CHRONIC PAIN – MANAGEMENT & METHODS

Let me make this clear, your pain is 100% real, no matter what is causing it or what you have been told.

There are unfortunately no quick fixes for chronic pain, however, there are steps we can take that have shown to help, but these require persistence, patience, trust and coaching. One of the tools that have been shown to help, is education about pain and how movement-based treatment can be used to help with your pain when done the right way.

Biopsychosocial Model

To understand pain further we need to discuss one of the main theories used to explain what influences pain, this model is called the biopsychosocial model. This model is made up of three categories; the biological factors such our biochemistry and genetics; the psychological factors such as what say, believe feel and what we drive our body to do, and finally; the social factors such as how we interact with each other, social support etc. Pain is influenced by the interaction of all three categories.

What is pain?

We have acute pain and chronic pain. Acute pain is when you have had this pain for less than 3 months, it is often associated with tissue damage. Whereas, chronic pain is pain that is persistent for greater than 3 months, with this sort of pain tissue damage is not that main issue.

What is the purpose of pain?

Pain is all about protection. While all of the pain you feel is real, what we have found through countless research is that the purpose of pain is to not measure how much tissue you have but rather about protecting that area. It has been found that anything you do that suggest to your body that it needs more protection will increase your pain and anything that suggests otherwise will help decrease it. This can be further explained through the twin peaks model.

Twin peaks model

Once you are ready to return to some form of movement, it is important to understand how your body uses pain to protect you during this process. This is where the twin peaks model has been found to be useful to explain.

Before Injury:

On the left, we have what happens before an injury. Here we have a line called tissue tolerance when we do something that reaches this line we cause tissue damage. It is, for this reason, we have a line underneath titled protect by pain. This means when we get close to this first line we get a signal from the brain (pain) telling us to stop or reduce what we are doing to help make sure we don’t go past that tissue tolerance line and cause tissue damage.

AFTER INJURY:

What happens after injury is represented on the right. What we find is that there is a new tissue tolerance line, and while the tissue has healed it may not operate the same way it did before, for example, you tend to be weaker and more easily fatigued in that area. Along with this, there is a new protect by pain line that has a much bigger buffer in-between the tissue. This makes your body’s protection system more sensitive, resulting in you having pain signal released at low levels activities.

Why you should not do nothing

Often those with chronic pain feel pain with activity. What happens in response to this is in order to protect themselves they choose to do less and rest. In theory this sounds great, can’t cause damage or aggravate my pain if I only rest. However, what happens with this is when you only rest, you start to decondition and become less fit. What people often find is that it takes less and less activity to make them feel pain, and they start to lose their ability to do day to day tasks due to losing strength.

Boom and bust vs Graded exposure

Great, so what you are telling me is I should just start to move and it should get better. Unfortunately, it’s not that simple, as mentioned earlier while movement-based treatment can help with your pain, it will only help when done the right way. There are two approaches we can take when we start any sort of movement, we can either take the “Boom and bust” approach or we can take the “Graded exposure approach”.

Boom and bust:

The most common mistake is often when someone starts to do an exercise program or movement of any sort is they get tempted to do too much, and in turn, end up paying for it afterwards with increased pain or restricted movements for the days following. What you often hear is that a bad day often follows are really good day, this is because they pushed themselves too much on a good day, resulting in increased pain on a bad day. Over time, with this approach, it often takes less activity to flare up pain due to going through the cycle of the body constantly wanting to protect themselves, and in turn lowering that pain line.

Graded exposure:

Graded exposure also known as pacing has been shown to have the best results when it comes to pain. Your body is designed to adapt to new stresses, is does this best if the load is increased gradually allowing the body to adapt and for the body to realize that this movement is not a threat. If the load is increased too quickly and the body is, unable to adapt it will consider it a threat and protect itself by increasing pain.

The idea of pacing or doing graded exposure is to take things easy to start with allowing your body to adapt so you can achieve more in the long run. For example going for a 10 minute walk each day for 6 days without a flare up, instead of doing one 60 minute walk all at once that causes a flare up and results in you having to rest for a few days to recover. Things that help with this are setting goals and breaking downs these goals, as shown with the walking example.

What we have found is that giving exercises using the graded exposure or pacing technique can help our clients manage their pain and reach other goals such as weight-loss, increased walking tolerance etc.

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