PAIN SERIES! PART TWO.
Hello again!
Last week we discussed pain – what it is, why we experience it and how it occurs. The take-home message was:
Pain is a complex process that acts as one of our primary protective mechanisms
Pain is an OUTGOING message from the brain
Pain is NOT a message from injured tissues
Pain, if it continues after tissue healing and longer than three months, is considered ‘persistent’
Today I want to talk about persistent pain (PP). What it is, how it differs from acute pain and some factors that can make us more susceptible to developing PP.
So, what happens when pain persists...? In some cases, our pain system can become ‘hypervigilant’. This means that it becomes OVER protective and more sensitive to perceived risk which results in more pain signaling from the brain. What ensues is a cycle that snowballs and pain messaging that constantly reinforces itself. Our wires get crossed, and the brain gets confused about what is and isn’t true risk. The longer this goes on the more adaptations there are in the body & nervous system.
As these images show, the key difference between acute and persistent pain is that one is linear and resolves whilst the other continues in an ongoing, self-perpetuating cycle. But what makes the difference!? What determines whether pain becomes persistent?
In the simplest (most reductionist) way, the factors that determine whether pain goes through the ‘typical’ process or becomes persistent are our thoughts, feelings and previous experiences of pain.
As I’ve said a thousand times already, pain is a very complicated process, and we’ll dive deeper into how these can have an affect but firstly I want to make one thing clear. Pain is NOT ‘just in your head’. Pain is always a real and lived experience <3
Our thoughts, feelings and experiences associated with pain are included in the messages being received by the brain and create the context we were talking about in our last post. If we have negative thoughts, feelings and experiences then the brain is more likely to perceive risk and become hypervigilant. That is, it is more likely to send out ‘unnecessary’ pain signals long after the original injury has healed.
As time goes on and pain is continued to be experienced then there is a cascade of changes that occur both in our musculoskeletal and nervous system which (you guessed it) feeds back into this cycle of perceived risk.
I’m aware of how complicated this can all get so we’ll run through an example... Let’s go with the all-too-familiar low back injury lifting something heavy at work.
Example one, someone who works in an environment they enjoy, did something a little bit ‘silly’ when they lifted, has no dependents, can afford a week off work and has had some minor back pain before whilst playing footy. This person may be less likely to develop persistent pain.
Versus example two who is someone that doesn’t enjoy their work environment, hurt their back due to unsafe practices, has three children and a partner on maternity leave, can’t afford time off work and will have to complete a worker’s compensation claim proving their injury. This person may be more likely to experience persistent pain.
If we compare the two, our first example probably has positive or neutral thoughts, feelings and experiences of pain and is receiving information regarding their injury within that context.
Our second example is more likely to have fear around the injury and implications, will have to keep re-engaging with the initial injury throughout the process of the claim or may be forced, financially, to work through it (and ignore the cues for rest that pain provides, making the brain scream louder). Likewise, these negative thoughts, feelings and experiences of pain create the context in which the brain is receiving its information.
If we stick with our second example, as time goes on and they continue to experience pain (even after the tissues have healed) they will start to protect their back – stop going to the gym, avoid certain positions or movements, anticipate when it will hurt. This has two impacts: 1) it will continue to create a landscape that encourages the brain to be wary of possible harm and 2) it will decondition the body (weaken and tighten muscles, etc) and make it harder for the brain to learn that it is safe.
You can see how we can get stuck in that pain cycle and how, over time, it can snowball.
A few things to clarify/reiterate before we wrap this up (thank you for your patience, I know it’s a lot to take in) …
Pain is not ‘in your head’. It is a response from the brain to perceived risk of injury and is informed by ALL of the information it receives
As our examples showed, there are countless factors that can contribute to someone’s experience of pain and they’re all individual. This is why pain is a unique experience for everyone in each situation.
As you know well by now, pain is complicated. I’ve done my best to explain the main principles but there are more layers to it (if you can believe that!). If you’re experiencing persistent pain, then I strongly advise you to talk to your osteopath or other health provider. They’ll be able to give you more insight into your own pain picture and develop a personalised management plan.
I understand that we’ve covered a lot in this post, and I hope it hasn’t been too overwhelming or doom-and-gloom. It's important that we understand how persistent pain occurs so that we can discuss the MANY different options there are for managing it - which we’ll do in the next part of this series!
Until then, all the best!
Zoe xo