- Adam R Whatley Osteopath
Dealing with Chronic Pain
Dealing with Chronic Pain
What is Chronic Pain?
The experience of chronic pain is quite different to that of acute pain. In simple terms, researchers have shown that pain signals don’t just go up to our brain, but once they reach the brain they send signals to individual electrical switches, or gates, within our nervous system. These gates are volume switches which can turn the pain up or down. How we feel about pain, how we interpret it, and what we do about it can often influence these pain volume switches. It is recognised in many people with chronic pain that there is often a problem with what they have been told about their pain, what they do about it and how they learn to manage it. If this problem goes on for a prolonged period the nerve pathways to the brain can become sensitised. That is, less of a threshold needs to be reached in our receptors for a pain signal to be initiated. Therefore although an original injury has healed, pain can persist for long after because the nerve pathways have become more sensitive. Long-term pain usually means the brain has misinterpreted signals and the pain isn’t serving a useful function.
There are many other factors which can influence our pain volume switches. For example, exercise turns our pain volume switches down. Many persistent pain sufferers consistently report feeling better immediately after exercise. Another important pain control mechanism is our mood. For example, when you are stressed or depressed, the pain volumes switches are turned up - this is why pain often seems much worse when we are feeling frustrated, gloomy, under pressure or simply tired.
Throughout this you will be using many strategies to help you to close the gates
Pain and Activity
Most of us tend to think of pain as some form of physical discomfort. However, most of the experts now agree that the experience of pain is the result of a complicated set of different factors. Most of the time this experience is linked to some type of injury or illness, which may involve damage to one or more parts of the body. Pain felt at the time of an injury or illness and soon after is called acute pain, whilst pain which continues after the normal healing times for an injury have passed is known as chronic pain.
Pain can be very distressing and may significantly restrict what we feel able to do. This may include hobbies, work or even just spending time with our friends and family.
Pain and harm
Unnecessary concern about what pain means leads to us stopping doing normal activities and our fear of pain may limit us significantly. This makes us less confident and more sensitive to many activities, both now and in the future. The less we do, the less we find ourselves able to do. This is termed a ‘hurt and harm’ belief and is one of the main reasons why pain is often maintained long after healing has occurred
Why does pain often stop us from recovering?
The fear avoidance model helps to explain what happens if we believe our ‘hurts’ will ‘harm’ us. The model suggests that when we experience pain, if we are given negative information about the impact of our pain, or we think about the worst case scenario, or we believe we have caused ourselves lots of irreversible damage, we are likely to do less and less in the way of activity.
As a result our muscles and ligaments become weaker, we lose the stamina to do normal everyday activities and we lose confidence in our own bodies. As long as we continue to believe we have significant damage, we are likely to remain inactive. If this belief is reinforced by other people, we remain in this cycle of inactivity. However this inactivity has more to do with our beliefs regarding the problem, than the problem itself.
It is therefore really important that you are confident that you are not going to damage yourself before you start increasing your activity, otherwise you are likely to continue to avoid activity.
It now becomes clear that longstanding pain is less dependent on the original injury and more dependent on other factors, such as the ones described above. For these reasons pain is not always a good indicator of how much activity we should be doing. The science tells us, contrary to common myth, that staying at active is actually good for people with pain. The longer you are inactive, or off work, the more likely you are to maintain the problem.
Graded activity : How to break Boom / Bust or fear avoidance and increase activity
The good news is that there is an alternative to the over-under activity cycle and its called graded activity. Graded activity enables you to gradually increase your ability to do a particular activity or position in a stepwise manner. e.g. sitting, lifting, driving.
Sportsmen and women instinctively understand these principles. Following an injury, they rest for a short while. But they are then quick to get back in action and gradually build-up their activities – despite the pain.
Of course most athletes are also very positive mentally about their ability to recover from injury. This may not be an easy thing to do when you have had pain for such a long time, but it is the best way to recover. We can now look at how you can increase your activity.
Principles of graded activity
Work out your starting point — That is how much of the activity you can do now, without overdoing it. This is the amount you can do on a good day and on a bad day. e.g. if you can manage to walk for 10 minutes but it’s a real struggle, maybe your starting point is 8 minutes. Baselines can be in any unit of measurement (time, distance, number of lengths, number of shirts ironed, no of lampposts walked past etc)
Write up a realistic plan for the week ahead (using the pacing up chart) Make sure the plan progresses in small equal steps
Progress every day, every second day or every third day- keep increases small but Consistent.
Stick to the plan on good or bad days
It is tempting on your good days to do a lot more, then do less on the bad days. Make sure therefore on the good days that you pace your self and don’t overdo it. On the bad days stretch yourself a little.
Review the plan at the end of the week and make and necessary changes.
If you have had one bad day- progress the plan at the same rate
If you have struggled a few days in a row – this would suggest you have been too ambitious and need to slow the rate of progression down in next week’s plan.
If you feel you could progress quicker, speed the rate of progression up.
Expect some increased symptoms as you increase your activity, this is normal, to be expected and will settle. Your plan should be realistic and will therefore keep any increased symptoms to a minimum. Remind yourself that you are not harming yourself, your body is already sore and s bound to complain as you ask it to do more. If your activity levels are significantly increasing your symptoms and putting you off being active then you may be overdoing it. In this case, you should start from a lower level of activity or slow down your rate of progression. Bear in mind that if you overdo things it may not be until later that you feel it. If you have any new symptoms and are worried then ask about them. (You can use the activity diary to make a note of how you have managed with each day). You can apply these principles to almost anything, although some things are harder to grade up and require a bit of imagination.
Initially there may be a trigger which causes a setback. We may have an excessively busy day which we weren’t expecting, or we may forget to take our medication, or we may receive some bad news about something. As a result of this our pain can often increase. We may be able to control some of these triggers. For example a common trigger for back pain is sustained sitting. By taking regular breaks from sitting, by getting up and stretching, we can reduce the chance of a setback from happening.
Other techniques to reduce the chances of setbacks from happening include doing exercises, going for a walk, changing to another activity, or doing relaxation exercises.
However, in spite of employing these techniques there will be times when setbacks cannot be avoided. Setbacks are not always triggered by particular activities and not all triggered pain is controllable. However, through applying the techniques recommended in the setback emergency plan, the impact of setbacks can be reduced.
The improvements you feel using the graded activity approach will remain beneficial if those improvements are maintained.
It is important that you keep your goals up and set new ones once you have achieved them. Without specific goals it is often difficult to motivate yourself to maintain changes, and things like exercising regularly, can fall by the wayside.
Situations will arise which will challenge your ability to maintain graded activity, or your goals and it is important you are able to identify these.
Try and identify situations or events that will challenge your ability to keep active ahead of time (Consider mood, thoughts, social, motivation, life events, environmental, other). For example, busy periods at work might make it harder to find time to exercises or relax. Problem solve this - Making exercise and relaxation a priority, good time management, being organised, going for a walk at lunch time, delegating at work and leaving work on time might all help you to keep on exercising and relaxing, even during this busy time.
For full information vist Dealing with Chronic Pain article with this link
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