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What is persistent pain?

Sam Suke

What is persistent pain? 

Simply put, pain is the bodies’ natural response to avoid being hurt or to signal that something may be wrong in the body, like the check engine light on your car. Your Central nervous system (CNS), (which includes the brain and spinal cord, including nerves) is the control centre for pain. Sometimes the CNS can become confused and as a result can cause a persistent state of heightened reactivity. There are many reasons 

  • Stroke

  • spinal cord injury

  • chronic lower back or neck pain

  • whiplash injuries

  • Tension or migraine headaches

  • Rheumatoid or Osteo arthritis

  • Post surgery

  • Disease/illness

  • General injuries

and more (Nijs et al., 2021)

So what does heightened reactivity mean and how can it affect you?

Heightened reactivity means the signals from all over the body that are sent to the sensory area in the brain for processing become up-regulated or exaggerated and therefore stronger and more noticeable (McAllister, 2017). 

Heightened reactivity, particularly in central sensitisation may mean stimuli that are normally not painful are producing pain, such as a high five or a massage. Subsequently, stimuli that would typically be slightly painful are perceived as more painful than normal, such as bumping your arm or receiving a small scratch. Furthermore, areas surrounding previous injuries or sites of pain can become painful despite no involvement in the original event.

Effects of Central Sensitisation aren’t always related to pain. People who are experiencing Central Sensitisation may also experience heightened responses to lights, sounds, smells and tastes. 

Who does it affect? 

Persistent pain unfortunately doesn’t discriminate and can affect anyone. In Australia it is most prevalent between 65-70 but has been shown to affect adolescents through to the elderly, with the Australian bureau of statistics determining 1 in 5 Australain’s are affected by persistent pain per year. The average percentage of people affected in Australia is 17.1% of males and 20.0% of females (Blyth et al., 2001). Factors such as smoking and obesity have also been shown to increase the risk of developing chronic pain (Australian Institute of Health Welfare, 2020)

The good news is however, if you do suffer from persistent pain there are some simple things you can do to help positively influence your pain

How can physiotherapy help? 

Start by developing an accurate understanding of the pain system and how chronic pain begins. 

Understand the meaning of pain

Knowledge about what can dial up your pain and how you can dial down your pain through knowing what is safe and can trigger a protection response. It’s all about building confidence to move

Find a good coach to help you understand your pain and its behaviours

Pain is protecting you, not telling you that you’ve done damage! Your brain is looking out for you, don't try to avoid all of life’s challenges but train your brain and yourself to cope with them

Use your educator, in this case your physiotherapist, and get creative! Remember situations/activities that were full of safety for you. 

(adapted from Tame the Beast) 

Education

Education is an important part of improving outcomes for people with persistent pain. Studies show that education reduces the intensity of the pain, the associated burden and fear of movement. However most importantly, education as a stand alone treatment is effective but when combined with physiotherapy, there is the greatest improvement. 

Education covering topics of acceptance, pain as an alarm, sleep, relaxation, negative thoughts, returning to pleasurable activities, relationships and importance of physical exercise combined with a physiotherapy program significantly helped individuals with persistent pain improve their pain perceptions and intensity. 

Study findings show that patients report change in both their pain cognition and self-management of pain receiving pain education. A key aspect is that patients were also more likely to have an optimistic view about recovery. 

Physical activity including stretching, strengthening, proprioception, body awareness and breathing exercises 

Dosage: 35 min sessions, twice a week, over a 7 week period 

Mindfulness
Mindfulness is a great strategy to help rethink your pain. Mindfulness involves accepting our thoughts and feelings without judging them, e.g., trying to view our thoughts without believing that there’s a “right” or “wrong” way to feel or think. This would mean attempting to accept your pain rather than focusing on how it feels or what it stops you from doing, instead letting your mind concentrate on only what’s occurring in the present and what you are able to do. This action helps to break the emotions associated with chronic pain and relax the body (Hilton et al., 2017). Mindfulness was proven by Hilton et al. (2017) to decrease pain intensity, associated disability and improve quality of life in people who suffer from chronic pain.

What can you do?

  • Book a physiotherapy appointment

  • Use mindfulness to replace negative pain thoughts with positive strong thoughts

“My body is strong, I can do this”

Other resources to help:

Written by Erin, Riley, Olivia and Adam, Physiotherapy students at Exercise Thought

References:

Australian Institute of Health Welfare. (2020). Chronic pain in Australia. Retrieved from Canberra: https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia

Blyth, F. M., March, L. M., Brnabic, A. J., Jorm, L. R., Williamson, M., & Cousins, M. J. (2001). Chronic pain in Australia: a prevalence study. PAIN, 89(2-3), 127-134. doi:10.1016/s0304-3959(00)00355-9

Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., . . . Maglione, M. A. (2017). Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Annals of Behavioral Medicine, 51(2), 199-213. doi:10.1007/s12160-016-9844-2

McAllister, M. J. (2017). Ideas that are changing pain. Institute for Chronic Pain. retrieved from https://www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/central-sensitization

Mittinty, M. M., Vanlint, S., Stocks, N., Mittinty, M. N., & Moseley, G. L. (2018). Exploring effect of pain education on chronic pain patients' expectation of recovery and pain intensity. Scandinavian journal of pain, 18(2), 211–219. https://doi.org/10.1515/sjpain-2018-0023 

Nijs, J., George, S. Z., Clauw, D. J., Fernández-de-las-Peñas, C., Kosek, E., Ickmans, K. & Curatolo, M. (2021). Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. The Lancet Rheumatology.

Positive effects of a pain education program on patients with chronic pain: observational study. BrJP. São Paulo, 2021 apr-jun;4(2):130-5. Retrieved from: https://doi.org/10.5935/2595-0118.20210026