Chronic pain is a growing problem facing many people with the most common complaints of low back pain, headaches or migraines and neck pain. With 100 million Americans suffering with chronic pain, it is likely you or someone you know has been dealing with pain for several months or years. Back pain is the leading cause of disability in Americans under 45 years old, so it is likely that those you know that are dealing with chronic pain are affected in most aspects of their life.
Chronic pain can be helped. But in order to do so, it must first be understood. Chronic pain is complex and differs from acute pain. Acute pain occurs in the presence of acute tissue damage. It is a signal sent to the brain and plays an important role in stimulating responses in the body to protect tissues from further damage. It is perceived by the brain and typically subsides if no tissue damage is present. In the presence of damage, pain persists until the tissue is healed due to continued stimulation of the nerve endings that send signals to the brain in order to protect against further damage.
Chronic pain is pain that persists beyond 3 to 6 months. There are two primary types. The first type occurs due to continued active tissue destruction such as in cancer and chronic inflammatory diseases. The second type occurs beyond the point of normal healing when tissue damage is no longer present. Most injuries within the body will heal within 3 to 6 months. With chronic pain however, pain lingers after the healing process. Chronic pain differs from acute pain in that the body signals pain to the brain; however, there is no imminent risk of harm because the tissues have healed.
In the presence of pain, changes within the body can contribute to the development of persistent or chronic pain. The first thing that happens in response to pain is a change in movement patterns. Most people avoid moving in to painful motions or avoid movement at all. This creates muscle imbalances and compensations. Changes also occur in the nervous systems that change the body’s response to painful stimuli, lowering the pain threshold in tissues that have been exposed to prolonged pain signals. This means that it takes a lower level of pain stimulus to signal pain to the brain. Many factors contribute to these changes in the nervous system such as dietary issues, lack of mobility and emotional distress. These changes result in a growth of the areas that perceive pain, an increase in the chemicals that signal pain and a greater representation in the brain of the body parts with prolonged pain signals. All of these things combined create a state in which the body perceives significant pain without active tissue damage while movement compensations and muscle imbalances continue.
Research has shown that the best way to treat chronic pain is through a multifaceted approach that may include medications, proper nutrition, exercise, reducing risk factors and sometimes counseling. Because of all of the factors that may contribute to the changes in the body and mind in response to pain, it is best to approach the problem taking all of these things in to consideration. Physicians may recommend medications to make pain more tolerable, allowing more participation in work and leisure activities. Lifestyle changes such as following a healthy diet, regular exercise and reduction of risk factors such as tobacco and alcohol use help to reduce pain by decreasing inflammation within the body. However, all of these changes can be difficult to make. Therefore, it is important to get guidance from your physician and other health care professionals as you work to retrain your nervous system and correct movement and muscle imbalances in order to make it less sensitive to pain.
Physical therapists are an important part of the healthcare team for a person with chronic pain. As you incorporate all the changes recommended by your physician, your physical therapist will guide your return to regular exercise and activity. They combine pain relieving modalities, manual techniques and graded exercise to restore normal movement and muscle balance to get you back to the things you love with less pain.
It’s not an easy road, but chronic pain can be helped. If you have had pain for a long period of time, talk to your health care team about ending the painful cycle.
- Institute of Medicine Report from the Committee on Advancing Pain Research, Care and Education: Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. The National Acadamies Press, 2011.
- National Centers for Health Statistics, Chartbook on Trends in the Health of Americans 2006, Special Feature: Pain.
- Gifford, L. Pain, the tissues and the nervous system: a conceptual model. 1998, 84:27-36.
- Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain. 2004;8:39-45.