Reframing persistent pain
How you understand and cope with your pain affects the pain itself. There is no set script for educating people about pain. Education is an interactive process that should be tailored to the individual's circumstances, experience, knowledge, and beliefs about their pain. So why am I writing a blog piece about this? I hope that some of the information in this blog will be relatable to your experience and could be useful to make sense of what you are experiencing. If you have a hard time seeing the path forward in your journey, I recommend getting in touch with a physical therapist that you trust.
Something that my patients find valuable when reframing their pain experience is understanding that pain doesn’t always equal harm, especially if pain is persistent. Your nervous system uses pain to protect you at all costs, not to inform you about damage.
Let’s dive into why your hurts won't harm you.
Key points about pain:
Pain is a normal response of the brain to a perceived threat or injury. When an injury occurs, nerve endings in the affected area send a signal to the brain with information about the injury or potential danger. The brain processes this information and, if it determines that you are in danger and need to take action, it will produce pain.
As healing occurs, the "danger information" coming from the injured area decreases and pain sensation generally decreases as well. However, in certain circumstances pain can persist long after the injury has healed. This could be in part due to the fact that persistent pain activates other mechanisms in the body that make the brain's "danger alarm system" more sensitive and easily excitable. This process is called sensitization (increased sensitivity to pain) of the nervous system.
Activity level, stress levels, nutrition, sleep, fears, emotions, coping mechanisms, beliefs about the pain experience are all factors that can affect how reactive your nervous system is.
Do you mean my pain is in my head?
Pain is not "all in your head". Although it is processed by the brain, pain is not imagined. While the sensation of pain itself is subjective and can be influenced by your thoughts, feelings, and expectations, the pain is a very real experience and there are effective treatments for it.
Why is this important to know?
Talking about the sensitization of the nervous system allows us to explain how persistent pain can be felt with normally innocuous stimuli or activities that are not truly harmful to us. This also means that amount of pain you experience does not necessarily correlate with the amount of tissue damage. Most of the times even when things hurt, you are safe to move and resume your life. Getting back to movement and enjoyable activities even when they cause some pain, are usually the same things that can speed up recovery.
It's important to know that you can change and reduce the sensitization. The nervous system is constantly adjusting the level of volume on the pain: sensitization can be modified. Our bodies, our nervous system is plastic and adapts to what we do and what we think.
So what can we do to help persistent pain? Check out this page.
References:
Butler DS Moseley GL. Explain Pain. Adelaide: Noigroup Publications; 2003.
Voscopoulos C, Lema M. When does acute pain become chronic? Br J Anaesth. 2010 Dec;105 Suppl 1:i69-85. PMID: 21148657.
Leake HB, Mardon A, Stanton TR, Harvie DS, Butler DS, Karran EL, Wilson D, Booth J, Barker T, Wood P, Fried K, Hayes C, Taylor L, Macoun M, Simister A, Moseley GL, Berryman C. Key Learning Statements for Persistent Pain Education: An Iterative Analysis of Consumer, Clinician and Researcher Perspectives and Development of Public Messaging. J Pain. 2022 Nov;23(11):1989-2001. PMID: 35934276.
