From ‘pain’ to ‘chronic pain’

May 2021

At Physiofusion we see many patients who seek treatment for pain that is persistent or chronic, despite taking rest from their usual activities to allow time for the tissues to heal. This can be the case for pain in almost any part of the body, but most commonly we see it as chronic back pain, neck pain and buttock pain.

So why do some aches and pains go away by themselves, and other aches and pains persist?

Most muscle and joint pains (‘musculoskeletal pains’) occur as a result of us increasing our activity levels by doing too much too soon, with insufficient recovery time. Our muscles, tendons and joints need to be strong enough to cope with the loads and demands we place on them every day. When we apply too much load or we do it over too short a time, our tissues react to this and send signals to our brain to tell us that something may be wrong – our brain perceives this as a ‘threat’, and our brain also then acts to produce the sensation of ‘pain’ so that we pay attention to the ‘threat’.

All pain is produced by our brain!

It is true to say that all pain is produced in our brain– even though we feel it in the injured areas of our arms, legs or spine etc.

Usually, we will pay attention to the ‘threat’ or the pain sensation that the threat has produced, and we make a decision of how to react based on a number of influencing factors – whether we have had this pain before and if so what we did to resolve it; maybe we heard that our friend who had the same pain rested for 2 weeks from football and so we choose to copy that as it sounds sensible; or maybe we decide to take pain medications to mask it as it is too inconvenient to rest from sport or work that week, or we decide to continue as normal and to take no action, if we consider that this pain does not represent a strong threat to our wellbeing overall. This might be the case in back pain for example, if we frequently experience a similar type of pain and if we rationalise that it has usually resolved by itself in the past and so no further action may be required.

On the other hand, we are also influenced by other factors as we make our ‘what to do’ decision, and these can escalate the significance of the perceived threat… For example if we know of a neighbour with back pain who went on to be diagnosed as a spinal tumour, our brain might pay more attention to the ‘threat’ of our own back pain and we may then worry that we may also have a tumour and then pay more and more attention to the back pain. If we have other stressful issues going on in our lives at the time the pain starts, this can have an effect on how our brain interprets and deals with the pain also – and our brain can magnify the pain sensation or ‘output’ it produces if we perceive this threat to be significant. A pianist with a sore finger pain may report higher levels of pain for the same injury that a footballer would be expected to report, as the personal and financial significance of the injury is different for both individuals.

So our brain is capable of escalating the level of pain we experience for a given injury or ‘threat’, and this influences the decisions we make as we decide how to protect our injured area. Both conscious an unconscious decisions can drive the course of the recovery – ie the persistence of the pain. Studies show that poor sleep quality, work dissatisfaction and overall stress levels are important predictors of pain outcomes.

“Learning about how your body works, and how it generates and responds to pain signals can help with recovery”.

Knowing this, how can we identify which pain may become ‘chronic pain’?

As physiotherapists, it is important for us to gain a sense of your ‘whole person’ during our initial assessment so that we can create a better understanding of how ‘your’ pain is affecting ‘you’. In acute or ‘recent’ pain or injury, we will take a thorough history and listen to your description of the onset and behaviour of the pain, and how it affects your ability to walk/play sport etc. On another level, we are listening to the words that you might use to describe your pain, and we try to uncover any underlying ‘pain beliefs’ or past experiences of pain which might help us to determine the best approach for us to take when managing your pain.

In pain that has been present for longer duration, we are trying to identify how much of a ‘threat’ you may perceive their pain to be, and we implement strategies that will help to address these issues also.

The best time to intervene in the pain system is within the first three months. Our bodies do their best healing of ‘actual’ tissue damage within the first three months after the injury/onset of the pain.

Pain that persists beyond three (and in particular six months) is less likely to be coming from the tissues themselves, and more likely to involve changes in our pain processing system. This means that chronic or longstanding pain will most likely need a broader approach to treatment than massage or hands-on treatment alone. This is not always the case, but we need to consider it when we treat chronic pain.

At Physiofusion our team of physiotherapists are all senior physiotherapists with over ten years of experience in the diagnosis and treatment of chronic persistent pain. This is particularly valuable when assessing and helping patients who have tried various forms of treatment in the past without results. We take an individualised approach to each patient which involves a thorough initial assessment from your first visit so that you can be assured you of a high quality treatment plan towards a successful recovery.

Watch out for our next blog on the strategies that we use at Physiofusion as we work together with our patients to treat chronic pain.

Please contact us if you wish to speak to one of our physiotherapists to discuss if we can help you with persistent or chronic pain.