What is chronic pain?

Image source: https://www.physio-pedia.com/Biopsychosocial_Mode

So, chronic pain may result from damage to body tissue from an acute or chronic condition.

But changes in the nerves or nervous system that result in the nerves continuing to signal pain after the original condition has healed (Painaustralia 2019a).

There also may be no apparent physical cause (Treede et al. 2015; Painaustralia 2019a). 

Thus, attitudes towards pain and biological changes in the perception of pain may influence the experience of pain. (Molton & Terrill 2014).

There has been many studies and research to try to understand people’s experience of pain. One thing is for certain: Pain and the experience of pain is subjective. For instance, according to Professor Lorimer Moseley, of the USA in Adelaide, the more pain we feel the less life threatening it is. Why is this?

However, people suffering from chronic/persistent pain do have a lower life expectancy: It can disrupt nearly all aspects of someone’s life – beyond physical pain, it can impede their ability to work and participate in social and other activities like they used to. It impacts their relationships and cause feelings of isolation, frustration, and anxiety. Recently, Australian researchers have found that there are actual physical alterations happening in a patient’s brain that likely leads to negative changes in their personality.

Chronic pain itself is not life-threatening, but it leads to higher rates of depression, suicide, and opioid use.

What can we do about it?

As physiotherapists, we have many ways of trying to understand a person’s level of perceived pain, which is especially important for us to know if and how our treatment made a difference.

How can we address the changes in the nerves or nervous system, attitudes towards pain and perceived pain?

By combining an active and passive approach to meet the patient where they are at.

An active approach:

1)      Empower the patient to understand their condition.

2)      Provide education regarding chronic pain.

3)      An exercise program that is gentle, gradually challenging fear and enhancing a sense of achievement.

4)      Create an understanding, acceptive space to promote confidence.

5)      Home exercises to promote self-management.

6)      Self-management techniques to cope with setbacks or flare-ups.

7)      Adopt a coaching role, assisting the patient to problem solve, rather than a traditional treatment plan.

A passive approach:

1)      Hands-on modalities, including different massage techniques, joint mobilisations, myofascial release, and craniosacral therapy.

2)      Electrotherapeutic modalities and cold/heat therapy and vibrations.

3)      Acupuncture/ Dry Needling

In my experience, a combination of an active and passive approach is more appropriate and most useful.

To summarise:
An image to explain chronic pain: