Chronic pain effects one in five Australians and is the most common reason that people present to their doctors or health professionals like physios or osteos. Text books describe pain as an unpleasant sensory feeling to protect our body from real or potential harm, but its simpler than that… Pain hurts and stops us from doing things.
Is it acute pain or chronic pain?
Pain is often considered as two types – but it’s not based on how severe it is.
Acute pain follows a specific injury or builds with repeated strain. Injury to body tissues can result in inflammation and pain, and importantly a healing response from our body. For most injuries pain stops us doing too much, and pain resolves when the body heals as much it can (often by three months or less).
Chronic pain is different but the term refers to the duration someone experiences pain rather than how extreme or severe the pain is. If someone experiences pain for more than three months it is described as chronic pain, which is why some people refer to it as ‘persistent pain’. The longer that pain is experienced the more complex it often is – but there are things that can be done to improve your function and pain!
Why do I have pain?
The body wants to protect us, and it relies on information from our body and surrounding environment to do so. Special nerves in our body called nociceptors detect potential dangerous sensations and warn our brain even before pain is experienced!
Nociceptors are special nerves found all throughout our body and are designed to detect certain stressors that could injure our body. They can be specialised into detecting:
Temperature changes (like something too hot it could burn us or too cold it could freeze us)
Mechanical changes (like stretching or pressure beyond what our body can handle), and
Chemical changes (which can be internal or external, think aching around a rolled ankle from inflammation or pain when you get shampoo in the eye).
These nociceptors send a message to our brain about potentially dangerous things happening to our body, but there’s no point warning us when our body has already been injured! So these amazing receptors and our brilliant brain work together to monitor our body and detect when an injury may occur before it actually does, but note that they aren’t enough to give us pain all by themselves and we don’t listen to every signal these nerves send. Instead our brain plays a vital role in computing and understanding what these messages mean, and ultimately generates the pain we experience. Our brains decide if pain is worthwhile to protect us based on the environment and context around us, our past experiences and if we need to be limited for a while. This is what we mean by pain protects us – it makes us change what we were doing if it thinks this will protect ourselves from injury or prevent further injury.
So if I have pain there must be something wrong?
Just because you have pain doesn’t mean there is something wrong or you are damaged.
After an acute injury where our bodies are stressed beyond their tolerance, damage to the body can occur and inflammation can result. This makes the nociceptors activate and the brain generates the pain we experience. This pain makes us change what we are doing to prevent injury or protect us from making injuries worse – think about limping after rolling an ankle. For acute pain this is important to allow healing to occur.
However the pain you feel is not always proportional to the injury you experienced. This is why people experience different pain from the same or similar injury, and why some people recover quickly from what seemed like a significant injury. Different people have different experiences, beliefs and tolerances to injuries and subsequent pain. It is also the reason why some scans and images don’t always reflect the pain you are experiencing because they can’t always identify the underlying causes of your pain – sometimes you have pain when nothing is found on the scans, and sometimes scans can show old injuries or things that aren’t actually related your pain. Did you know that at least a third of the population have disc bulges that are not and may not ever be an issue? So severity of damage is not always reliable in determining how much pain one experiences.
The body can also become more sensitive to protect itself after experiencing pain by ‘activating the pain alarm’ more than it would have done previously. Think about a sunburn, it hurts to touch even lightly days after you were out in the sun. This is the result of nociceptors and body becoming more sensitive and protective – even though touching your skin lightly isn’t going to cause damage to the skin. You may also notice this when particular movements may be okay, but other times the pain resulting from the same activity can be dramatic. This can be a greatly frustrating thing for people with chronic pain: their pain seems to have a mind of its own! The longer we experience pain, or the more significance pain or injury holds, the more likely our nociceptors are to become more sensitive. Over time, less and less stress is required to give you pain and even simple daily tasks like walking or driving can stir up your pain.
So pain is all in my head?
No, it’s not that simple. Pain is a real experience and occurs without your own body, even if someone else can’t physically see it.
When we have pain we move differently and act differently. Over time this can mean we lose our physical abilities, our body and tissues are less resilient to stress and load, and we learn different ways of moving. There can often also be ongoing local tissue changes that require direct treatment. Treating chronic pain does not mean manual treatment should be disregarded, however we still need to understand all things contributing to your pain.
So what can I do?
Chronic and persisting pain can be treated and managed, even if you have failed before.
The first step is to get a thorough assessment and developing a conclusive plan which may include your GP, physio and osteo. This ensures you gain a better understanding of the things contributing to your unique pain, helps guide what treatment is best for you, and helps in setting realistic goals. Your therapist should focus on function and things you can do, rather than things you can’t. With your therapist you can develop ways to ease your symptoms, and rebuild your physical abilities. Being actively involved in your own recovery and completing reconditioning and strengthening programs are vital, as this improves your bodies tolerance to stress and load while decreasing sensitivity and the need for protection. You may have also created bad habits or adaptive ways of moving while you had pain which should be corrected.
Remember chronic pain is complex, and there is no “one-size-fits-all” treatment available, but you are not alone and your therapist can help guide you through your recovery.
If you are suffering from acute or chronic pain our highly experienced team at 13th Beach Health Services would love to help you achieve meaningful results so you can get back doing the things you love. Give us a call at the clinic on 5254 2668 to book an appointment today!!
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