Understanding Chronic Pain
Pain is the most common reason for seeking medical care. It is also the most common reason why people choose our physical therapy practice for help. If you are considering physical therapy for pain, this information can help. Understanding the factors that influence pain — other than the tissues — make your road to recovery clearer.
Most of us grew up with specific thoughts and beliefs about what pain is and how it works. We have the basic understanding that pain is reflective of a tissue injury. While pain is the body’s alarm system, it’s not always that simple. Sometimes that alarm doesn’t turn off and it becomes less of a tissue problem and more of a pain problem.
What are the differences between Acute, Subacute, and Chronic Pain?
- Acute pain is common with tissue damage that may occur with a ligament sprain, a muscle or tendon strain, inflammation within a joint, or a tear of a muscle, tendon, or meniscus.
- Subacute pain is pain that lasts for 3 to 6 months. Subacute pain is common with more complex conditions where there is prolonged healing (joint replacements and the pain associated with the recovery after surgery).
- Chronic pain is pain lasting for more than 6 months. While the body’s musculoskeletal tissues may heal from an initial injury or degenerative change, pain may persist for months past the tissue healing process. Nearly 50 million American adults have significant chronic pain or severe pain, according to a new study prepared by National Institutes of Health’s National Center for Complementary and Integrative Health.
within 6 months almost all tissue damage completely heals. Rarely is there a case when the body cannot heal. Rare cases of diabetes may limit the healing process; however, in almost all cases, tissue healing will occur within 6 months.
The good news is that means there are lots of ways to positively impact your pain.
Chronic Pain is Complex
There are many factors that contribute to your perception of pain. Some of them are:
- Injury & inflammation – tissue damage itself, stimulates nerves that work through the spinal cord and may be perceived as pain.
- Neurophysiology – the way the nervous system works, the body’s threat sensors, how they interact at your spinal cord, and the pattern of activity, can all impact your perception of pain. Your brain also has an internal medicine cabinet that can release some of the most powerful drugs known to help minimize pain. These are called endorphins & enkephalins.
- Pain Experience – your perception of pain. There is good pain and bad pain. Past experiences with pain matter.
- Fear – some may have no fear of pain when they experience pain, while others may be thinking about the worst possible outcomes because of the pain (catastrophizing).
- Helpful vs. Harmful Words – improper use of diagnoses, terms, diagnostic test results, and communications with patients can be helpful or harmful. For example, a positive MRI for a disc bulge, disc tear, herniation, or arthritis is rarely helpful. Why? Scientists have performed MRIs on hundreds of patients, that have major damage but THAT DON’T HAVE ANY PAIN AT ALL!!
- Knowledge About Pain – understanding that pain is complex, and much more than just damaged muscle, tendon, ligament, or joint tissue can help relieve the pain.
- Avoidance of Movement – pulling back because of pain or fear of pain.
- Deconditioning – movements that are normally pain-free or don’t cause fatigue, may stimulate chronic pain. In other words, with fear and avoidance, your body can get out of shape; movements that usually don’t cause pain or fatigue, can cause pain.
- Boom…Bust Cycles: Performing heavy activities or exercise a lot when you feel good and then paying for it. You end up reducing activity until you feel good again and then the cycle repeats.
- Emotions – when emotions are low, pain is typically less, and when emotions are high, the brain may exaggerate the perception of pain.
- Hormones – hormones like adrenalin and cortisol have been shown to impact pain.
- Stress – family, financial, and work stress all play a role in the perception of pain.
- Contributing Health Conditions – anxiety & depression both can factor into chronic pain.
- Sleep Habits – proper sleep habits can certainly help with the perception of pain. Almost everyone has had a headache when they were tired. The headache doesn’t mean you have cancer, it means you didn’t get enough rest.
- Nutrition – eating the proper foods can positively impact pain.
- Hormones – certain hormones can decrease or in some cases increase your perception of pain.
The Principles of Chronic Pain Treatment
We now know from studies by the top pain scientists in the world, that there are four basic components to the successful treatment of pain. These are:
- Pain education – pain neuroscience education (PNE) or therapeutic pain neuroscience education (TNE) helps patients understand that pain is an output from the brain, it’s complex, and not just in your head.
- Exercise – numerous scientific studies have demonstrated that pacing & graded exposure to activities and exercise can have an extremely positive impact on pain.
- Sleep Health – addressing sleep issues can also decrease pain
- Goal Setting – it took months, even years for your body and brain to experience the chronic pain. Setting specific, reasonable, and progressive goals are part of a successful chronic pain treatment program.
If you have chronic pain, we encourage you to set up an appointment with one of our physical therapists. We will take a thorough health history, perform a physical exam, create a custom program for you and help put you back on the road to recovery.