A growing body of evidence from high-quality research 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 the complex, persistent pain patient.
Pain is the body’s way of telling us something is wrong. More specifically, pain is the sensation projected by the brain when it fears impending tissue damage. 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 mechanism, 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 how the severity of their pain. 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.
Everyone who suffers from pain can reduce it’s impact on their life.
The role of the physiotherapist in managing a persistent pain patient is very different from in the acute phase of injury. Once the pain becomes persistent and 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 experience of their pain. 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, 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.