Persistent pain affects between one-third and one-half of the UK population according to a review by the British Medical Journal. This equates to just under 28 million adults, and the consensus is that this figure will likely rise in line with an ageing population. But what exactly is it and what can we do about it?
What is persistent pain?
You may have heard the term “chronic pain”. Many people think this means severe pain, but really it means pain that keeps on going longer than expected. Health professionals now commonly use the term “persistent” which is a more accurate term.
Acute pain is short term and is usually more associated with damage or possible damage to the body. When you twist your ankle you will likely feel pain associated with bruising and swelling. This acute pain is a good thing and will protect the body part as it heals, stopping a person running on an injured ankle or keep us from opening up a healing wound. Healing usually takes no more than 3 months, even for quite severe injuries.
Persistent pain lasts longer than acute pain and often does not indicate ongoing damage even though it will likely feel like it. The pain is less to do with damage and more to do with our central nervous system.
The Brain Produces Pain
The brain is really important when it comes to understanding pain. All pain is produced by the brain, the nerves around the body can only feed information to the Brain that “something” has happened and then the brain uses all the information available- immediate environment, life factors, previous injury, future plans etc. Only after sorting through all this and more in super quick time will it tell you if you feel pain or not.
When you repeat a movement or activity over and over, your brain creates a pattern of nerve connections and you get better at performing that movement. Similarly if a movement is painful for a long enough period the brain will strengthen the connection between movement and pain. This unhelpful pattern can become sensitised or as many pain experts call it “turned up”, comparing it to a radio with the volume knob stuck on loud. Once this happens even preparing to do that certain movement will cause the pain pattern to kick in and even though the body has healed as much as it’s going to, the movement still hurts. This pain that remains after tissues have healed has more to do with changes to the nervous system and the biggest problem is this “increased volume”.
The way a person experiences pain is influenced by many factors. Persistent pain is a whole life problem and needs a whole life approach. The way we experience pain is influenced by overall well-being, many stressful or emotional situations can affect our pain. Tiredness due to lack of sleep, argument with loved ones, anxiety, grief and poor nutrition are just a few examples of influencers on our pain. Pain is not a conscious decision but research has shown that conscious decisions and actions can have a huge impact on our pain. These factors alongside pain can cause a vicious pain cycle where pain causes low moods and low moods increase experience of pain. This leads to avoiding movement and activity which leads to weakness and stiffness which then feed into the cycle.
What can we do?
Understanding the pain is a good start, and with time and effort it is possible to turn the volume right down on persistent pain. When a person starts to make positive changes in their life, one small gain leads to another. With increased activity and increased confidence, people experience less pain, which in turn leads to more positive changes and they are into an upward spiral rather than downward pain cycle. Examples of positive activities are appropriate exercises, doing things that you enjoy, helping others or working towards meaningful goals. The way you think about pain is very important, the research shows that if you understand your pain more, then you will feel more in control, make better decisions and experience less pain.
Acknowledgement- Tasmanian Health Organisation South
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