Chronic pain is traditionally one of the most complicated and frustrating disorders to treat, however, recent research and treatment interventions are providing light at the end of the tunnel for many chronic pain sufferers. Research has shown that education about pain is one of the most effective ways of treating it. New treatment protocols which emphasize pain education alongside graded exercise programs are showing excellent results, which can be life changing for the chronic pain sufferer.
So what is pain?
In very simplistic terms pain is a mixture of sensations arriving from nerve endings in the tissues (skin, muscle, tendon, ligament etc) and the interpretation of these sensations by the brain. So for instance, if we touch something hot, nerve endings in the fingers detect the heat and create impulses which travel along a nerve (like an electric current travelling along a wire). These impulses reach the spinal cord and travel up to the brain. The brain then processes these signals and decides what we feel (pain in this instance).
There are 3 different areas in the brain that process pain:
Emotional areas – process how we feel
Cognitive areas – process how we think
Sensory areas – interpret the quality of the sensation (sharp, dull etc)
Recent research has shown that how we think, how we feel, our beliefs, experiences, environment and mood can all influence the severity of pain we feel – the brain can turn pain intensity up. Most people believe pain means damage, however, with chronic pain there is often no underlying injury, yet pain can be felt with everyday activities such as walking or sitting. This is caused by the nervous system becoming sensitised so that the brain perceives a threat to the body with normal activities and initiates a pain response. The brain increases the intensity of this pain so that severe pain can be felt without any underlying damage. A number of factors can play a part in this.
Fear of damage – if you fear that pain is due to permanent damage in your body then you are likely to experience more severe pain.
Fear avoidance – People can become fearful of movement due to pain and concerns about causing damage, so they avoid certain movements and activities. This can lead to muscle weakness and tightness, joint stiffness and increased nerve sensitivity.
Past experience of pain – affects expectation and has a powerful impact on shaping our pain experience.
Hypervigilance – this is a common feature of anxiety and depression which is often associated with chronic pain. People are constantly on the look-out for threats to their body and are constantly aware of any painful symptoms or strange sensations.
Pain focus – constantly focusing attention on your pain is likely to increase pain severity.
Catastrophisation – people who have a negative view of their situation and repeatedly play over their problems in their mind often have poor outcomes. Indeed, Main et al (2010) found that the way someone thinks about pain is a better predictor of pain related disability than the intensity of the pain itself.
Feeling out of control – managing pain isn’t easy and people often feel they have no control over their symptoms. Having pain that you can’t control is worrying and often interpreted by the brain as a greater threat resulting in more severe symptoms.
Stress and low mood – when under stress the body releases an excess of certain hormones which influence how we think and feel. This often results in us experiencing more pain. It is quite common for people’s pain to have a direct link to stress.
Anxiety and depression – Anxiety and depression affect the way we think, feel and behave so that people with mental health conditions often experience more pain. A deterioration in mental health can often coincide with an increase in pain.
Thankfully there are ways in which you can retrain your nervous system to help turn down your pain.
Distraction – our body constantly receives feedback from all over our body, however most of this information is filtered out as it is not deemed useful at that time. For instance, we rarely take notice of how our clothes or shoes feel on our body. Or when we put on a new pair of glasses our body is acutely aware of this new sensation, however after some time we filter this out and forget we are wearing them. Pain can be filtered out in a similar way, especially once we are re-programmed to realize that the pain does not necessarily mean injury!
Pacing – do as much exercise as you can manage without exacerbating your symptoms. For example if you can walk for 5 minutes without any pain, but 6 minutes hurts, then just walk for 5 minutes. This time can slowly be increased as you are able. This puts you back in control of your pain and allows you to stay active so that you no longer associate activity with pain. It also gives you achievable short term goals that you can work towards, such as increasing walking time to 10 minutes. It is important to focus on these short term goals so that you can see progress in your condition
Relaxation – relaxation is an essential element of any pain management programme as it reduces stress, anxiety and catastrophisation. This could be through meditation, progressive muscle relaxation or any formal relaxation technique. Some studies have shown that meditation can reduce chronic pain by up to 50%.
CBT – Cognitive Behavioural Therapy helps people to identify and challenge negative thoughts (eg. pain means damage) and in doing so can improve mood and alter negative behavior (such as fear avoidance).
So there is hope for chronic pain sufferers. With the correct approach that emphasizes education, a graded exercise programme, Physiotherapy and other interventions (CBT, relaxation techniques, meditation) excellent results are now being seen.