Dealing with chronic pain

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Pain may be a pain, but it does serve a valuable purpose. If we didn’t have pain, we may not realize that there is a problem that needs to be addressed. That said, it is important to understand that it is our brain that decides whether or not to give us pain.

In situations where it would be counterproductive to be in pain, like on a battlefield for example, pain often is not felt until soldiers have made it to safety.

The brain’s job is to analyze all the information that it receives from all our senses and determine whether or not it is in our best interest to be in pain.

So if you are in pain, your brain has somehow concluded that creating pain will serve you – a certain tissue in your body is under threat, and your brain wants you to do something about it. So, if you are in pain, the key is finding out why your brain has made that decision.

The amount of pain one has is unrelated to the severity of the injury. Paper cuts often hurt more than much more serious injuries do. And a paper cut on the tip of the finger would be far more painful to a professional guitar player than to a professional singer, as the guitar player’s job would be directly affected.

So the pain an individual feels depends on context, whether it be gender, culture, age, someone else nearby, fear of what might happen, beliefs about the cause of the pain, what happened last time etc.

It is also interesting to note that frequently amputees feel pain in the limb that isn’t there. Pain therefore, is not about the tissue in question, but rather about the brain’s decision regarding the tissue, and sometimes that decision doesn’t make sense.

Think of pain like a complicated alarm system that is set to protect you. You accidentally touch a stovetop, and the alarm goes off, you instantly feel pain, so you take your hand away before too much damage is done.

Initially physical pain is caused by tissue damage. But if there has been sufficient healing time, and you are still in pain, there may have been a change in the sensitivity of the alarm system (the central nervous system and brain), and it takes less stimulus to set the alarm off, so activities that didn’t hurt before, now do.

Something like those super sensitive car alarms that go off when you walk by on the other side of the street. You are too far away to actually steal the car, yet the alarm went off. 

Chronic pain usually isn’t about the tissue anymore. Instead, the brain is receiving a faulty message that there is more danger to the tissue than there actually is, and is therefore creating pain. 

The alarm goes off way before there is any chance of tissue damage.  So, dealing with chronic pain is frequently about resetting the alarm system to function normally again.

Coping with chronic pain is undeniably difficult. Taking full responsibility for your own pain and treatment is often helpful. Be certain you completely understand your problem and the treatments being suggested.

Be active rather than passive in your coping strategy, and acknowledge your fears without catastrophizing your situation. Be aware that once pain is chronic, pain does not equal tissue damage, and if you always stop the activity once pain starts, over time your life may shrink as your alarm system becomes more and more sensitive.

Movement is necessary to nourish all tissues and systems of the body, so find your baseline in the activity that you want to do, where you know you for sure that you will not flare up, even if all you can handle is 2 to 3 minutes.

Very gradually add time to your baseline over the course of the next days and weeks. Pain flare-ups may happen. Take them into stride and be persistent with your gradual increase in activity.  Over time your alarm system will begin to re-adjust.

This information is from the fantastic book Explain Pain by David Butler M.App.Sc (The Sensitive Nervous System) and Lorimer Moseley PhD, a clinical and research physiotherapist and pain researcher at the University of Queensland.

If you are in chronic pain, get this book, as it will help you understand the physiology of pain, which in itself can often do a lot to relieve it, and it will give you ways to manage and recover from your pain.

It is written for the lay person, and the illustrations by Sunyata are delightful.  If you are a healthcare practitioner dealing with people in chronic pain, reading this book will bring you up to date on the neuroscience behind pain and help you be more effective with your patients.

Related tips:
FEAR = False Evidence that Appears Real
How hormones, neurotransmitters and steroids work
Mind and Body, Psyche and Soma

David; Moseley, Lorimer Explain Pain Noigroup Publications, Adelaide, Australia, 2003

Moseley GL. Pain, brain imaging and physiotherapy–opportunity is knocking. Man Ther. 2008 Dec;13(6):475-7.

Schley MT et al. Painful and nonpainful phantom and stump sensations in acute traumatic amputees. J Trauma. 2008 Oct;65(4):858-64.

Moseley GL, Arntz A The context of a noxious stimulus affects the pain it evokes. Pain. 2007 Dec 15;133(1-3):64-71. Epub 2007 Apr 20.

Arntz A, Claassens L. The meaning of pain influences its experienced intensity. Pain. 2004 May;109(1-2):20-5.

Moseley, Lorimer Joining forces – combining cognition-targeted motor control training with group or individual pain physiology education: a successful treatment for chronic low back pain. J Man Manip Therap 11:88-94, 2003.

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