Coping with Chronic Pain

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The most common complaint of patients when they attend physiotherapy is pain.  Pain is something that everyone experiences sometime during their lifetime. So throughout the month of May we will be taking a look at various causes of pain and how to deal with them along with our physiotherapist, Diaan Jooste. Recent studies have shown that between 38-48% of the population battles with chronic pain, so today we will share some more information on how to manage this.

Chronic pain has been marked by pain that had lasted for 3 months or more since onset.  But the more popular definition of chronic pain is “pain that extends beyond the expected period of healing.”  Chronic pain does not only affect people physically, but has a huge impact on emotional health and their quality of life as well. Most chronic pain patients also complain of cognitive impairment, such as forgetfulness, difficulty with attention, and difficulty completing tasks and the most common area of chronic pain is back and neck pain.

You might wonder why pain becomes chronic and at this point it’s still a subject that’s keeps researchers very busy.  An interesting thing to note when it comes to pain is that the nerve cells that sends messages to the brain have a specific threshold that determines when they tell your brain about potential damage. If these nerve cells keep on firing messages to the brain, the brain has the ability to lower their threshold and so becomes more sensitive to stimuli. This is a protective mechanism to make you more aware of potential pain and to not cause more damage to the area. The problem with this is that it can lead to the nerve cells becoming over-active, as when the firing threshold gets lowered, the nerve cells may fire warning messages to the brain without even being under treat.  And so the perception of pain can be present without there being actual threat or damage to an area.

The other very interesting thing is that the brain has a map of the body where it allocates a specific portion of the brain to that area.  So for instance, your face and your hands have got a bigger area allocated to them than your legs.  Now when those nerve cells, let say in the knee keeps on firing warning messages to the brain, the brain has got the ability to change the area on the map and focus a bigger area of the brain in on the knee.The other very interesting thing is that the brain has a map of the body where it allocates a specific portion of the brain to that area.  So for instance, your face and your hands have got a bigger area allocated to them than your legs.  Now when those nerve cells, let say in the knee keeps on firing warning messages to the brain, the brain has got the ability to change the area on the map and focus a bigger area of the brain in on the knee.

In short, pain can be an illusion that’s all just in you mind.

Complete healing from chronic pain is not something that is often achieved.  Some people battle with pain even though there is clinically no reason for them to experience pain.  But like we said, when chronic pain sets in, there are actual changes that happen to nerve cells and even in the brain that cause nerve cells to fire even when they are not suppose to.

Luckily there is much that can be done to reduce suffering and improve quality of life.  Chronic pain management is most effective when it is done in a multi disciplinary team approach.  A typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists and nursing staff. The patients themselves also form an integral part of the team.

From the physiotherapy side, we would take a complete history and do a thorough assessment to determine what areas need to be addressed first.  Often hands-on treatment is given to help relieve some of the symptoms, but the bigger goal is to help patients retrain their brain and bodies to cope better with the pain and to help change the firing thresholds of the nerve cells that are affected. This is done with a wide variety of techniques which take a lot of dedication from the therapist as well as the patient.

The other very important role that physiotherapists play in the management of chronic pain is to incorporate movement back into the patients daily lives even though their bodies are telling them not to move.

Most chronic pain sufferers are found to have the following thought pattern….when they experience pain, it increases their stress and anxiety levels, so to try and decrease stress, anxiety and the pain, they start doing less, which causes them to get weaker because muscles don’t get challenged as it used to, that is when muscles get weak, it leads to less stability in the body and around joints, which causes more pain over time…and so the vicious circle repeats itself over and over again.  So it’s the medical teams’ goal to get that cycle into reverse gear.

Most chronic pain patients get so frustrated because they are so limited with movement.  We encourage these patients to start with very easy, non threatening exercise programs and as they improve we adjust the programs to incorporate more movement into their daily lives.  We also use programs to retrain certain movements of painful joints and limbs where patients are for example very scared to move because of pain.

The aim in the end of the day is not to be pain free, but to have a better quality of life.    Chronic pain tends to disable some patients so much that something like a walk along the beach seem impossible. Chronic pain might never completely be gone, but if patients can learn how to pace themselves and to manage their pain properly, they can end up doing things that they never thought they will be able to do again.

There are a lot of different ways to exercise that is non threatening to your body like exercises in a heated pool, cycling on a stationary bicycle and walking.  The best would be to visit your physiotherapist if you are a chronic pain sufferer and let them help you to get in touch with a multi disciplinary team.

Diaan Jooste is a registered physiotherapist in Nelson Mandela Bay. Her practice is in 339 Cape road, on the corner of fifth ave and cape road in Newton park. If you have any questions or would like to make her appointment, you can contact her at diaanjooste@yahoo.com

Tune into Kingfisher FM every Friday throughout the month of May between 11:00 and 11:30 to find out more about pain management with Diaan. www.kingfisherfm.co.za

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