A growing body of evidence from high-quality research and ongoing practice has dramatically shifted the way we understand pain, and it’s role in the body. This has lead to new and more successful techniques for managing people who suffer from the lived-experience of persistent pain, and gives real hope that even those severely disabled for many months or years can recover.
Hills Physiotherapy, teamed up with Emerald Psychology have been running a Pain Recovery group since 2017. This group focuses on Patient centred education about the contemporary understanding of pain to help people reframe their condition and understand what may have contributed to it becoming persistent. Information about the complex nature of pain, that pain and damage are not well correlated, that thoughts, beliefs and past experience directly affect how much you suffer can start to help you understand that you can be sore but safe, and that re-engaging with meaningful movement and activity can be a real step in the road to recovery.
Combining this with psychological approaches Acceptance and Commitment Therapy (a type of CBT) to help people be more aware of their thoughts and how to respond to them in ways that don’t continue to drive sensitivity and protection, and mindfulness meditation to calm down sensitised nervous systems, this multi-modal approach can be astoundingly successful in changing the life of people who’ve really suffered for years.
What is a Persistent Pain Recovery Group?
Research has shown that recovery from a condition as complex as Persistent Pain requires input from different types of health care specialists. Since pain is both a sensory, and emotional experience, it makes sense to have contact with therapists who are experts in each of these realms. Combining physiotherapy, pain education, and psychology is proven to be more likely to succeed than any of these approaches on their own.
Also, group therapy sessions have some distinct advantages over individual care. To share your experiences with others who’ve suffered similar problems can be more healing that discussing your issues with apparently well therapists. Others may challenge some of the education in a way you hadn’t considered, or ask questions you’d not thought about, leading to further discussion that often makes the information more complete, and make more sense. The more you understand pain, the less it bothers you.
The role of a Physiotherapist in persistent pain management is both parts physical treatment (movement education and advice) and education. Pain hurts, and fear of it hurting makes it hurt worse. Education can drastically shift your understanding of your condition, and how you engage with it both physically and emotionally. Read more about this here
The emotional and cognitive part of the pain experience is where a psychologist excels, helping you understand and be more aware of thought processes that have become unhelpful and are causing to both negative behaviours that can make pain worse as well as emotions that drive stress responses, which cause more sensitivity and therefore pain.
Benefits of Persistent Pain Recovery Group
- Reduced pain
- Education about how persistent pain works , how to understand it better, and how to reduce it’s impact on your life
- Understanding that persistent pain in most circumstances does not mean a worsening condition or more damage
- Re-Engaging in activities you’ve stopped doing, and feel have been taken away from you
- Run via Zoom for maximum comfort and convenience, allowing participation without leaving home
Book an appointment today to see if Persistent Pain Recovery Group is right for you.
Pain is the body’s way of telling us our tissues are under threat. More specifically, pain is the experience produced by the brain when it fears impending tissue damage, and decides we need to change our behaviour to protect ourselves. In most cases, the pain experienced due to injury is the result of mechanical and chemical nerve stimulation in the body from damaged tissues, and the blood products released which are involved in healing. This has many “flavours”, as we’ve all experienced, such as the sharp, local, intense pain felt when a ligament is torn (sprain) or bone is fractured. This initial pain response is usually short lived (seconds) and then gives way to a deeper, throbbing ache. This longer lasting pain is due to chemicals released from damaged cells stimulating a different type of pain nerve fibre, and this can last from a few hours to a couple of months.
However, stimulation of nociceptors (the nerves that send signals about tissue damage) doesn’t always cause pain. Conversely, severe pain can be experience without a single nerve impulse in the nociceptors. It depends on how much attention the brain is paying to them, what the person’s previous experience with pain and painful stimuli is, the cultural and societal expectations on the person and their expected response etc. This is a very complex experience, but is becoming much better understood.
It is now well established that the mental/emotional state of a persistent pain sufferer has a direct effect on the severity of their pain experience. A person suffering Fibromyalgia can be coping well, learn about the death of a family member, and without any physical trauma, their condition exacerbates severely. This is because the brain can normally have a descending inhibitory effect on the experience of pain, particularly if kept in a happy and occupied state, but this is diminished markedly if the brain has to suddenly deal with anguish, depression, anger or frustration. It stops producing happy chemicals (serotonin, dopamine, oxytocin) which are pain relieving, filtering our danger messages, and starts producing stress chemicals which the immune system detects as the sign that the system is organism (person) is under threat, and so immune cells squirt inflammatory chemicals into the nerves to make them more sensitive. This causes the person to increase protective behaviours, because things hurt worse.
Everyone who suffers from pain can reduce it’s impact on their life.
The role of the physiotherapist in managing a person who lives with persistent pain is very different from in the acute phase of injury. Once the pain hangs around long enough the central nervous system becomes sensitised, regular “passive therapies” from physiotherapists (while giving a little short term relief) tend to feed in to the patient’s focus on their pathology and it’s “cure”. This increased focus tends to increase their understanding of their own body being fragile or damaged, and therefore their experience of their pain worsens. Instead, our role is to educate the patient about the role of pain and the biology of normal pain, reassure that the experience of pain during activities is NOT a sign of worsening condition, and encourage focus on a patients ability to function rather than their injury or condition. Combined with gentle, progressive strength and function based exercises to improve endurance and strength, these techniques allow a patient with persistent pain to get back to normal life, valued activities, work, and family with their condition playing a more minor role, rather than defining them or absorbing them.
Not all injuries can be fixed, but everyone who suffers from pain can reduce it’s impact on their life.
For more pain management information and resources, visit PainManagement.org.au.