Chronic Pain – How Knowledge Helps

As we discussed in our last post, chronic pain is pain lasting more than 3 months. But whether your pain is chronic or not, knowledge about pain and how to manage it can be extremely helpful. Especially when it comes to pain with exercise.

Below we discuss 3 things you should know about pain.

1. Pain doesn’t always equal tissue damage. 

Many studies have shown that experiencing pain doesn’t always mean you’ve damaged tissue in your body. And studies have also shown that you can have tissue damage and no pain. In the research study here, results found that patients who had no pain still showed spinal disc degeneration.

So what is pain if it doesn’t always mean you’ve sustained an injury?

Pain is like a warning sign. It alerts you to threats on your body so that you are aware of those threats and can take care of them. If you damage a ligament by rolling your ankle for example, your body will tell you that you have an injury through pain. That way you stop using it and allow it to heal.

But since pain is processed in the brain, your pain signals can get mixed up. This causes you to experience pain well past the timeframe it takes your ankle to heal leading to chronic pain. But why, exactly does this happen?

2. Our pain system can become over-sensitive.

With chronic pain, your pain system itself becomes “inflamed” and you keep experiencing pain well past the timeframe it takes for the tissue to heal. The study here reports that 1 in 5 patients experience persistent pain after a total knee replacement. Why does this occur?

One reason our pain system becomes over-sensitive is failed treatments. Things like a unsuccessful surgery, injections that didn’t reduce your pain, or a therapy session that pushed you too hard, for example.

Other causes can also be financial or family stress, identity struggles caused by the injury, or fear of what changes this injury may bring into your life. Since pain is processed in the brain, things like stress and fear can make you experience more pain. And cause your pain system to become over-sensitive.

If you rolled your ankle, but walking is the way you manage your weight and keep your blood pressure down, you may fear that you will gain weight and not be able to mange your blood pressure. And this fear if not managed well can cause your pain system to become over-sensitive and your ankle pain to stay around longer than it should.

This is why knowledge about pain can help reduce your pain. When you start to feel stress and pain becomes elevated, you can rest assured that you’re not actually damaging your tissue in that moment. But rather the pain is increasing because of the other stressors in your life. And with proper management of fear, stress, and pain, all can reduce. This leads us to our third fact about pain.

3. Exercise can reduce pain.

In physical therapy, I spend a lot of time educating patients on how to use exercise to reduce or avoid pain. In one example, I was treating a patient with knee pain and we found a stretch that reduced her pain. Specifically, she had less pain going down a step after doing this stretch. When you find an exercise that reduces pain, you can use this exercise to reduce your pain throughout the day. And you can also use this exercise before an activity that usually causes pain in order to avoid pain. 

How do you know which exercises will help reduce your pain? A good physical therapist or other healthcare professional can help you do this. But general movement like walking, stretching, and light strength training can also help reduce your pain, especially if it is chronic.

But what if chronic pain is keeping you from exercise?

What should you do to manage chronic pain if it is keeping you from exercise? First, see your doctor and a physical therapist to make sure your pain is not caused by an injury that needs specific intervention. Remember that physical therapists are experts when it comes to bones, muscles, and movement patterns (shameless plug for my profession).

Next, modify your workouts. Start with gentle, pain free exercise and progress the intensity in ways that don’t increase your pain.

In my next post, I’ll talk more about properly progressing exercise and how aerobic exercise can help you manage chronic pain.

If you are experiencing chronic pain, remember: pain doesn’t always equal tissue damage, our pain system can become over-sensitive, and exercise can reduce pain.

Disclaimer: You should always consult your doctor before making changes to your health strategy especially if you have a chronic condition. If any of these strategies sound especially helpful for you, be sure to discuss with your doctor the best way to implement them into your health plan.

Reference:

Adriaan Louw, PT, PhD. Why Do I Hurt? (Adriaan Louw, 2013), pg 5, 7-8.