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Chronic Pain? Now what? A brief introduction for patients

Updated: Sep 29, 2021

First of all, like many of my peers, I believe the word ‘Chronic’ has become a dirty word amongst sufferers. Nowhere within the English Dictionary does it define the meaning as anything other than an illness that persists for a long time, yet its use can brand someone which may have a certain stigma behind it. On the other hand, the term ‘Persistent Pain’ is probably too light to describe the suffering it causes to the estimated 28 million people with the condition within just the United Kingdom [1]. We should not shy away from this.

Persistent Pain can cause tenacious, tireless, relentless pain and suffering that might have impacted your everyday life. From the things you love doing, your work and employability, being the person you pride yourself on being and its ever-presence is a constant reminder in the foreground of every aspect of you. This is secondary pain – the suffering pain causes. What we know for sure is that there is no cure, nor is there a super-pill than can simply switch pain off. In fact, in Western Medicine other than the body’s natural healing process there is only one cure for anything, ever. That is anti-biotics for the treatment of bacterial infections. Have a think… high blood pressure, diabetes, osteoarthritis, the common cold. These conditions and all other have treatment and management options but no cure. A little depressing. Maybe it is in fact reassuring that it is the management approach we take to conditions and to Persistent Pain that make the difference. So, wouldn’t it be great if you could push that pain to the background of your life and get on with the doing and the being of the great person that you are?

You will notice that I will talk about primary pain and secondary pain. We all experience primary pain. This is what happens when you twist your ankle, bang your funny bone, get a paper cut or even break a bone. Pain is a completely normal response to a nociceptive stimuli. Imagine us having this conversation in a kitchen somewhere and our lovely friend Nic didn’t tell us he has just used the hob for his kale, beetroot and lentils power-lunch. It has been a long day and as we talk I rest on the outside of the cooker. I don’t consciously consider then conclude that, “…yes, that’s bloody hot”, because my nervous system will automatically make that decision for me. It is a protective mechanism. Pain can be pretty handy in that respect, agreed? Congenital insensitivity to pain (CIP) is an incredibly rare condition where you can be born without the ability to perceive physical pain. Unfortunately, without this basic life function over time you can become unaware of disease and injury and eventually life expectancy is shortened. So you can die without the ability to experience pain; has anyone ever died from pain itself?

We have scratched the surface but already pain is looking pretty complex, a little confusing and definitely not always what it seems like.

The question that may be bothering you may not be, "Why am I in pain?" But instead, "Why am I still in pain?” Science tells us that most things within the body will repair themselves within 3 months. And science also tells that your brain changes instantly to new and ever changing experiences. This is called neuroplasticity. Neuroplasticity happens instantaneously. When we experience pain beyond the duration of tissue healing time then we know that your central nervous system (your brain and spinal cord) has ongoing heightened sensitivity called ‘Central Sensitisation’. Essentially the volume is stuck on high and it is very likely starting to cause distress and suffering. So you’re thinking, “…so how are you going to treat my brain?” right?

Our brain adapts and learns new information like, did you know, you burn 150 calories an hour by banging your head against a wall? Interesting or relevant information sticks, I believe this is why to explain pain to someone it is pretty important to make it about them and not a science book. Now, although it may feel like you are banging your head against the wall with failed treatment approaches for your on-going pain, please don’t physically bang your head against the wall or it may turn into scrambled eggs, which, funnily enough is also 150 calories. There are far more effective ways to shed calories and I am sure we don’t need science to tell us this would be a bad move. So just in the way that our brains have learnt useful (or not so useful) facts and figures in everyday life there is a science behind creating newer pathways. Learnt pathways based on understanding your pain, feeling assured with your pain specialist physiotherapist, feeling confident with your exercise program, graded exposure to daily activities, being stronger, stop the avoidance of pain, returning to your activities, getting your life back on track and then we know despite still having pain it is now in the background of your life, you are moving forwards and the future is looking a heck of a lot more rosy. Not convinced? I feel that you’ve read this far so you are obviously keen to learn more.

How many calories do you burn banging your head again? Yes, neuroplasticity helped you remember it was 150. If I have changed your brain with words on a page just imagine the changes in your brain each time you physically move and exercise with positivity and confidence. Unfortunately you do not see the changes day-to-day. It is not easy. The decision that you make next will be the defining moment when you will start to improve your quality of life again. It is the doing that does, so it is important to be active in your treatment and find the answers you are looking for.

Stay tuned for the ‘Now What’.

(1) Fayaz, A., Croft, P., Langford, R. M., Jones, G. T. (2016) ‘Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies’, BMJ Open, 6(6)

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