function and getting back to the things that you are not doing because of your pain, as opposed to being pain free. You should be ready to embark on a journey of recovery as opposed to a quick fix.
‘Start focusing on personal goals instead of how to ‘fix’ the pain.’
Daniel is an Exercise Physiologist and rehabilitation specialist. He is a Soft Tissue Therapist (Remedial Massage) and is a member of the Association of Massage Therapists, ESSA, Fitness Australia and is the founder of Accelr8 Rehabilitation.