If you’ve ever been injured you will have experienced acute pain. Acute pain is the response to damaged tissue and is critical for our survival. It is a warning that alerts us to danger, as well as being an important protective mechanism. The amount of pain you experience is a reflection of how bad the injury is. It is also a reflection of how much danger your brain thinks you’re in. This all makes sense when the injury is new. It’s when pain becomes chronic, and lingers longer than you’d expect, that it becomes hard to manage.
Problems arise when pain persists after normal healing times have elapsed. This can be anything from a few weeks to three months. Ongoing pain is one time our natural human instinct doesn’t work in our best interest. It causes us to continue resting the painful limb, use pain relief and move in an abnormal way. Unfortunately this all leads to secondary problems.
Chronic pain is a significant health issue in Western society. It results in high levels of health expenditure. It can interfere with a person’s ability to return to work, or force a career change. Chronic pain is also related to depression, isolation and being misunderstood by others.
So how do we manage pain that won’t go away?
First we need to understand more about how pain works. We need to know how the human body responds to pain. We also need to know how we can influence pain by changing our body’s response to it, and what physical and emotional actions we can take to affect change.
Pain is produced in the brain. When we injure ourselves messages travel from the area involved, through nerves to the spinal cord. These messages end up at the dorsal root ganglion (DRG). This is where the severity of the message gets assessed. If the pain is deemed bad enough a second message then travels from the spinal cord to the brain.
The brain has many parts to it. Some are for organizing, preparing movement and co-ordination. Other parts are for concentrating, focussing, problem solving and memory. There are also areas that house our emotions, including fear and stress.
All these areas talk to each other and create a neurotag. A neurotag is what makes us aware of pain. The amount of pain we experience is influenced by many factors. These include the degree of tissue damage, as well as our previous pain memories. These pain memories then influences the message that gets sent back to the injured body part.
It’s normal to recover from a soft tissue injury within six weeks. What’s abnormal is when pain persists beyond normal tissue healing times. This is due to a hyper-sensitised nervous system believing it still needs to protect us. While this can be good in the short term, in the long term it can cause stress and mood swings. If the immune system gets involved it can also cause an increase in inflammation. These changes can be ongoing and distressing. At this stage traditional pain relief strategies are often ineffective.
What’s more effective is a combination of strategies that work together to manage chronic pain. The strategies found to be most effective include:
- Understanding the problem and what is triggering your pain. This involves talking with your physiotherapist, doctor and often a psychologist. When we understand how our body operates, persistent pain becomes less frightening.
- Exercising in a mindful way. This creates a clearer image in our brain of how our body is moving and can help reduce pain.
- Learning relaxation techniques that calm the nervous system. These techniques include breath work, yoga and meditation. Theses are all long-term strategies which take time and practice, but can be life changing.
- Seeking help if you aren’t sleeping well. Sleep disruption has a significant impact on the healing process. It is while we sleep that the body does a lot of it’s healing. Adopting a regular routine before bed helps the body prepare for sleep. Try not to watch television in bed, and keep all electronic devices out of the bedroom. Remember that the bedroom is for sleeping.
- Learning to pace activities to avoid the boom and bust cycle. It is common to try and catch up on jobs when you’re having a good day, then wonder why your pain is worse the following day. Plan to do a consistent amount of activity on a daily basis. A Physiotherapist can guide you on how much activity to do at any given time. They can also give advice on how much pain is reasonable to expect and help set activity goals.
- Having a first aid plan for flare-ups. Even as pain starts to improve it is common to experience flare-ups. If you have a go-to plan in place it will help you cope with times of increased pain and often reduce its duration.
Persistent pain can be managed in many different ways. Gaining a greater understanding of the problem is the first step to healing. While there are instances when someone’s chronic pain can’t be resolved fully, implementing the above strategies will still improve their quality of life.
At Physiotas many of our Physiotherapists are specialists in the management of persistent and chronic pain. They are also committed to helping you move better and feel better.
Please contact us at any of our clinics to discuss how we can start helping you manage your pain today.
About the Author:
Margaret has enjoyed a long career in physiotherapy. After graduating Margaret worked in acute care hospitals, before working in rehabilitation and with children. She then started in private practice after completing a graduate diploma in musculoskeletal physiotherapy. Margaret has worked in all three regions of Tasmania, the UK and also spent a year in Canada. Margaret has been involved in private practice for 30 years. She founded George Street Physiotherapy in Launceston. She later joined with Sally McLaine to create Active Physiotherapy Launceston, now Physiotas Launceston!
Margaret enjoys working with patients with challenging neck and back issues, as well as hip problems. She has more recently developed an interest in chronic pain. At home Margaret is kept busy caring for two dogs and a cat, a low maintenance garden, and has aspirations to get fitter, stronger and resume bush walking after a 20 year gap!