Chronic or persistent pain is an umbrella term used to describe pain that persists typically for longer than 6 months.
The mechanisms of persistent pain are poorly understood but recent advances in neurophysiology have given us a better understanding on why pain may persist past typically tissue healing time frames.
Chronic pain is a hallmark condition of many common conditions such as different forms of arthritis, auto-immune disorders, cancer, trauma, fibromyalgia and many more. The most common source of chronic pain we see are disc bulges, whiplash and poorly healed joints.
When an injury occurs, the nervous system will become sensitive. This happens so you rest the injured body part to create ideal conditions for tissue healing. The nerve endings that sense pain throughout the body are called nociceptors. After an injury, the inflammatory chemicals around the nociceptors lower the pressure threshold at which they are activated in a process called peripheral sensitisation.
Over time, this can also lead to changes in the way pain is processed within the central nervous system (the spinal cord and the brain). This is called central sensitisation and it acts to amplify signals coming from the nociceptors in the injured tissues. This is why light touch to an injured ankle or neck may cause significant pain despite relatively low pressures. For example, light touch to an injured lower back may start as a 2 out of 10 in the muscles but be perceived as an 8 out of 10 in the brain. Please don’t think “it’s all in my head”. While mental health does impact pain, the changes to the nervous system are grounded in known physiological processes at the level of the nerve cells.
Additional factors such as stress, poor sleep and genetics can also contribute to central sensitisation. Pain processing occurs within the limbic system of the brain which is also heavily involved in emotion. This is why many people may complain of physical pain during times of mourning or periods of prolonged stress. (As we Bajans would say “it hurt my belly!”). It can be overwhelming as the initial injury that started the sandstorm of chronic pain can be a major stressor in itself. Fortunately with the right management and support, the vast majority of chronic pain does improve and has a high chance of resolving for good.
To sum it all up, chronic pain is extremely complex and involves many moving parts. This is the reason why I believe one on one individualized care is essential to provide the best possible care. It is vital that a healthy therapeutic relationship is built between you and your Physio that is based on trust, accountability and realistic expectations. There is no magic pill or quick fix for chronic pain hence the need for a tailored intervention to each individual case. In some cases a multi-disciplinary approach that involves multiple professionals who communicate and coordinate care is needed. This may involve (but not limited to) your Physio, General Practitioner, Specialist Pain Physician, Psychologist, Occupational therapist and other health professionals who are well versed in chronic pain management.
For more info regarding chronic pain I recommend , “Explain Pain Handbook” by David Butler and Lorimer Mosley is an easy read with plenty of illustrations and activities to help you on your journey.
If you want to know more about how Bajan Physio can help you, feel free to call or WhatsApp us on +12462532821 or email bajanphysiotherapy@gmail.com.