Everything You Need To Know About Chronic Pain

Pain is the most common reason why people seek medical help. Within the healthcare system, pain remains a challenge to treat and still to this day is one of the most misunderstood areas in the literature.

Despite advances in medicine and science, pain levels continue to rise, with 1 in 5 Australians suffering from chronic pain. Everyone experiences physical pain at some point in time. Although unwelcomed, pain is an extremely important bodily function vital to our health.

What is pain?

Pain is an unpleasant emotional and sensory experience associated with potential tissue damage. It is one of the bodies inbuilt alarm systems that make us aware that something has changed leading to a series of adverse events.

Despite being uncomfortable, pain can be a helpful tool. Without it, there would be significantly less motivation to avoid and address potentially damaging issues to the body. It serves as our body’s natural defence promoting longevity. However, in certain situations, the bodies alarm system can become dysfunctional causing chronic long term pain.

Long term/Chronic pain

Long term chronic pain is a result of an oversensitive nervous system that no longer warns against damage. Sometimes our detection system malfunctions where pain still presents after the initial injury is gone. This type of pain can be confusing as listening to pain normally is beneficial but in these situations, it is reporting pain to non-painful stimulus. The pain signals remain active in the nervous system for an extended period of time.

Pain, tissue damage and pathology do not always correlate

Too often people get radiographic imaging and are instantly under the impression that the findings on the report are the reason behind their pain. For some patients, imaging can provide evidence of a significant underlying pathology that can explain their pain and guide further treatment. However, in a large percentage of patients, imaging has no or little correlation with clinical findings and can provide a ‘red herring’. For example, studies have found that up to 30% of asymptomatic adults will present with disc herniation on MRI. It is essential to find a correlation between symptoms and imaging results to consider the results significant.

Have you ever banged your shin on a coffee table? It’s excruciating for the first two minutes and then the pain drops significantly. The damage to your shin is the same yet the amount of pain you experience drastically changes. Pain does not always indicate physical damage. People associate pain with physical damage but it can also be influenced by one’s beliefs, emotions, personality and social influences. It can directly drive one’s behaviour, be quite debilitating and negatively impact a person’s health.

Pain is from the brain

Pain doesn’t exist until the brain tells us it does. The brain protects itself from danger. Any situation your brain perceives as harmful will increase your likelihood of pain. However, the amount of tissue damage doesn’t always correlate with the amount of pain experienced. For example, have you ever got a big bruise but can’t remember how you got it? But then you get a tiny paper cut and it hurts a great deal. This is what makes pain so complex! Although we experience the feeling of pain in different regions of the body, pain is generated always in the brain. The brain is the control and interpretation centre of the body.

Perception of pain influences your experience

It is important to remember everyone experiences and perceives pain differently. Some people claim to have a high pain threshold however there is no accurate way to measure and compare pain tolerance. Anxiety levels, past experience, culture and knowledge all influence perception of pain. This is important when considering how much you understand and know about your pain. When someone has a better knowledge of their pain, they can develop effective coping strategies compared to those who don’t understand their pain. Pain is less like a thermometer and more like a discussion where parts of your brain vote on how much pain to express. Regardless of the injury, pain experience can increase if the injury has significant financial implications, or if you are scared about it being a serious injury. Likewise, pain experience can significantly drop if in a present environment such as a social event.

Components that influence the bodies pain response:

• Psychological beliefs of pain.
• Nutrition and diet sleep hygiene.
• Stress and anxiety.
• Physical activity levels.
• Movement patterns and fear of movement.

How can Allied Health Professionals help with your pain?

There is no quick fix for persistent pain. Recovery can be prolonged and challenging with many bumps along the way. It requires active participation, being open-minded and having the willingness to start making a change to your beliefs, routines and mindset.

Pain is a complex topic that has many reasons for its presence, physiotherapy and other modalities of health care at able to assess why your pain exists, help understand what your pain means, and help you remove or reduce the pain you are in.
Health professionals can help by:

• Identifying factors that could heighten an individuals pain response.
• Set individualised goals that are realistic to achieve.
• Offer continued education and challenging thoughts and beliefs about what pain actually is.
• Recognising barriers to an individual’s progress and find ways to address this.
• Incorporating a graded exercise program to address and correct movement or positions that might be influencing the pain response.
• Helping an individual become more functional in their chronic pain journey.