Persistent pain: how to help?
When managing persistent pain, it is important to look beyond the painful body part and make sure to consider the whole person. As you read in the previous article, pain is influenced by many factors.
Because of this everyone’s pain management journey varies, although there is a general structure to follow. We influence pain by: 1. decreasing the factors that exacerbate or contribute to it and by 2. building up our tolerance for a painful activity. Often we can target these two goals at the same time.
How does this apply in practice?
Because multiple factors can contribute to sensitization, there are various ways we can reduce it. We start by finding ways to lessen your symptoms in the short term, unless you already have some go-to methods. Some people use things like heating pads, ice packs, pillows, or massages to get some relief.
In addition we address specific factors that might make you sensitive like addressing a fear of movement (bending forward with persistent low back pain) or changing the way in which you approach an activity. For example, if you are a runner with back pain we choose an appropriate entry-point for the running and we gradually go from there dosing it properly over time.
Other times we choose general approaches that help you get healthier. General factors we often consider are the following:
Overall physical (in)activity level
Recovery strategies
Sleep habit
Stress and coping mechanisms
Unhealthy diet
Luckily we don't have to make drastic changes to every single factor to “turn down” the pain alarm system. A more accurate way to see this is that there are many strategies we can try to get your pain more under control.
The specific approach will vary for each person. You and your physical therapist can discuss your current situation, identify any relevant contributing factors that might be worth addressing, and create a plan to address the ones that can be changed with consistent gradual steps.
These are a few options that my patients have found helpful to manage their pain on a day-to-day basis:
Not skipping downtime/lunch time: take time to decompress;
Identifying stressors and address them: if a psychologist is already in the picture, it could be helpful to dive into this;
Taking a movement break every hour: getting up and walking to the bathroom/ to get a coffee or a water break;
A walk or a short workout before work;
Resuming hobbies and engage in social activities you enjoy: these activities can create "feel-good" chemicals that benefit your whole body and brain.
These strategies when chosen appropriately can help with diminishing the sensitization involved in persistent pain.
Persistent pain can be very difficult to navigate. It may be helpful to think about the bigger picture and not just the body part that hurts.
References:
Butler DS Moseley GL. Explain Pain. Adelaide: Publications; 2003.
Nijs J, Leysen L, Vanlauwe J, Logghe T, Ickmans K, Polli A, Malfliet A, Coppieters I, Huysmans E. Treatment of central sensitization in patients with chronic pain: time for change? Expert Opin Pharmacother. 2019 Nov;20(16):1961-1970.
