The reason I have written this blog is to help you understand pain better, and to be able to approach treatment for pain in the most effective ways. Even though things are hurting, usually there’s no harm done, but your brain is concerned that you’re in danger.

We know that pain exists as a motivator to do something about it — it is unpleasant to get us out of danger, whether that danger is real or otherwise. Pain very easily breaks through our consciousness and makes us do something about it — which is a very helpful and adaptive thing to do if we’re causing our brain to perceive danger through our postures and positions in daily life, or if we’ve done some tissue damage through an actual acute injury (remember from our understanding of pain as an output, that it may not necessarily hurt at the time!)

Chronic pain cost more than $635 billion a year in the US alone, which is more than the yearly combined costs of cancer, heart disease and diabetes. Combined with the monetary cost is the loss of happy, healthy productive lives to pain disability and the loss of human potential and contribution to society. We have to use the science we have better to treat the real causes for people experiencing persisting pain.

By virtue of the fact that pain is invisible, there is a tendency for people in pain to feel their disease is invisible and unacknowledged. The lack of visibility results in the often heartbreaking effect of people being labeled as faking or over-reacting to their pain — and as a clinician without the right information about pain, we can underestimate the central nervous system’s might to shut down a whole person if the situation is deemed threatening enough. You should know that whatever symptoms you’re feeling, they are REAL, but they may not be correlated correctly to a damaged body.

Medication

Let’s start by talking about medication, as this is often the most accessible first line of treatment. The smart use of medication under the guidance of a doctor or pharmacist can be a very sensible solution as a first-line approach to treating pain — particularly for infrequent or unaccustomed pain. Simple medication can allow you to return to normal activity, but it’s not a solution for pain that continues — but it can be a useful tool to allow you to seek other forms of treatment. You may take analgesics (which work directly on the nervous system) or anti-inflammatories (which work on inflamed tissues) but remember that all medication has side effects and should be taken under direction of a professional. You may be prescribed opiate medication for long-term pain conditions — and may have breakthrough doses of pain medication that you can use as needed if pain gets worse. You may be someone who uses specific medication for nerve pain or to assist in the management of a rheumatological conditions- and you will know your body and have a regimen of medication to be used for breakthrough pain or in the event of a flareup. The purpose of this blog is not to teach you how to reduce pain medication — which is often a worthy goal — but to be able to talk about useful additions to appropriate medical management.

Understanding Pain

After talking about medication, the next most important part of treatment is deeply understanding pain. The most common question asked by any patient I have treated is “Why did I get pain”? Once we do a thorough examination and look at relevant functional movements, there’s almost always a change to optimal movement patterns that could have contributed to some structures becoming overloaded and sore, but it may simply be a result of the pain too, so it’s hard to know for certain. Even with a movement-based reason for pain, it will still be affected by our fear, meanings and thoughts related to the pain condition. For some people, crossing the thought gap around what pain is can be very confronting — and getting to a place of accepting you are sore but safe empowers you a better way to understand your pain and your own body. Deeply understanding how pain is affected by so many factors subconsciously gives you a new context to talk to your care providers and provide a better understanding of the many factors related to your pain and what you feel. You’ll find more meaningful patterns related to not only physical factors but situational and thought conditions that can become part of a treatment program.

Get Moving

The effect of appropriate movement as a way of decreasing pain cannot be underestimated. For some injuries you must heed professional advice; a tendon graft or a broken bone should not move, and it needs to be protected for a period of time to allow your body to do the magic act of healing. For a healthy body, ‘motion is lotion’. The effects of movement of the painful area, the surrounding areas and even simply walking, have been well-documented and proven to have a whole body pain relieving effect.

For someone with long-term pain, movement CAN hurt and be perceived as dangerous and threatening to your body. After a long time not moving due to pain, your brain can quite rightly perceive movement as a threat and create pain as a response to keep you safe. You may notice that nothing hurts if you don’t move — and you only have pain when you move. It would be easy to interpret this as being harmful to move. All the parts of the nervous system associated with movement get “tuned” to pain — so normal movement starts to hurt too. The only way out of this situation is to gradually desensitize the brain to movement and stimuli, and we need to go slow. ‘Pace it, Don’t Race it’ is what we tell our clients.

Movement training should involve desensitizing the brain to global movement, to specific movement patterns that cause pain and fear or anxiety, and then progress on to retraining faulty movement patterns and training for fitness and strength when your body is able to tolerate more strain and loading. If you don’t do slow, you risk flaring up pain, not necessarily causing injury, but putting life on a rollercoaster that might not be moving forward in the right direction.

What not to do when you have pain…

- Panic and catastrophize about worst case scenarios

- Continue to do specific painful activities — especially involving lifting, carrying and fast movement, since you

- Consult Dr Google for inaccurate self diagnoses

- Retreat to bed for days on end

- Make Surgeon/ Specialist appointments

Why haven’t I said “see a Physical Therapist” first up? That’s my professional education after all. Physical Therapy can do an enormous amount to help — it enables you to partner with a good therapist to change the way you move, do treatment that will have direct impact on the outputs of the brain, teach you how to monitor and manage your own body and assess you for possible persisting pain factors.

Unfortunately, until PT assessment and treatment is standardized, reliable and data driven , it is a best guess. Humans are falliable, and make mistakes — so what I have sought to do here is give you a framework for your thinking

Your care providers should be sitting beside you — metaphorically and ideally physically. They should be a team hand-picked for you — for their ability to access the best clinical experience and skills, work in a co-ordinated team and listen to your hopes and dreams in the most empathetic manner to determine what matters to you and your life. Too many times have I seen patients that have seen their Physical Therapist for years only to have their pain get worse (evidence of a worsening physical condition? Or not the right treatment)

I want you to have a new context for talking about pain before you see a professional — you can and should have the ability to add your knowledge and understanding to the mix, and create a collaborative solution. I’d love to hear if this is helpful for you to understand pain in a new way.