Persistent pain, also known frequently as chronic pain, is any pain that extends or prolongs longer than three months after an injury or illness.
Before we talk about persistent pain, we need to understand first about pain.
What is Pain?
According to the International Association for the study of pain, “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”
The alarm System:
Pain is like an alarm system that warns our body of actual or potential threat or danger.
Potential tissue damage or threat: Bend your finger back until it hurts, and the brain warns you of potential damage well before any tissue damage can occur.
Actual danger or tissue damage: When you step on a sharp object, the alarm system goes off, the danger messages are picked up from foot, sent to the spinal cord and the brain. The brain then interprets the message back to the foot to act upon quickly.
What is the purpose of pain? Is the pain normal?
Yes, the pain is a normal response, and the purpose of pain is to get your attention so that you could take action and take care of the problem. For example, in the above scenario, stopping from bending the finger or taking the foot off the sharp object, address by cleaning the wound and applying the bandage.
Pain’s most specific purpose is to keep you safe. Once the brain understands you have done the necessary management for the injury/ threat, the alarm system slowly returns to normal, gradually but slowly for healing to happen, and it tells us about the need to take it easy so that the injury can heal.
It is essential to understand that pain usually stops long before the tissues have healed. It is a great way to understand that brain produces the pain and not the injured tissue itself. Since the brain knows that you have taken appropriate action to the injury and therefore, it perceives the injury no longer as a threat, and the pain stops once the threat stops.
Our body and the nervous system are amazingly programmed in such a way to heal itself. The treatments that you receive or initiative that you take to help your pain like exercises, physiotherapy, massage sessions, stretching exercises speeds your recovery process and enables you to get back to life.
Then why does the pain persist?
Sometimes the pain lasts even after the tissues have healed, and then it goes into a state of persistent pain. In this case, the Nervous system has remained extra sensitive, limiting our movement and function, which is known as having a “Sensitized nervous system” or an Extra sensitive Nervous system. Where even a light touch and activities/ movements that previously did not hurt now produces pain.
If my tissues have healed and I am still having pain, is this pain real?
Yes, your pain is real 100% of the time, and your pain is the output of the brain 100% of the time.
So, coming back to Persistent Pain now.
It is the brain that decides if the pain messages that you receive are a threat or not, and every person’s brain is different each time with perceiving the pain messages. If the brain believes it is a danger message, it can magnify the pain level with the pain continuing to persist even after the tissues have long healed.
There are many studies to support that emotional response to just thoughts and fear of pain often having a more significant impact than the degree of initial or actual injury itself.
Persistent pain has shown to affect every aspect of an individual’s life, from physical and emotional function to levels of activity, including the ability to work at home, workplace and engage in social and recreational activities.
The research has shown that pain education and knowledge about pain is associated with less activity-related fear. In other words, reducing fear and anxiety through pain education in people with persistent pain may provide an effective strategy to help manage fear related to pain, which lessens the threat value of pain and improves the overall quality of life. It also has shown to decreasing pain, disability, pain catastrophizing, movement restrictions, and healthcare utilization.
So why is my Nervous system extra sensitive?
Sensitized Nervous system means your reasonable pain threshold has become very low, which in turn can cause pain with even your typical day to day activities and movements that were once not painful. The brain does certain things usually to protect you in the event of any stressful situations or injury. It initially produces pain; it tells your muscles to go into tightness or inhibit; hormone changes happen with the release of Adrenalin and Cortisol for flight and fight response, changes in breathing, increase in heart rate etc. Once the stressful situation is resolved, the body returns to a normal relaxed state.
These normal healthy changes in tissues and hormones can sometimes continue even after the situation has resolved. As more pain alarm signals are consistently sent to the brain, it can change your nerve excitability, which can, in turn, cause more pain and further need for more protection. Again there is more pain and needs more protection, as this vicious cycle is going on and on, and your brain keeps getting more danger alarm signals even though your tissues are no longer in danger.
Persistent pain Cycle:
It shows how certain negative emotions can influence your pain
Increase in pain—>Increase stress/ anxiety—>Increase fear —>Increase pain medication use—>Sleep problems—>Inactivity/ fatigue—>Muscle spasm and Muscle weakness—> Increased fight/ flight hormones—> Isolation/Loneliness—>Increases inflammatory response and Nerve sensitivity—> Persistent pain.
How to come out of the persistent pain cycle:
There are some things that you can do to help with persistent pain by increasing your positive emotions that release positive, happy chemicals like endorphins and serotonin to reduce your nerve hypersensitivity.
“The man who moves a mountain begins by carrying away small stones.” ― Confucius
Steps to come out of persistent pain cycle:
- First, accept your pain
- Education on understanding your pain
- Increase your day to day activity level
- Improve your sleep
- Pacing your activity
- Setting real-time goals
- Exercise regularly
- Have a flare-up plan
- Improve your positive social connection
- Healthy diet plan
Where do I start with my pain recovery journey?
It starts with you by being an active participant in your recovery process. Start with
- gradual progressive exercises it could be just a relaxed walk or a brisk walk for 20-30 min at a time,
- going for a bike ride
- joining the community strength training program or fitness program
- starting with gentle aerobic exercises
- Meditation, yoga, tai-chi, Qi-gong movement practice etc,.
They all can help calm the nervous system and enables you to get back to the life that you deserve.