Breaking the cycle of chronic pain. What is chronic pain?

One in five Australian adults suffer from chronic pain. It affects one in five people globally and is the primary reason people seek medical treatment. In most cases, chronic pain starts with an acute injury or illness. Sometimes, what can happen, is that even after you’ve healed from an injury, surgery or other conditions, the pain continues. If the pain lasts longer than 3 months it’s then considered chronic pain.

Chronic pain syndrome can then be considered short term pain, or acute pain, that doesn’t go away and has a physical and psychological impact on a person’s life.  Chronic pain syndrome often creates secondary complications such as sleep deprivation, depression, irritability and fatigue, affecting a person’s personal and social relationships.

What is Pain?

Pain functions as a warning signal. The nervous system senses danger and responds to it with actions called guarding responses, designed to protect and defend us from further injury or harm.
Muscle tension, decreased range of motion, anxiety, fear of movement, increased sympathetic responses (raised heart rate, increased blood pressure, change in respiration) and a mechanism called low pain threshold (becoming excessively sensitive to pain and minor impulse or stress to the body region cause pain) are all consequences of the guarding response. This is the way the body protects itself from future painful incidents.

In chronic pain, even after the injury has healed, this mechanism remains and continues to affect the body creating a vicious cycle of real pain.

Your Brain and Pain

When we adopt this instinct to guard ourselves against future pain, it actually does the opposite and keeps feeding your pain cycle and increasing symptoms including pain (scientific research “Pain Processing in the Human Nervous System: A Selective Review of Nociceptive and Biobehavioral Pathways).  This guarding mechanism is most likely to occur to those people that view their pain or condition as a threat, rather than something that just is and that in all likelihood can be overcome or at worst worked through towards acceptance and continuing on with life in as normal or your new normal way as possible.

Being extremely apprehensive about your injury and symptoms, avoiding activities believing that that may be harmful, stress and negative emotions are coupled with autonomic, endocrine, and immune responses which may amplify pain through a number of psychophysiological pathways prolonging your “fight or flight” response to the original injury. This will lead to a downward cycle of deconditioning, weakness, muscle spasms and/or tension, increased anxiety and depression.

The vicious cycles of pain become clear

Chronic pain causes stressful problems, which, in turn, can create additional stress that makes the pain worse, if we allow it to.   This combination of chronic pain and the resultant problems that make the pain worse is what we call chronic pain syndrome.

Chronic Pain affects every aspect of our life

Chronic pain and its psychological effects may reduce a person’s quality of life, not only for the person who is suffering but also for their family and close friends or colleagues. Many people have trouble with sleeping because of pain, becoming tired, exhausted and which then decreases their ability to cope with chronic pain. Working, taking care of the family and maintaining a social life may become increasingly more difficult to manage.

As a result, many people struggle with guilt over things like not contributing to household upkeep tasks, missing their children’s activities, family gatherings, or outings with friends. Combined with the other emotions that we covered above such as fear, irritability, anxiety and depression, people tend to lose hope and meaning in their life. They may feel like they are stuck in pain and may become depressed.

All those stressors bring more change into the nervous system which keeps feeding the guarding system and pain cycle.

What can City Physiotherapy do to help reverse pain?

Part of our job as physiotherapists and massage therapists is to help you and guide you, our patients, to overcome any fear avoidance behaviour (learned fear), such as fear of movement, by using not only hands-on treatment, dry needling or exercises, to target your injury or pain, but to talk to, explain and assist you in understanding the way that pain and our brain works. We can help you to overcome or negate some of these non-helpful brain responses. By doing this we help you to down-regulate your brains protective response in order to minimise your pain experience.

Working with you in this 1:1 way, taps into your brain and nervous system. Your brain and nervous system is complex. We can work with you to change your neural pathways and learned patterns of thinking and beliefs that in turn produces more of your own natural brain chemicals like endorphins. This resetting and rebalancing, forming positive neural/brain connections,  plays a large part in you overcoming your injury or pain experience.

Of course, each individual person is unique and we all come with our own history and life story that also plays a major part in how we experience pain and how we as therapists target your particular treatment. The way we think about our pain and ourselves, how we act and what kind of self-talk we undertake can all play a major role in the way that our Physiotherapists work with you, our patients who suffer from injury, pain, chronic pain, pain sensitivity, learned fear, anxiety, and depression.

Florio Serena, Remedial Massage Therapist, 2019.

References

Eric L. Garland, 2014, “ Pain Processing in the Human Nervous System: A Selective Review of Nociceptive and Biobehavioral Pathways”, access 28/09/2019 from US National Library of Medicine National Institutes of Health

Physiopedia, Considering the stress pain cycle in assessment, viewed 28/09/2019, https://www.physio-pedia.com/Considering_the_Stress_Pain_Cycle_in_Assessment

Bupa Australia Health pty ltd, Chronic Pain Statistic- Information and research- Bupa, viewed 28/09/2019, https://www.bupa.com.au/health-and-wellness/health-information/az- health-information/chronic-pain-fact-sheet