We have all experienced pain in our lives. Perhaps it’s been acute pain where you roll your ankle, or it’s more chronic pain, something like low back pain that’s been around for months or even years. It could also be from surgery or some kind of procedure that you may have had done that could cause a considerable amount of pain. Therefore, it is important to understand pain—understand the pain in your own body, and what implications it has. Just for a quick statistic, 15 million U.S. adults suffer from some kind of chronic pain, and 80% of our global opioid supply is consumed in the U.S. There are 125 deaths per day due to opioids, which are most commonly prescribed for low back pain, which is why it’s such a powerful topic to talk about and understand implicitly.
What’s a common course of low back pain in America? You have an acute episode of low back pain, go to your medical doctor, and get some kind of prescription pain medication. The pain medication doesn’t work, so maybe you get a muscle relaxer, too. Now your primary care is going to refer you for an X-ray, and it shows nothing, or maybe some degeneration that everyone over 35 years old typically has. Then you’re referred to get an MRI, and it shows a herniated disc or some degeneration as well. Of course, that doesn’t give you any information either because imaging in most cases does not correlate to your symptoms. So, then you are referred for an injection. You get an injection that doesn’t really do much at all or lasts for a short period of time before your symptoms return, and you’re referred to physical therapy. The course of low back pain in America is problematic because this is what contributes to moving from acute pain to chronic, which we’ll discuss.
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Let’s start with the definition of pain. Pain is an unpleasant sensory and emotional experience associated with tissue damage or potential tissue damage. Essentially, pain is an alarm system. What it’s telling us is where the pain is, the amount of pain, the nature of the pain, and it is signaling to us, danger.
Now let’s talk about acute pain versus chronic pain. An example of acute pain is when you put your fingers on a hot stove. We have nociceptors, sensory receptors in the skin that will signal through the spinal cord to the different areas of the brain, to create a motor response or reaction. With somatic pain as described, we are signaling to the brain to pull back. Now we can also have visceral pain of the organs or the lining of the organs. Lastly, referred pain, which can be something like a heart attack referring pain to the left shoulder. All of these can be different forms of acute pain.
Chronic pain is much different. Chronic pain is defined as pain that you’ve had for three to six months or longer. With chronic pain, there is no tissue damage, however, your brain is sensitized and signaling that there’s still danger. This causes you to have a heightened sense of pain because your brain is still perceiving that this pain is happening even though the injury has healed. The key take home with this is that pain is not directly correlated to the amount of tissue damage. For example, someone that has had chronic pain for years would indicate that there is no tissue damage at that point, yet the pain can be very heightened. Conversely, someone with an acute tissue injury could have a very low level of pain.
Now that you know a little bit more about acute versus chronic pain and that it is not necessarily related to tissue damage, it’s important to know what you can do about it. It is not simply a matter of taking Advil or Tylenol, because we actually have our own natural painkillers. Endorphins, enkephalins, and serotonin are some of the best natural painkillers; better than NSAIDs.
Also, it is important to recognize that pain is not simply a sensory experience. It is always an emotional experience as well. It has been shown that if you are in a positive mental state, this can impact your ability to manage pain. So, what can you do about your pain?
1) Don’t Panic
Pain is information. Whether you’ve had it for a day or you’ve had it for three years, it is information that your nervous system is either on high alert, or you have some kind of potential tissue damage. Either way, you want to explore it with a gentle curiosity. You want to understand your alarm system because that is your nervous system that is giving you this powerful information to be able to do something about it. Recognizing that no matter how long you’ve had pain, you can continue to make improvements, and be able to be in a pain-free state.
2) Improve your Movement
You should get evaluated to see what your movement patterns look like so you can limit compensations that are so common. The more that you compensate, you continue to alter your motor control, and the more you will have pain. When you have pain, you have more distorted motor control, so it ends up being this vicious cycle of pain.
3) Stress Management
This is one of the key things that you want to think about as it relates to pain. Incorporating things like mindfulness, yoga, and meditation into your life to make sure that you are in a positive emotional state to be able to manage the pain. If you have pain, and it’s already heightened, and when you add stress on top of that your pain tolerance will decrease. So, your pain is actually higher.
4) Graded Exercise
With all of the pain science research, one of the most important things is exercise, specifically, graded exercise. This means it has to be done at a very slow pace and returning to a comfortable state over time. For example, if you’ve had chronic low back pain for 10 years, then beginning a walking program starting at 45 minutes is way too much. Starting with 10 minutes is more appropriate and then every other day progressing to 12, 15, 20 minutes slowly and working your way up to a point that feels great for you.
That’s just a quick taste of a little bit of pain science and how you can manage pain in your life. I hope this was helpful for you.
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