FACTS ABOUT CHRONIC PAIN

Chronic pain can be difficult to deal with – step 1 is gaining knowledge!​

FACT 1: 

The intensity of the pain is NOT ALWAYS directly related to the severity of the underlying condition. 

In chronic pain, your symptoms can become worse without there being anything specifically new wrong with your body. This can be very confusing and worrying. Lots of different factors can make things hurt more. One of the things that can make pain worse is increased inflammation, which can cause peaks in pain without new tissue damage. ​

If you are unsure, seek out a member of the interdisciplinary team. In many instances some education, simple analgesics and staying active will manage the pain.

FACT 2:

Where the pain is on your body, frequently is not where the problem is. 

Nerves carry signals across long distances through the body all the way to the brain, giving it information about bits of skin and specific muscles in all the different parts of our bodies. Along the way to the brain these nerves may pass along sections of inflamed tissue, or become irritated due to pressure, stretch or problems with alignment, and the signal they carry may become scrambled. The receivers in the brain then misinterpret the signal. The brain may not understand why the signal is scrambled,  what is causing the signal to be scrambled, or where along the length of the nerve the scrambling is taking place, so it does the only thing it can – it reports pain at the site that the nerve originates. ​

So, if you have a nerve in the neck that is irritated by pressure, you may have no or little neck pain, but severe pain in your hand, because the brain is reporting the problem of the irritated nerve in the neck, at the site where that nerve starts – the hand. Referred pain such as this needs a specialist interdisciplinary team to help make the diagnosis and recommend appropriate treatment.  ​

FACT 3:

What you feel might be false.​

Let us continue with the nerve in the neck scenario.​

When the pressure is slight and the nerve is just a little bit touchy, the signal is only slightly scrambled. The receivers in the brain struggle to make sense of it and it presents a bit like static or white noise coming from the hand...so you feel ‘pins and needles’ in your hand. ​

If there is a bit more pressure, and the nerve becomes really touchy 
and irritable, the signal can become 
more scrambled. The brain now becomes really worried! It starts reporting a burning, severe pain in the nerve’s distribution - the hand. ​

It is natural to be anxious and worried about ‘pins and needles’, and severe pain- it feels as if there is something terribly wrong with the hand, but really, it frequently is just a scrambled message from a touchy, grouchy nerve. 

FACT 4:

You do not need an injury or illness to develop chronic pain.

Most chronic pain patients do not have pain due to an injury. Pain may rather be due to a chronic condition such as arthritis. However, if you already have a chronic condition, and then suffer trauma, or an injury, this could aggravate the underlying 
condition and be the start of your pain. This may be the first time you becomes aware of discomfort and then, incorrectly, you might attribute the pain as resulting from the injury. ​

The reason this is important for you, is that if you feel that an injury caused your chronic pain, you might want someone to fix it, or be angry about what happened.  You might become quite passive in your approach, experience more suffering, be less resilient and rely on your healthcare providers to give you an answer. Studies show that passive coping strategies (e.g., taking medication, resting, using hot/cold packs) were associated with three times as many healthcare visits and doubling the level of pain-related disability compared with the use of active strategies (e.g. exercise).​

Chronic conditions need active management, with you as the leader of your own team. You must be galvanised into action, to become an active participant in your own health journey, gather a team around you, educate yourself and become a warrior in your fight against pain. ​

WHAT TYPES OF PAIN ARE THERE?

Most people with chronic pain have more than one type of pain and can even have all three. That is why looking for the one magic treatment that is going to fix everything is not helpful – treatment must be multi-dimensional and must be provided by an interdisciplinary team.​

  • NOCICEPTIVE PAIN

    Nociceptors are special receptors that respond to something that is dangerous or potentially dangerous to body structures, such as pressure, chemical changes, extreme temperatures, stretch, or when body tissues do not receive enough oxygen. Nociceptive pain is pain that is caused by actual or potential body tissue damage. It is normally related to a specific injury or event, is short lived and settles as healing occurs.  ​

  • NEUROPATHIC PAIN

    This is pain caused by lesion (damage) or disease of a nerve or a group of nerves, including peripheral nerves (any nerves outside the spinal cord), the spinal cord or the brain. It is typically burning, sharp, shooting pain, is there all the time, does not settle with normal pain medication and follows the pattern of the nerves that are damaged or diseased. ​

  • NOCIPLASTIC PAIN

    This is pain caused by functional and structural changes to how the nervous system understands danger messages. The nervous system becomes over-sensitive and creates pain as a warning even in the absence of ongoing damage or disease.​

OTHER TERMINOLOGY YOU MIGHT HEAR

Referred pain
Referred pain is pain that is felt somewhere in the body that is distant to where the actual problem is. It is normally on the same side of the body, is felt deeply and normally relates to the strip of skin or muscles supplied by a specific nerve.​

Peripheral Sensitisation
Nerves outside the spinal cord or brain are known as peripheral nerves. These nerves tell your brain about every part of your body – your skin, muscles, joints, ligaments, tendons and organs. When something dangerous or potentially dangerous happens somewhere in your body, your brain wants as much information as it can get – these nerves become sensitive, sending more information, faster and more loudly. This process is known as peripheral sensitisation, and is a normal part of healing. ​

Central sensitisation
The central nervous system (brain and spinal cord) is your body's primary alarm system. Its job is to protect you from harm. When pain has been present for a long time, the alarm system becomes over-sensitive and starts protecting you from things that are not dangerous, like normal movement and normal work. This means that you now have more pain, more frequently, and you might have pain even when you are not doing much of anything. 

Central sensitisation is the term used to describe what happens to the nervous system (spinal cord and brain) when it becomes over sensitive.

Endogenous opioids
Opioids (like morphine) are some of the strongest medications we have for treating pain. Your nervous system is really good at producing its own (endogenous) morphine (opioids) when it thinks you are under threat. Exercise is one of the ways in which you can help your body produce its own morphine – this is why we say that movement is medicine!​

Sensitivity to physical activity
When your nervous system is working effectively to protect you from danger, exercise causes your brain to release happy hormones and natural morphine. When you have chronic pain, this system does not work as it should and exercise makes pain worse. This is called sensitivity to physical activity and means your nervous system is over-sensitive and is not producing natural morphine. Learning how much of what kind of exercise your body needs can help you reset your nervous system and teach it to produce your own morphine again.