What is Chronic Pain and how to manage it?
What is chronic pain?
Everyone has heard the term chronic pain, but what does it really mean? Chronic pain refers to pain that has been present or recurs for more than 3 months. This pain can come from many different conditions or pathologies.
There are many other factors, outside of the physical ones, that can cause chronic pain. Psychology, environmental factors, and social factors can all play a role.
Pain is an experience
Everyone experiences pain differently. For example, we have all likely been asked by our doctor, “On a scale of 0-10, how bad does it hurt?” My friend Savanah knows that she has a lower pain threshold than the average person. When asked to rate her pain she usually responds with, “It is a Savannah 7.” Because I have a higher pain tolerance than Savanah, she knows that her 7 is probably equal to my 3. The pain that you experience is never the same as someone else’s. Let that sink in for a minute.
Another way that I explain the pain experience to my clients is through a story. Imagine you had a great day. The sun was shining, work was great, you went outside and moved your body, and you did everything you love to do. When you get home, you stub your toe. That would hurt, right? Now think of this scenario: you had a bad day, it is rainy or cold outside, work was a nightmare, and your kids are picking fights with each other. Now you stub your toe. It hurts so much more, doesn’t it? Our emotions can influence how we view our pain and how we respond to pain.
Now, I am not saying that the pain you feel isn’t real and that it is all in your head. What I am saying is that the amount of pain we experience can be heavily influenced by our emotions and our environment. Your brain also has the ability to ignore pain. Another analogy I use for clients is that if you were in a room and a bear walked in, you would be scared, right? You would probably run away. Let’s say that as you were running you tripped, fell down, and sprained your ankle. You would most likely ignore that ankle sprain and continue running until you were in a safer place. Once safe, the adrenaline would decrease and your body would allow you to feel the pain from the ankle sprain.
The level of pain that you experience does not always correlate with the level of tissue damage. This is why some people can walk around with rotator cuff tears or meniscus tears and not feel any pain. However, some people with the same rotator cuff tears could be in excruciating pain. Your brain is what perceives the pain and determines whether something hurts or not.
Is pain a gift?
When I was a physical therapy student, my orthopedics professor told me to read, The Gift of Pain by Dr. Paul Brand and Phillip Yancey. This book is about an MD who works with patients that have leprosy. These patients are not able to feel pain as part of their condition. I have had multiple patients tell me over the years, “I wish I never felt pain.” This is a common feeling for someone experiencing chronic pain or when you are in the chronic pain spiral. However, this book explores the importance of pain and why we need to feel it. Pain is our body’s natural warning signal and defense mechanism. It lets us know if something is wrong with our bodies so that we can take action. This book views pain as a gift. Without it we would not know if we were having a heart attack, walking on a broken bone, or dealing with some other pathology that we need to get checked out. Dr. Brand writes about the lack of pain sensation in these patients and since they were unable to feel pain, they often ended up with significant injuries or infections that could have otherwise been avoided.
What is the homunculus?
Oh, the homunculus…I remember this picture fondly from my PT school days. The homunculus is a cross-sectional representation of how your brain views your body. The homunculus assigns a larger area of the brain to areas of the body that need more specific information. Notice how the hands and feet are much larger in this picture. We use our hands to do a lot of things like type on a computer, write with pencils and pens, etc. We need more information from these parts of our body than, say, our kneecaps.
What is even more fascinating is that this picture of our body in our brains can change. It is moldable, like a piece of clay. For example, if you use your hands a lot for fine motor skills (like playing piano or violin), the picture of this area of your body will become larger since the brain is getting more information from it on a daily basis. This way you can have more awareness and control of your hands. The same goes for your feet if you are a soccer player.
The opposite effect can happen when we stop using certain parts of our body. Let’s say you broke your ankle and you have to be in a cast for 6 weeks. During the time you are in a cast you are not moving your ankle, walking on your foot, or touching your ankle. Since your ankle is not getting input from various stimuli, like movement and touch, the picture of your ankle in your brain map (homunculus) becomes smaller and the image will not be as crisp or distinct. This is called cortical or homunculus smudging.
The good news is there are a lot of different treatment techniques and therapies to help these images become more clear and crisp to decrease pain. Introducing a graded exercise program and working on remapping our brains through touch and movement are imperative for recovery. One of the most important tools that can be used to treat chronic pain is education about pain.
So how can we best educate our patients about pain?
Education is one of the best things a clinician can do for their patient, regardless of their condition. Pain neuroscience education (PNE) is a strategy that can help teach and reshape someone’s mindset and perception of their pain. PNE has been proven to reduce pain, disability, psychological problems, improving patient’s knowledge of pain mechanisms, facilitating movement and decreasing healthcare consumption. PNE can empower patients to manage their condition and help them have a sense of control over their body. This is crucial for long-term recovery. When someone is experiencing chronic pain, they often feel out of control. They feel like they are spiraling and nothing can help. If we can empower them and give them back some of their control, this can have a profound change in their condition.
Rather than viewing chronic pain as a result of unhealthy or dysfunctional tissues in the body, PNE suggests that chronic pain is due to something causing hyper-excitability of the central nervous system. This hyper-sensitivity is called central sensitization. When someone has central sensitization they may have a heightened response to a stimulus (a pin prick of the skin for example). This stimulus experienced by someone without central sensitization may be mildly uncomfortable; however, to someone with central sensitization, it will be very painful.
The ultimate goal of PNE is to increase pain tolerance with movement, reduce any fear associated with movement, and reduce central nervous system hypersensitivity.
Summary
I know that was a lot to take in, and there is so much more information that I did not cover in this article about how chronic pain is treated. Let’s just recap what we have discussed:
Chronic pain is when someone has been in consistent pain for 3 months or more.
Pain is an experience, and there are multiple factors that determine how someone experiences pain.
Our brains have a map of our bodies built into it, and some areas of our bodies will give our brain more information the more we use them (hands, for example).
With an interdisciplinary approach and using PNE, chronic pain can improve.
While chronic pain can be scary, it is imperative to find practitioners who understand chronic pain and can provide resources to help you in your journey to recovery. If you live near Charlotte, NC or Cornelius, NC, reach out to one of our clinics!
