Understanding Chronic Pain
Chronic or persistent pain is a serious condition that can be debilitating, leading to chronic pain syndrome, depression, anxiety, and other medical conditions. Learn how patients with chronic pain can find relief with non-invasive treatment options.
What is Chronic Pain?
Chronic or persistent pain lasts for more than 3 months or beyond the normal healing time. If you've been in pain for a long time, you're not alone. According to the Australian Institute of Health and Welfare, one in five Australians aged 45 or over (or 1.6 million people) live with chronic pain. Chronic pain can significantly impact your life, leading to frustration, discomfort, and limitations in everyday activities.
Nociceptive Pain Differences
Identifying the difference between pain and nociception early can reduce potential harm and management delays. Typically, a person with chronic pain experiences pain in more than one area (like neck pain and headaches) for months or years. They may have had various diagnoses and seen relevant specialists, often trying different medications that were ineffective or had unacceptable side effects. Some have undergone surgeries to 'fix' the issue, only to find short-term relief. This belief that "nothing works" impacts their physical and psychological well-being.
What is Nociception?
Nociception describes what happens when your body perceives actual or potential harm. For instance, when we hurt ourselves by touching a hotplate, the perception of harm activates certain chemicals and channels. This signal travels to the brain via a complex series of nerves, including the spinal cord.
The above diagram titled "Basic Anatomy of Nociception" illustrates the process of nociception, the body's response to harmful stimuli. Key elements include:
Brain: Processes harm signals.
Spinal Cord: Connects the brain and peripheral nerves.
Peripheral Nerve: Transmits signals from the injury site.
Skin: Contains free nerve endings (nociceptors) shown in detail.
Free Nerve Ending (Nociceptor): Detects harmful stimuli.
Injury: Depicted with a hand holding a hammer, showing the source of harm.
The diagram shows how an injury activates nociceptors in the skin, sending signals through peripheral nerves to the spinal cord and brain, resulting in the perception of pain.
What is Pain?
The brain processes this signal and generates a response or message. If this message indicates danger (like taking your hand off the hotplate), it registers as pain. If there's no perceived danger, there's no pain. Therefore, pain is a response, not a stimulus.
How Do We Perceive Pain?
Even when harm signals are triggered, our brain doesn't always express pain. Pain is a danger signal perceived by the brain, coming from sensations within our body or from our external environment. A harm signal from a body part travels through the nervous system, and if the context is perceived as dangerous, it is expressed as pain. This makes us seek safety, either by retreating from a situation or taking action to resolve the danger and feelings of anxiety.
The brain areas receiving nociceptive signals also deal with memory, emotions, logical thinking, and fear/worry. Harm signals can get intertwined with feelings, thoughts, and memories, explaining why chronic pain can worsen under certain circumstances, like when you're tired, unwell, or stressed.
Chronic or Persistent Pain
If pain lasts longer than the expected injury/surgery healing time (more than 12 weeks), it is classified as chronic or persistent pain. Chronic pain has two main subtypes:
- Neuropathic: where there is proven nerve damage.
- Nociplastic: involving inflammation in the immune system of the brain and spinal cord.
Central Sensitisation
Central sensitisation involves changes in the way the central nervous system processes sensory information. It's like a hotel fire alarm going off at the slightest hint of smoke. Changes in nervous system wiring mean signals that wouldn't typically cause pain, such as pressure or movement, trigger a danger warning.
Several chronic pain disorders, including fibromyalgia, irritable bowel syndrome, chronic headache, TMJ disorders, and pelvic pain syndromes, share common features despite affecting different body parts. These disorders, known as 'central sensitivity syndromes,' involve persistent pain and other symptoms like fatigue, sleep problems, dizziness, cognitive issues, depression, and anxiety.
Managing Chronic Pain
Curing pain without understanding its complexity is futile. A comprehensive approach targeting brain and top-down mechanisms is essential. Treatment strategies should include:
1. Education and Explanation: Pain neuroscience education helps patients understand their condition and develop better pain beliefs and coping strategies.
2. Active Interventions: Stress management, sleep management, graded activity/exercise therapy, and graded exposure benefit patients with central sensitisation pain.
3. Cognitive-Emotional Factors: Addressing pain catastrophising, anxiety, varying pain beliefs, and coping strategies is crucial for long-term pain control.
Developing a pain-free mindset is not a quick fix, but it is the most evidence-based and successful way to regain control of your life, find purpose, and return to activities you love.
Remedial Massage and Chronic Pain Relief
Chronic pain can be incredibly debilitating, impacting every facet of daily life from simple movements to mental health. Remedial massage provides a non-invasive, effective approach to managing chronic pain by targeting the underlying causes, such as trigger points, muscle tension, and connective tissue issues.
Trigger points, or muscle knots, are hyperirritable spots within muscle tissue that cause discomfort and referred pain. Remedial massage alleviates this by applying direct pressure to these points, which stimulates nerve fibres that send non-painful signals to the brain, effectively blocking pain signals (Pain Gate Theory).
This process also promotes the release of endorphins, the body's natural painkillers, and utilises myofascial release techniques to stretch and loosen the fascia surrounding muscles. These actions reduce muscle tension, improve circulation, and enhance overall relaxation, offering a comprehensive approach to chronic pain relief.
Billy Gilhooley: Chronic Pain Management at Specific Physiotherapy Preston
Billy Gilhooley, a dedicated physiotherapist with a special interest in chronic pain management, brings a wealth of expertise and compassion to his practice. With extensive experience in treating complex pain conditions, Billy is committed to helping his patients achieve lasting relief and improved quality of life.
His approach combines evidence-based techniques, including remedial massage and targeted exercise programs, to address the underlying causes of pain and promote holistic healing.
Disc Bulge
Fact: 50% of the population aged 40 and above are asymptomatic for a disc bulge in their spine. Pain is not equal to harm, and vice versa.
Questions to Consider
What does that mean for treatment? Invasive (surgery) vs. non-invasive (Physio, yoga & massage)?
Pain is a complex and fascinating topic. For more information, refer to the following resources:
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