In the last blog, we explained the science behind pain and why pain can be such a complex experience for many individuals. To refresh, according to the International Association for the Study of Pain, pain is defined as, “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage (1).” Meaning that pain can be present beyond just a physical injury or harmful phenomena initiating that pain at that moment. This is the point when pain crosses over from acute pain into a more chronic experience.
As stated previously, acute pain usually lasts 12 weeks or less which is the usual healing window of a tissue injury (2). Where chronic pain is persistent and lasts beyond the 12-week healing window. However, it is not always this cut and dry and can vary based on the situation. Chronic pain is the malfunction of the portion of the nervous system that interprets and produces the pain messages in our body causing an exaggerated response beyond the physical state of our body (2). For example, when a person’s bone has fully healed several weeks ago but continues to have significant pain that does not match their current state of tissue healing.
Unfortunately, chronic pain has become far too common today and sometimes can be perceived as normal daily pain by many. Such as a person who has back pain on and off for many years but feels it is just a part of life and ordinary aging. Up to 23% of the world’s population has developed chronic low back pain and that number continues to grow (3). A few important characteristics of chronic pain include (2):
- Symptoms can be hard to identify or reproduce at times
- The pain can be hard to localize to a specific area and can spread to different body regions
- The pain can be brought on by a variety of factors including movement, physical touch, stress, emotion, temperature, etc.
- It is usually not consistent and can vary from being dull and achy to sharp and burning
As seen with the above characteristics, chronic pain can be very difficult to correctly diagnose and can lead to multiple incorrect diagnoses and failed treatment pathways. This can create a negative feedback loop producing an amplified pain experience. Sustained stress on the body can lead to an increased activation of our sympathetic nervous system also known as the fight-or-flight response putting the body continuously on high alert (2). The overstimulation of the nervous system can cause sensitivity throughout the body and musculoskeletal system producing an exaggerated pain response. Meaning it requires a smaller stimulus (input) to produce the same if not a greater pain response, also known as hyperalgesia (4). Pain that is reproduced by stimuli that usually would not create a pain response is called allodynia. An example of this would be the light touch of a feather on the skin causing a person to have pain when usually they would barely feel it or may even be ticklish.
The complexity of chronic pain requires a very careful approach to properly treat and manage it. It is rarely a quick fix and takes a multi-dimensional approach. This is due to a variety of factors that may contribute to a person’s pain experience including but not limited to (2):
- Physical inactivity
- Mental health
- Stress and anxiety
- Diet and nutrition
- Culture
- Posture and mechanics
- Social interaction
- Genetics and environment
- Sleep hygiene
- Thoughts and beliefs etc.
Having a variety of professionals to work with can be very helpful in managing chronic pain including a medical doctor, physical therapist, mental health expert, and nutritionist. This is a short list, but there are a variety of pathways to help you get back on your feet and begin enjoying the life you want again.
It may be helpful to begin by ruling out a multitude of issues including autoimmune conditions, systemic diseases, cancer, and other organ-related issues first depending on the symptom presentation and duration of the issue. This will help point you in the right direction and rule out anything that may not allow you to go in a specific direction for treatment. However, the important part is remembering that you need to look at the whole picture of what may be contributing to your pain and where you may be able to improve certain aspects of your life to put you on the pathway of healing. This is different for everyone and could look like increasing the amount of movement for one person, drinking more water, eating better, getting more sleep, finding ways to better manage your stress and anxiety, attending more social events with others, and so on. Again, this does not look the same for everyone, but leaving out one piece of the puzzle may lead you to incomplete results and you may not attain the outcomes you desire.
This is where we come in as physical therapists. We can assist you on your pathway to healing and/or help point you in the right direction if it is something we feel we may not be able to support you in that present moment. With our ability to differential diagnose and know how the body moves, we can assist you in better understanding what may be going on and help you get started to a better quality of life.
Whether you or someone you know suffers from occasional aches and pains or lives with chronic pain, this blog series will be a must-read for anyone seeking to better understand their pain and current situation. You can sign up to receive our newsletter here so you don’t miss this series.
Request an appointment with one of our many qualified physical therapists to help you get back on the road to recovery. Please click the link below or call any of our locations.
References
- Malik NA. Revised definition of pain by International Association for the Study of Pain: concepts, challenges and compromises. Anesthesia, Pain & Intensive Care. 2020:24(5).
- Walters, Tom. (2023) Rehab Science: How to Overcome Pain and Heal from Injury. Victory Belt Publishing Inc.
- Casiano VE, Sarween G, Dydyk AM, et al. (2023). Back Pain. StatPearls. 2023.
- Jensen TS, Finnerup NB. Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms. Lancet Neurol. 2014 Sep;13(9):924-35.