1 in 5 Australians suffer from persistent or chronic pain. It is a debilitating, disabling, overwhelming, frustrating and confusing condition, and for many people, it is a condition that they manage alone.
Persistent, or chronic pain occurs when pain persists beyond the normal expected healing time for that injury or condition. This is normally around 12 weeks.
Unlike most acute injuries, you cannot see chronic pain. You cannot see a plaster cast on your wrist, show off stitches or explain what is happening on an x-ray. The pain should have gone away when the initial injury, surgery or process had healed, around that 3 month mark, but it didn’t. Health professionals can have a hard time explaining chronic pain, meaning it is really hard for the sufferer of chronic pain to understand their condition, let alone explain it to friends and family who care for them. Sufferers of chronic pain walk an endless and confusing journey, jumping from one health practitioner to another, trying to remember various appointments, taking a myriad of medication, some to combat the side effects of others, and struggling to work out how they will manage their work, home and social lives with this pain.
Chronic pain affects people physically, psychologically, emotionally and socially. Chronic pain is invisible, complex, life altering and really hard to treat.
Many people who suffer from chronic pain have, at one point or another, feel like they have been told that ‘the pain is all in the head’. Many people who have not experienced chronic pain believe ‘the pain must be all in their head- the doctors cannot find anything wrong with them’. Well I am here to tell you that the pain actually is all in the head… but not in the way you think.
How does chronic pain work?
Let’s start off by understanding a little bit about how we feel pain. When we injure ourselves or cause ourselves pain, we are actually setting off a cascade of nerve impulses, known as ‘nociception’. These nerve impulses translate through our nervous system, to our spinal cord and up toward our brain. Before the impulse has reached the brain, it is just that, a nerve impulse. It has not registered as pain yet, it is merely a series of electrical signals. The body sends these ‘nociception’ signals as a way of telling our brain that our body is in danger- it is telling our brain that the body’s tissues have been damaged, and that there is the potential for further damage if the body is not removed from that situation. For the sake of simplicity, let’s call these ‘nociception’ signals, ‘danger messages’.
When the brain receives the ‘danger message’, it analyses the message and selects the most appropriate response for that situation. More often than not, when it comes to injury or tissue damage, the appropriate response is ‘pain’. Pain is incredibly motivating for removing ourselves from whatever is causing the damage (such as touching a hot plate), for protecting the injured area (not weight bearing on a broken leg) or for seeking help (yelling or screaming). It is our bodies way of making sure we survive, and it has close correlations with our ‘flight or fight system’- also important for survival.
Now… how does all this end up in chronic pain you ask? Well chronic pain simply occurs when the ‘danger message’ is highly sensitive and highly amplified. It works much like a car alarm that has been dialled way up, resulting in even the smallest trigger being able to set the car alarm off, such as someone walking by. In chronic pain, ordinary, non-painful things such as movement or touch can set off the ‘pain danger signal’, resulting in an amplified and exaggerated pain response.
When we use functional magnetic resonance imaging to see what is happening in the brain, we can actually see areas of the brain light up to produce pain signals in response to ‘nociception’ or ‘danger messages’. Because pain is a construct of the brain, it is merely responding to the ‘danger messages’ it receives from the spinal cord and the rest of the body. It believes that action needs to be taken in the form of pain, in order for the body to survive, even though that may not be the case. The electrical system that conveys the ‘danger messages’ to the brain is somewhat dysfunctional in people who suffer from chronic pain. So as you can see, just because there may be no tissue damage occurring in the body, it does not mean that the experience of pain is any less real. And as you can also see, chronic pain does exist ‘all in your head’, but so does every other single experience of pain, for everyone! That is how our body and mind work.
How do we fix this?
As I mentioned earlier, chronic pain is really hard to fix. It is phenomenally complex and we see so many variations of chronic pain that it is often difficult to predict what the most effective treatment may be. Many options exist to help treat or manage chronic pain such as:
- Mindfulness meditation
- Group therapies
- Injections or procedures
- Graded motor imagery
- Acceptance and commitment therapy
- Physiotherapy and …
More often than not, more than one therapy is required to treat chronic pain. Chronic pain is a mind-body experience, and as such, is best treated with a multi-modal approach.
Where to get help?
As a starting point, many websites and services exist to help sufferers of chronic pain. My favourite website is ‘Pain Management Network’ and can be accessed at:
At Calm & Connection Physiotherapy, we specialise in treating chronic pain, and offer packages to help you begin your journey to managing chronic pain and reclaiming your life. Get in touch to find out more.
Speaking to your GP, health practitioner, friends and family is also a great starting point to getting help. Remember, you are not alone, and you do not have to manage chronic pain alone.
And for a little bit more understanding of how chronic pain works, here is a short video that helps explain it.
We get back on the band-wagon to discussing some of the changes that can occur to our pelvic floor throughout the lifespan. Until then…
Be kind to yourself,