Research suggests that the better we understand the cause of our pain the better we are able to manage it. As a physical therapist I never underestimate my patients' ability to understand their underlying pathology. But what about understanding the nature of pain itself?
Over the past 15 years there has been a tremendous amount of research on the pathophysiology of pain. We now know,for example, that pain is 100% produced in the brain. This is all pain, whether it be sharp, dull, mild or severe. This also includes pain which is short in duration called acute pain or pain that is persistent or has lasted for months called chronic pain.
Acute pain is the result tissue damage such as a back strain or ankle sprain. Generally, this can be managed with anti-inflammatories, active rest and a gradual increase in activity.
Chronic pain, however, is different. Most tissue damage has healed in 3 to 6 months, so chronic pain is less about tissue damage and more about the sensitivity of the nervous system. This makes it a little more difficult to treat.
According to the International Association for the study of pain, "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". The key concepts in this definition of pain are that pain has an emotional component and that pain is "experienced".
Anyone who has chronic pain has experienced this emotional component of pain. What is not so clear it is where does all this pain come from? As I mentioned before, all pain is produced in the brain. Any input into the brain can affect our perception of pain. This includes our past pain experiences, our emotional state, our life experiences, our genetics, our general health and our brain's processing systems. Chronic painful conditions are usually the results of an injury going untreated, under treated or undiagnosed. Nerve reactions and responses are heightened such that normal mechanical stimulus such as a touch on the skin is perceived as very painful. It is as if the volume on our pain system has been turned all the way up and doesn't know how to turn itself back down.
Physical therapy treatment for chronic pain needs to address several issues. First of all it is important to address primary location of the pain and any areas connected to the areas of pain. Secondly, because the way the brain processes pain is different in chronic pain "brain treatments" such as guided imagery, visualization and Mirror therapy can be very helpful. Thirdly, patients with chronic pain need to be educated regarding the pathophysiology behind their symptoms. Taking some of the "mystery" out of their pain perception can ease anxiety, decrease sympathetic input and decrease a fear of movement.
In addition to physical therapy treatments other treatments include medication, cognitive behavioral therapy, relaxation, biofeedback and stress management.
Mo Crane, PT
Jayson DeLeaumount, DPT