An introduction to persistent pain

An introduction to persistent pain
Why do we experience pain?

We experience pain to protect us and to alert us to possible danger. Pain makes you move and think differently.
Most of us imagine that pain is a bit like an alarm going off. If one of our nerves picks up on an injury to the body it rings an alarm bell, which is a pain to warn us there is a problem. We think that the louder the alarm (the pain) the worse the injury. Nowadays we know this is wrong. The way in which we experience pain is very complex. All sorts of factors influence our pain experience, including our thoughts, feelings, behaviour, past experiences and future intentions.

 

What is acute pain?

Acute or short term pain is typically a new pain that is gone in a few weeks or less than three months.
There is often a known cause (e.g. a strain to the back muscles, a twisted ankle, a broken arm). The pain will lessen as the injured tissue heals itself.

What is chronic or persistent pain?

Acute pain and persistent pain are very different from each other. Persistent pain is also known as chronic or long-term pain.
If pain lingers for more than three months it becomes chronic or persistent.
In this case, the original site of the injury is unlikely to be the main source of the problem. There is no longer a strong link between the pain and the tissue damage as the tissues have healed. Instead, the problem may be with the pain alarm system (the
central nervous system: which is compromised of the nerves, spinal cord and brain).
The pain alarm system can remain switched on – the alarm keeps ringing loudly when there is no ongoing tissue damage or injury. For example, a car alarm going off when no one is near the car. Your pain system is no longer working to protect you, the nervous system has become sensitised.

Pain is Our Alarm System

How do I know if I have a sensitised nervous system?

If you have had pain for more than three months then it is very likely that you have a sensitised nervous system.
If your nervous system has become sensitive you may experience pain from normal sensations such as someone touching your skin, a change in temperature, a small movement or trying to sit or stand for any length of time. With a sensitised nervous system, it is common to have pain every moment of the day (for some people the pain levels may go up and down). A pain flare-up can happen when you try to do an everyday activity (e.g. housework or going out with your family), it may take days or
weeks for your pain to settle to its normal levels. It is possible to have a sensitised nervous system as well as arthritis in a joint or due to other medical conditions.

 

What turns up the pain volume?

Pain is complex and we know many different factors can make your pain worse:
• If you fear pain
• If you are worried about a disease or diagnosis
• If you pay attention to every sensation in your body
• If you no longer do anything you enjoy
• If your stress levels are high
• If your mood is low or you feel anxious
• If you worry about the future
• If you have disturbed sleep patterns
• If you fear movement
• If you have a tendency to overdo things or underdo things
• If your body has become unfit

How do I turn down the pain volume?

1. Change the meaning of pain – It is important to understand the truth about your pain and to challenge any frightening
thoughts. When we have terrible pain it is very difficult not to fear that the pain may be a serious medical problem that
needs urgent attention. Thoughts like these make the pain messages far more important to the brain, which makes the
pain alarm much louder (worse).
2. Keep your attention occupied elsewhere – This is not easy when the pain is shouting for attention. Being involved in hobbies or things you enjoy and taking an interest in life helps to distract you from the pain.

3. Work on your emotions, lowering stress and improving sleep – Feeling relaxed, happy and optimistic helps to turn down the alarm. Breathing and relaxation techniques are often very
helpful.

4. Activity and exercise – Taking the right amount of exercise for you will help develop your fitness and prevent deterioration of your muscles and joints.

5. Learn to move again – Completing small regular movements or changes of position can help reduce the fear of movement. Going for a regular short walk can be a good start.

6. Give your body calming and pleasant messages  – Using comfortable sensations like self-massage and heat can help reduce the volume.

7. Goal setting  – It can help to set yourself small achievable goals to help keep moving forward and motivate yourself.
Consider giving yourself a reward when you achieve your goals. This sense of achievement can show that your pain is
not in control of you.

8. Pace yourself – Doing more than you can manage on a regular basis can turn up the volume and the threat associated with a particular activity. Try and split activities into smaller more manageable parts. Avoid staying in one position for too long. Plan ahead and prioritise what you need to do.

9. Understanding your pain better – Improving your knowledge about what causes pain can reduce the threat and worry around pain. Talking to your health professional about what is causing the pain can help.

10.Time  – These are lifestyle changes that take practice and time to implement. Allow yourself several months for your
body to adjust. Talk to people around you to get support whilst you make these changes.

 

Resources: 
. Self-management tools written by a person with persistent pain: www.paintoolkit.org
. Research into the role of the brain and the mind in chronic pain: www.bodyinmind.org
. www.nhs.co.uk

*Disclaimer- Information presented here is not intended to be qualified for medical advice. Nothing expressed herein creates a doctor-patient relationship.

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