I wanted to give people a simplified explanation of the very complicated process that is pain. There are a lot of patients, and people in general, who don’t understand why something hurts. Furthermore, they don’t understand why something can hurt for so long. So let me take a minute, just sit right there, while I tell you about pain, and why you should care (think Fresh Prince).
What Is Pain?
First, what is pain? Why does something hurt? Pain is a physiological process. What that means is there is a signal that comes from your body somewhere. That signal goes to your brain. Your brain does all types of complicated brainy things and interprets whether that signal means pain. It is a SUPER sensitive system. Think about it for a second. If someone came up and just touched their finger to your arm, you wouldn’t jump away from them and say “ouch!” This area of the brain has to be highly specific. If the brain does suspect the signal is dangerous it will try to protect you from an injury or disease. Using that same touch example. If someone is poking you with a knife you will be more likely to try to get away from that person (I would hope).
Not all pain is the same either. Pain is about perception. My leg fracture (break) isn’t going to hurt the same as yours. There are a ton of factors that go into this as well. Culture, beliefs, and upbringing can all affect your pain levels. Like when someone says they have a high threshold for pain (side note, the people who say this, usually have a really crappy threshold in my opinion) they perceive pain differently than someone else. I think a great example of this is children. If your child is running around and trips a little and bumps into the wall, they may perceive this as “pain.” What they will usually do is look to mom or dad for confirmation. If the parent reacts in a way that can signal pain, the crying will commence. If the parent plays it cool, the child will usually get back up and start running again. Those perceptions get ingrained in the brain and will stick with them for life.
There are different pain time frames as well. Acute pain, is pain that lasts up to 3 months. Chronic pain, is any pain that persists longer than the 3 month time frame. Acute pain is a normal process that is the brain’s attempt to protect you from an actual threat. It is necessary for our survival. Let’s use the leg fracture example again. If you broke your leg you were probably involved in an accident of some sort. Let’s say you were cleaning out the gutters and fell off the ladder. “Ouch.” What the brain does is tell you there is something wrong that needs attention. It will hurt so you won’t put the leg on the ground. That will give the leg the time it needs to heal. Once it is healed, your brain turns the pain signal off, and you can put your leg back on the ground. Yay! Totally normal.
Chronic pain, however, is a false alarm. After the 3 month healing time, most of the tissues in your body have had enough time to heal. Any residual pain past that is no longer associated with that tissue damage. It is more due to anticipation of pain. Many different factors go into the perception of chronic pain including fear, anxiety, and hyperactive nerves. Chronic pain is real, but when someone says it’s all in your head, they are actually right. The nerves are sending extra “danger” signals to the brain which are then interpreted, along with emotional, cognitive, and other stressors, and the output is pain. So what can be done to right the ship and quiet the pain signal? You have to learn that something doesn’t hurt. Here are some of the strategies that we use.
Laugh it off (and no I’m not joking) and have a good time. Laughing, and pleasure centers in the brain help to combat the pain signal. Think about it. Have you ever been in pain when you are laughing your ass off? We always try to keep it light in the clinic. There is a reason for that. We want you to enjoy yourself while you are there, and start to associate movement with a pleasurable response. The more you can do that, the more your brain will stop perceiving movements as painful.
Go back to the scene of the crime and concur what gave you pain in the first place. Chronic pain has a huge psychological component. You need to prove to yourself that you can do that task again, and that it doesn’t hurt. Back pain is a great example. I treat patients all the time that hurt their back picking something up. When I put a 20 lb kettle bell on the ground and tell them to pick it up they look at me like I’ve been on a 5 day bender. That anticipation of pain is what leads to fear avoidance and chronic pain. If you can successfully lift the kettle bell without it hurting you are proving to your brain, and your back, that the next time you bend down to pick up that tissue off the ground, it should not hurt.
Pain is not your identity. People who suffer with chronic pain are always thinking, “I can’t do this or that because it will hurt.” The pain starts to become their identity. They forget about how well they used to play golf, or how much fun it was to pick up their grandchildren. They will avoid these tasks because they are fearful of the pain. Just like the example above with the kettle bell. Even if you can start small and build your way up, you will re-gain the person that you used to be. Lets take golf for an example (I'm sure you are surprised). Instead of avoiding playing 18 holes because you know that will hurt, start off with just practicing your putting. If you can putt for 20-30 min without pain that will start to teach your brain that maybe it’s possible to play again without significant pain. Starting slow with 30 min of low level activity releases endocannabinoids (no idea what that is, just wanted to appear smart) which produce a feeling of well-being. It doesn’t even have to be 30 min of continuous activity. So if you don’t feel like you can do a whole 30 minute, do 10 sets of 3 minutes. Start small with something that you can be successful with and build from there.
Lastly, go get a hug or give a hug. Physical touch releases oxytocin which is another chemical in the body that gives you the sense of well-being. That is why people feel so good when they go to Physical Therapy. A little massage, some healthy movement, and a feeling of accomplishment is all it takes to break that chronic pain cycle.
OrthoCore is available to discuss your chronic pain issues and help map out a solution. Call us today 401.667.0131 to get started!