Making Sense of ‘Persistent’ Pain
It seems self evident that pain is caused by tissue damage and is
therefore resolved by tissue healing. But what about when the initial
injury should have resolved long ago and yet our pain continues into
many months and possibly even years? This is known as ‘persistent’ or ‘chronic’ pain and in order to understand how it can develop we need to explore where pain really comes from.
Tissue damage is not actually what causes us to feel pain per se, rather, it is our nervous system’s RESPONSE to PERCEIVED DAMAGE or even just the perception of POTENTIAL damage that leads to this. This mechanism can be described in terms of inputs and outputs.
An input is where the body picks up signs of potential tissue damage via ‘nociceptive’ nerves, which detect things such as increases in tissue pressure, shearing or tearing forces, extremes of hot or cold and so forth. This information is then sent to the central nervous system (CNS) for consideration.
If the CNS perceives these signals as a threat to your well-being, it will
effect an output response by modifying or activating the function of a
number of bodily systems. One good example is the sympathetic
nervous system, which helps to bring about the body’s stress response commonly know as ‘fight or flight’. These output responses can lead to symptoms such as:
• Muscle spasms/aches/tightness/weakness,
• Changes in your posture
• Increased rate of breathing• Increased pain and sensitivity to pain
• Increased heart muscle tone,
• Increased arousal, alertness and attention.
These responses are generally necessary to aid our recovery, but there are times when they can become excessive and counterproductive. For example, if tissue damage is allowed to go on for prolonged periods, it can lead the CNS to accelerate its response causing it to react to things that would not normally be painful. Also, because responses are based on the CNS’s PERCEIVED level of injury or threat, a person’s beliefs, past experiences and emotional state (anxiety/low mood) can be enough to lead the body to mount a pain response even in the absence of any actual tissue damage.
A counterproductive or prolonged response like this can also lead to:
• Slow healing of cuts and recovery from illness
• Difficulty in concentration and memory
• Changes in sleep patterns
• Altered libido
• Digestive problems
• Widespread and spontaneous pain
• Increased muscle activity
In these situations, conventional treatments alone are not always
enough and a deeper knowledge of how to bring back true balance is
essential. Holistic physiotherapy treatment will help you to move away
from a persistent, painful and domineering ‘fight or flight’ state by
boosting areas such as your immune and parasympathetic nervous
systems (areas all too often ignored!).
Some examples of things that can help include:
• Relaxation and breathing exercises
• Having a good understanding of your condition
• Graded fitness training and exercises
• Doing away with unhelpful and damaging beliefs and worries
• Developing a healthy sleep pattern
Further articles to come! If you’re struggling in the meantime, book in today to see Doug to start your journey of understanding and lasting recovery.
Doug has been practicing physiotherapy for over 12 years after graduating in 2008 from the University of East London in the UK. He gained a variety of experience and expertise working in large hospitals in England, treating people within intensive care, neurological rehabilitation units, respiratory care centres and acute trauma settings before focusing his career in sports and musculoskeletal therapy.