How to deal with Persistent Pain
The International Association for Study of Pain (IASP) defines pain as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” It further states that “pain is always subjective, and each individual learns the application of the word through experiences related to injury in early life.”
Understanding pain is important. How you think about your pain can change the way it feels and how you respond to it.
Healthcare design and delivery doesn’t always reflect the best scientific understanding. It often fails to fully embrace the complicated biological, psychological and social nature of pain
Watch this helpful YouTube clip by Professor Lorimer Moseley — a Pain researcher and scientist, on ‘Why things hurt’.
…
Acute pain is a type of pain that typically lasts less than 3 to 6 months, or pain that is directly related to soft tissue damage such as a sprained ankle or a paper cut. Acute pain is of short duration but it gradually resolves as the injured tissues heal
So what exactly is Persistent pain?
Persistent or chronic pain lasts longer than acute pain and often does not indicate ongoing damage, even though it may feel like it. In the past we assumed this was because we had not healed properly after an injury but for most people we know that this is unlikely. Instead, the pain is less to do with injury in our bodies but more to do with our central nervous system. It’s like the volume knob on our pain system has been left turned up like a radio stuck on loud. Persistent pain can be all consuming and take over a persons life.
It’s really important to recognise that we can turn down the volume again but it often takes patience with effort and time invested. As Physiotherapists, we can help guide you in this process but in the end, you have to take charge yourself.
Persistent pain is often related to increased ‘sensitivity’. The ‘buzz of chatter’ in our nervous system starts to set up self-reinforcing feedback loops.
Watch this animated film for a great summary on ‘Understanding Pain’ in less than 5 minutes. .
Every system that keeps our bodies going can get involved in producing and responding to pain. The way a person experiences pain is influenced by a lot of factors. We are social, spiritual, mental and physical beings. Persistent pain is a ‘whole of life’ problem, so effective management needs to take a whole of life approach. Put simply, the way we experience pain is impacted by our overall wellbeing.
Can you recognise how stressful or emotional situations have affected your pain? Tiredness, money worries, arguing with a spouse, a rough day at work, grief after a death. Our thoughts, beliefs and emotions can also make us susceptible to a ‘turned up’ nervous system.
…
What is your story?
Sometimes it can be really helpful to think through and reflect on your story. Exploring where you are, how did you get here, what was your journey:
1. Write down what your main problem is.
2. Then write down what physical sensations you get associated with this.
3. How has your behaviour/habits changed due to this. Some may be helpful adaptions ?
4. What feelings/emotions do you notice are associated with your pain?
5. What thoughts run through your head?
6. What else was going on around about the time your pain started?
7. What have you found helpful and unhelpful?
Sometimes building a picture and mapping out your story from when symptoms started until now, how things have changed e.t.c can be really helpful. Can you see a pattern? Is there anything you think you can do to improve your situation?
…
Building your Pain Management Strategy
- Figure out your values. Our values make up who we are and what is truly important to us. By working out your values, you can then set goals and do more of the things you want to do. Instead of fixing the pain, start focussing on personal goals. This may not take the pain away but will help you to increase in confidence and enjoy life more.
- Mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us.
Mindfulness is a quality that every human being already possesses, it’s not something you have to conjure up, you just have to learn how to access it.
While mindfulness is innate, it can be cultivated through proven techniques. Here are some examples:
- Seated, walking, standing, and moving meditation (it’s also possible lying down but often leads to sleep);
- Short pauses we insert into everyday life;
- Merging meditation practice with other activities, such as yoga
- Breathing exercises…come back to your breath! Try just by closing your eyes and taking 3 deep breaths in through your nose and out through your mouth.
3. Pacing. It is understandable if you are living with persistent pain that you might get into a pattern where pain dictates your choices around behaviour and activity.
Activity usually increases when pain is more manageable whereas rest tends to increase when pain is greater. In the short-term, this approach might makes sense and, particularly on difficult days, it may feel like the only option.
However, in the long term, this approach frequently leads to unintended consequences of gradual, overall reduction in activity and increased time spent resting and recovering. The behaviour pattern described might be labelled ‘over and under activity cycling’, ‘boom and bust’ and ‘yo-yo activity pattern.
Instead, focussing on using pacing strategies can be an effective way at managing pain and keeping active and engaged in the activities that bring you joy. So, instead of cleaning the whole house in one go, how about doing one or two rooms and then having a rest and then doing the rest later in the day or even the next day?
4. Exercise. For those living with persistent pain, the initial response can be to avoid activity and seek rest but this often leads to muscle weakness, joint stiffness and low moods which can then lead to more pain.
Exercise therapy is often prescribed as a treatment to manage pain. There are well known benefits of exercise and regular physical activity. Some of the many benefits of physical activity include: controlling weight, reduced risk of cardiovascular disease and metabolic disease, reduces risk of some cancers, strengthens bones and muscles, improves mental health and mood, improves sleep, improves ability to perform daily activities and prevent falls, and increases chances of living longer. Exercise and physical activity not only have benefits in healthy individuals but also has proven benefits in patients. Considering this some authors have postulated an idea that exercise should be considered as a drug for improved pain control.
There has been SO much research into pain and exercise — the benefits are now well known. By gradually increasing your activity levels, you can reverse the negative effects of inactivity and pain.
Cardiovascular exercise and strength training are two different types of exercise which can be aquatic or land-based. No specific type of exercise is better for those living with persistent pain but variety is always best. This might involve walking, cycling or swimming as well as Yoga, Pilates, Thai Chi or body weight strengthening. Musculoskeletal pain is one of the side effects of exercise, and hence deciding a right balance is very important. Too little exercise is not beneficial whereas too much could aggravate symptoms. This is where pacing comes in and finding your BASELINE of activity is so important.
Remember, slow and steady wins the race. Don’t run a marathon before you can walk a mile!
Try these low intensity mobility, strength and stretch classes to get started.
5. It’s very important for people with persistent pain to maintain a healthy, balanced diet. The nervous system is plastic and has the capacity to dampen pain. Most people have heard of the body’s own pain relieving substances called endorphins. In order to be able to function optimally, the nervous system requires specific nutrients such as essential amino acids. One example is tryptophan, which is a building block in the synthesis of the neurotransmitter serotonin which is important in the body’s own pain-dampening systems. Foodstuffs such as nuts/seeds, fish, eggs, beans, oats and turkey contain high levels of tryptophan.
The nervous system along with the other systems in your body, require nutrients. Certain vitamin deficiencies can cause pain disorders. For example, vitamin B12 deficiency can cause unpleasant peripheral polyneuropathy, which is nerve pain in both feet and also sometimes in the hands. Vitamin D deficiency can cause musculoskeletal pain, as can vitamin C deficiency.
Omega-6 has been linked to inflammation, which is something we need to aid healing in our body. But an exaggerated inflammatory response creates its own problems. Omega-3 has anti-inflammatory effects. Foods containing relatively high levels of omega-3 are cold water oily fish such as mackerel, herring and salmon, fish oil and flax seed. The body needs a healthy balance of omega-6 and omega-3 fatty acids. Excess consumption of omega-6s can trigger the body to produce pro-inflammatory chemicals. These fatty acids are found in oils such sunflower, grapeseed, soy, peanut, and vegetable oil; found in many fast foods. Other pro-inflammatory foods include sugar, saturated fats and alcohol.
6. Prioritise sleep. Did you know that the average adult needs 7–9 hours of sleep to feel rested. We live in a fast paced world with so much stimulation and high levels of stress. Often sleep is at the bottom of the list of priorities for many as there are ‘more important’ things to do. But sleep deprivation has been shown to have negative effects on our immune systems, concentration levels, accuracy, healing and a key trend emerging from studies is that sleep impairments reliably predict new incidents and exacerbations of chronic pain
…
Flare- ups are normal and to be expected if you suffer with persistent pain. Try and put together a ‘tool-box’ with techniques and resources you know help you.
During a flare-up of pain, relative rest is fine but try not to take to bed for too long. Keeping up with regular pain medication or using ice or heat or even a TENS machine can also help. Other alternative therapies such as acupuncture and massage can also help ‘turn down the volume’. Try to keep up with gentle exercise and as the pain eases gradually increase.
It is all too easy to let the pain get on top of you and start to rule your life. Choose to take control.
Resources
There are also a wealth of resources out there to access which I highly recommend:
SLEEP —Sleepio ● Headspace ● Noisli
Mindfulness — Calm ● Headspace ● Simple Habit
Exercise — Downdog ● Couch to 5K ● NHS Fitness Studio
Pain Management Course — ESCAPE Pain
Coping with Pain — Arthritis Research UK ● Pain Concern ● British Pain Society ● Flippin Pain ● Live well with pain ● The happiness trap ● Tame the Beast ● Ten Footsteps
Mental Health — Good Thinking ● Mind
Book: The Reality Slap — Russ Harris
Based on the scientifically proven mindfulness-based approach called ‘Acceptance and Commitment Therapy’ (ACT), this self-help book will teach you how to cope effectively when life hurts and you will learn not only how to survive life’s unexpected curve balls, but also how to thrive, despite them
Podcast: Empowered Beyond Pain
A fortnightly podcast brought to you by Body Logic Physiotherapy and co-hosted by Professor Peter O’Sullivan, Dr JP Caneiro and Kevin Wernli. As both clinical researchers and physiotherapists, they aim to empower you to better health, and empower clinicians to provide the best care for people in pain. They speak to leading researchers and clinicians, and hear from patients who have escaped the pain merry-go-round. Each episode is full of practical tips and insights to help you get back to living! Visit www.bodylogic.physio for more
References:
Tazzy Persistent Pain Bookelt
Arthritis Research UK
