I talk a lot about treating people with chronic pain, so I thought it would be helpful to explain a little about what it actually is. Pain is a complex beast, so I can’t claim to do the subject justice in one blog. So, here is a tip of the iceberg description and why it is such a huge part of the work I do.
Perhaps perceived as a physical manifestation, pain is more to do with the brain and the central nervous system. When we first feel pain, through injury or illness, the brain receives signals telling us something is wrong. Initially, there is an expectation that we will recover and return to our pre-incident, pain-free self fairly quickly. I’m pleased to say that most of the time this is true. When the pain continues for a more prolonged period (usually more than 12 weeks) it is then classed as chronic pain. If acute pain is the sharp pointy corner of a triangle, chronic pain is a background noise that never goes away. It has a volume control all of its own and has a habit of turning it up too loud.
Research has shown that the pain we feel, does not necessarily corelate with the amount of damage to the tissue in our body. For example, one study of subjects with no back pain showed that 52% of them had bulging discs, and 27% had disc protrusions. The inverse can also be true; very little tissue damage, resulting in unbearable pain.
In this case the brain continues sending out pain signals, even if the original injury or illness has resolved itself. There might not be an obvious reason for the pain now and the intensity may even increase. This is, in part, due to central sensitisation, whereby the central nervous system amplifies the pain you are experiencing. It does this to protect you, as it uses this sensation to warn you that there is danger. However, in central sensitisation, the threat is no longer there, but the pain is still real and can have a huge impact on your daily life.
It is impossible to tell who will experience chronic pain, but there is a strong link between pain, stress, anxiety and unhappiness. Things always feel worse when you are tired or stressed and this is the same for pain. On the other hand, when you are happily distracted, we can also tune out the pain. Going back to the background noise theme, when you are in a good mood, the car radio is on loud, but if you are lost, the radio needs to be off.
Historically pain was believed to be caused by biological factors and therefore treated with classic medicines, particularly in the west. This started to change in the late 1970s when psychiatrist George Engel proposed a new approach – the Biopsychosocial Model.
The model looks at the whole person, not just the biological factors. It considers how psychological and social factors may influence health, illness and recovery. People with the same biological condition, but widely differing psychological and/or social circumstances can have very different responses to an illness and how they recover.
That is why it is so important to look at all aspects of life when considering a pain condition. For example, repetitive strain injury is not only an overuse condition. Often there are other factors involved, such as stresses at work and a feeling of overwhelm or lack of support. Being able to identify these psychosocial influences can really aid recovery.
A pain diary is one way to understand the pain; it highlights when it feels better or worse and what was going on in your life at the time. If there are things that are within your control that you can change, then this may help with your recovery.
Ultimately, it is about looking at the person as a whole and not just focussing on the part that hurts. There is a wealth of information around about how to manage chronic pain (see links below for a starter). It is important to find what works best for each individual. Obviously, I am an advocate of the work I do. I have seen great results working with many clients suffering from a variety of chronic pain conditions. Using a mixture of relaxation, trigger point therapy and after care, I fully support people with their recovery.