What is Pain?
When experiencing pain should we always be worried? When we sustain an injury, this stimulates the nerves at the point of contact i.e., the hand or foot and transmits a signal to the spinal cord, up into the brain, most importantly the somatosensory cortex (part of the brain) via the nerves. This then allows our brain to send signals back to the injured area to act appropriately i.e., move the limb away from the stimulus and protect.
However, when we continue to feel this pain despite pain relief, physiotherapy or specialist input, we can start to feel overwhelmed. This pain we feel is no longer linked with immediate danger, but the brains memory of that pain. This memory/interpretation of the pain can be amplified by a wide range of biological, psychological and social factors. This long-term pain is known as chronic or persistent pain.
A common term heard from patients experiencing chronic pain is that they feel like professionals tell them ‘it is all in your head’. But if we were to explain more about the role that pain and psychological response play in the development of persistent pain and disability, would this more beneficial? We know ourselves how pain can have a significant and clear effect on our emotions and behaviours, however, these factors can have a significant influence in the development of that pain and the outcome of treatment. Research has found that integrating psychological principles into physical therapy treatment can potentially enhance the outcomes.
If we looked at a summary of the psychological processes that take effect when we feel pain, research has categorised these into 4 areas: attention, cognitions, emotions and emotion regulation, and overt behaviour. When we sustain an injury the pain, we feel demands our attention, then how we think about that pain may influence the type, severity, or duration in which we feel that pain. Secondarily, this pain often generates negative feelings, which starts to influence our mood and behaviour. Those behaviours then potentially influencing our perception or coping strategies.
Commonly, when we are experiencing significant persistent pain, we start to feel low in mood, withdrawn, isolated, maybe lose relationships and friendships due to our behaviours or perceptions of others, or theirs of us. We know this then intensifies the pain we feel, results in inactivity which leads to further deterioration, heightened pain, and likely pain referral. This is called the pain cycle. What treatment hopes to do is stop this cycle and focus more on the self-care cycle.
Examples of treatment strategies are things such as relaxation, advise around sleep, activity planning and goal setting, challenging thoughts and feelings, pacing etcâ€¦ looking at overall to try and build a happier and healthier mindset and life. This helps the individual to take back control.
When looking at recovering or self-managing our persistent pain keeping it simple and picking 2 to 3 things to focus on first can be the best approach. For example, if you felt stiff and inactive, and felt stressed or fearful, working on gentle graded stretching in a comfortable position such as lying on your bed mixed with relaxation/controlled breathing may be significantly beneficial and aid with engagement.
Or, if you wanted to know more about managing flare-ups or setbacks, goal setting and healthy eating, liaising with the appropriate healthcare professional or reviewing online literature on KnowPain or NHS websites, can help with taking the first steps.
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