Persistent Pain – Part 1
What is Persistent Pain?
The dictionary definition of chronic or persistent pain is “any pain that lasts longer than 12 weeks.”
For many of my patients, by the time they come to see me, they have seen numerous therapists, tried many medications and even had surgeries, all with varying degrees of success. And those weeks have become months or years.
Is Chronic Pain different?
The difference lies in how we understand pain –
- There is a problem in a muscle, joint, bone, ligament, organ . . . . some form of tissue in the body.
- This sends a message through the nerves that there is pain
- We feel pain
Except that actually pain is a LOT more complicated than that. An amazing guy called Lorimer Moseley, a physiotherapist who went on to train as a neuroscientist and now does pain research in Australia has done a huge amount of research and explains it far better than I can, so if you want to understand the mechanics better I suggest watching one (or ten!) of his video lectures. This is one of his shorter ones and one of my personal favourites.
Now the important part for chronic pain sufferers is this:
Once a pain “pathway” or route is created in the brain it becomes easier to use.
The Road Often Traveled
Think of a neural pathway that would lead to a pain experience as a dirt road. If you get a lot of traffic along that pathway, eventually the pathway is going to have to get bigger to accommodate it. So the pathway is widened. Maybe the next step is the pathway gets paved, then the pathway becomes a dual carriageway and so on.
The more that pain pathway runs, the better it does it. The pain experience happens faster and faster and easier and easier as the traffic increases.
So what does this mean for me and my persistent pain?
It means that patients with chronic pain do, genuinely, feel more pain from less stimulation. And this means certain treatments aren’t applicable. Patients with chronic pain are more sensitive.
It means a proper, physical assessment is hugely important – when you have chronic pain these pain signals get confused and cover a wider area – so you get more pain, more easily, over a wider area.
It means we need to help teach your body to stop protecting something that doesn’t need protecting anymore (that’s what pain is – a protection signal!).