Nobody likes to hurt, and most of us will do whatever it takes to ease pain when it arises. But without pain, we would not be aware of injury or disease, and we would be oblivious to other important messages that pain symptoms convey. In fact, people with congenital analgesia – the inability to feel pain – tend to have shortened lifespans. Learning about pain can help you better manage it, and give you a better idea of how to get rid of it.
It is logical to assume that pain originates where you “feel” it, but in reality, pain begins and ends in your brain. That is not to imply that pain should be ignored, or that we can consciously control our brain’s pain signaling by telling it to calm down. But knowing that the brain is in control of pain symptoms is a good place to start when trying to understand pain, especially when it appears to have no structural source.
It is not uncommon for people to seek surgical intervention for ongoing pain, and there is no lack of doctors willing to put you under the knife. But the truth is that many surgeries do not succeed in alleviating chronic pain. That is because the surgery targets the site of pain, and not its origin, which is the brain.
Generally speaking, acute pain is a reliable indicator of some sort of tissue damage — maybe you sprained your ankle, or scraped your knee, for example. Acute pain can often be managed with ice and analgesics, and it diminishes as the tissues heal. Most acute pain, even from a serious injury, disappears after three to six months or sooner.
Chronic persistent pain, on the other hand, is much more complex, It is often not caused by structural or tissue damage, and sometimes it can persist after an injury has healed. Yet despite the absence of damage, the sensation of pain is very real. Common examples of persistent pain are low back pain, fibromyalgia, and other chronic pain syndromes. Pain medications may help to ease the symptoms of chronic pain, but in order to eliminate it, you need to retrain your brain.
Contrary to what many think, nerves do not convey pain. They merely respond to a stimulus in the tissues and send a message to the brain, which in turn decides how to interpret that stimulus. Essentially, your brain forms an “opinion” about the stimulus, and decides how you should feel about it. To arrive at that opinion, your brain draws upon multiple resources, including past experiences, stored knowledge, cultural influences and a plethora of other information.
It goes something like this:
- Nerves send a message from the affected area to the brain;
- The brain forms an opinion about whether a threat exists, and what actions need to be taken;
- In cases of chronic pain, the brain and nervous system become hyper-sensitized, increasing pain symptoms;
- All sensations coming from the problem area are interpreted as danger, even when there is no structural damage. Pain messages can come from multiple areas of the brain, including those that govern fear, emotions, movement, learning and problem solving.
- As pain persists, the perception of pain can be intensified by a number of stimuli, including emotions, sensations and thoughts about the affected area.
Fear can play an important role in pain perception. There is a solid body of research to support the idea that anxiety and fear of pain can actually intensify the perception of pain. Moreover, the large majority of people who experience ongoing chronic pain are reluctant to exercise for fear of doing further damage, even when no structural damage exists. Yet exercise has been proven to be one of the most effective antidotes for chronic pain.
The physical therapy team at NYDNRehab can help you confront your chronic pain and learn to overcome it. We begin with a clinical exam and assessment to confirm that there are no structural problems associated with your chronic pain, like compressed nerves or damaged tissues. We then create a treatment plan based on your individual patient profile.
Some strategies we use to reduce chronic pain include:
- Patient education to help you manage pain and begin to work toward eliminating it.
- Strengthening and stretching exercises to improve movement and flexibility. A graded exercise program will help your brain recognize that movement does not pose a threat, and is not causing damage to the problem area.
- Hands-on manual therapy to increase your range of motion, improve tissue quality and desensitize the brain and nervous system.
- Training for posture and body mechanics to promote good body alignment and increase the efficiency of movement.
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