By Michael Hall
Chronic pain is pain that is constant, relentless, draining pain for longer than 12 weeks. Unless you have had it, you can’t imagine it. It may involve back pain, neck pain (whiplash), migraine / headaches, tinnitus (ringing in the ears), phantom limb, fibromyalgia / fibrositis, chronic regional pain syndrome (CRPS) pain.
Chronic pain may affect every part of life, from sleeping, to morning to night. Every posture, movement, every activity, every word, every thought, every moment may be coloured by its presence until it becomes all consuming,
Chronic pain is serious
So pervasive, so invasive is chronic pain that it can wear you down, until it breaks you. Apkarian et al (2004) showed that people with chronic low back pain had lost 5-11% of neocortical brain matter, or 1.3cm3 of brain grey matter for every year of chronic pain. This is equivalent to 10-20 years of normal aging. The seriousness of dealing appropriately with chronic pain could not be more apparent.
Chronic pain is complex
One thing that is clear is that chronic pain is complex involving a complicated interplay of almost every bodily system. The sensations that we experience through our senses (sight, touch, hearing and smell), are transmitted to the spinal cord and then on to the brain. In the case of a severe pain, a response may be initiated from the spinal cord (reflex) directly as in the case of pulling our hand away from a fire. The brain also receives the information and on-sends it to all many different areas for processing, interpretation and the initiation of a response. These responses may affect all systems of the body from the activation of a movement, to changes in the immune system, to changes in the autonomic system. Essentially these responses have to do with either a protective response (fight or flight) or a nurturing growth and repair response.
Fight or Flight Vs Growth and Repair
The response that is activated depends upon how the stimulus is perceived. Our most primitive, automatic response is one of fight or flight. In the case of a perceived pain, threat, or fear, our body is readied to fight or take flight as our awareness is heightened, our heart pumps harder, breathing quickens, perspiration increases, muscles are tautened. At the same time, blood is diverted away from the digestive system and the nervous system is put on alert as the immune system is “deactivated”. In other words, our need to survive is prioritized ahead of every other need of the body, including growth and repair. This survival instinct, in the case of short term threats to our safety, is appropriate to help us stay alive. However, with repeated exposure to this pain, threat or fear, and repeated activation of the fight and flight pathway, our body’s ability to grow and repair may become impaired.
The brain is a computer with no delete button
The brain learns from every experience and may draw on the learning not just of this sensation, but of how the sensation is perceived you felt about this experience in the future. This means, just thinking about the experience is enough to trigger a response, irrespective of whether there is a problem with the body’s tissues or not. Moseley (2008) found that just imagining a body part worse than it is can increase the swelling and perceived pain, whilst imagining it better than it is can reduce the swelling and perceived pain. Maihofner et al (2006) also found that not only could the pain be magnified but that its location couldn’t be accurately identified. And further research has also shown that chronic back pain is experienced in a different location of the brain when compared with acute back pain (Moseley 2008).
Other studies have shown that using the reflection of an unaffected limb has reduced the pain experienced by individuals with their affected limb. Amputees have also been shown to have reduced phantom limb pain when their “legs” are projected walking underneath them on to a screen. What these studies show is that pain may not just be experienced at the local level but that chronic pain changes the brain biochemistry and actually rewires the brain’s neural pathways. This has major implications for the treatment of chronic pain and necessitates a holistic, multidisciplinary approach, if treatment is to be successful.
So where to begin
Given chronic pain’s complexity, chronic pain treatment or chronic pain management must tackle chronic pain on multiple levels, psychologically, physically and socially. Having said this, these levels may fall into two broad categories. The first is to discourage an environment of excessive or abnormal stress which may lead to a fight or flight response. The second is to encourage an environment of healing, repair, growth and building capacity.
Here are 7 guidelines of how chronic pain therapy and chronic pain clinics must deal with chronic pain
- The first rule of many chronic pain management clinics is to acknowledge that chronic pain is real. Sometimes not being believed is the most difficult thing to deal with especially as chronic pain can’t be seen, imagined or picked up on a scan.
- Have hope that chronic pain can be overcome. Gaining an understanding of the complex mechanisms behind chronic pain can help to give this sense of hope as well as a sense of control and empowerment.
- Change your attitude and change your behavior. Easier said than done, it is important to see yourself not as a victim of chronic pain, but as a person who has choices and things that they can control. If you can focus on those things that you have control over and your control them perfectly, many of the things you can’t control will go away.
- Create an environment which encourages nurturing, growth and repair. Being supported by and feeling connected with others is important as is sleeping well when most growth repair occurs. Food which reduces inflammation (fish/krill and flaxseed oil, turmeric and ginger) and which assists with growth and repair (vitamin C, Activated B and adequate amounts of protein) may also assist. Relaxation techniques, meditation, prayer or even warm baths can all be used as strategies to help to reduce tension and promote an optimal healing environment.
- Whilst there is no evidence that hands on techniques (such as remedial massage and mobilization) and modalities such as heat is of benefit, at Bodywise Health we have found that they may help exercise to be more beneficial by reducing sensitivity and increasing exercise tolerance.
- For maximal benefits, exercise should first be directed towards increasing joint mobility, improving muscle length and balance with the objective of correcting and optimizing posture and movement patterns. For these exercises to be effective, they may be performed under the pain cover of heat, cold or electrical stimulation and must start at an intensity which is below pain thresh-hold. Then using the overload principle, this postural exercise program should be increased first in volume and then in intensity, so that a training effect may be experienced which carries over to sustained physical improvement.
- Taping or bracing may be used to “unload” hypersensitive body tissues and enable assisted accommodation of correct posture, further reducing physical forces on the body’s structures.
Chronic pain management doctors and the chronic pain specialist in chronic pain management clinics across Melbourne may prescribe non-steroidal anti-inflammatories and opioids to manage chronic pain.
Chronic pain management Melbourne may abide by the evidence which suggests that non-steroidal anti-inflammatory (NSAIDS) medication should be considered as an appropriate treatment for chronic low back pain. However, whilst there are demonstrated benefits, there are also significant side effects that may have meaningful clinical consequences. NSAIDS are favoured over opioids both in terms of cost and safety. (Roelofs et al 2008)
Whilst dealing with chronic pain is extremely challenging, it is important to know that hope is at hand.
With Bodywise Health providing physical, nutritional and psychological services, we are well placed to assist chronic pain sufferers. Whilst medication may have its place, it doesn’t empower you as to how to avoid chronic pain stresses nor build your capacity to tolerate stress. Unless you are enrolled into an appropriate, graduated, progressive and empowering physical, psychological and nutritional training program, it is likely that your ability to cope with everyday life will decrease over time.
Unlike medication which can become a “crutch” upon which the body becomes dependent to cope, Bodywise Health’s philosophy is to empower you, your body and mind, by giving you the knowledge, training and resources that enables you to get stronger, physically, mentally and nutritionally.
Bodywise Health has been providing chronic pain management solutions to the people in the Bayside suburbs of Hampton, Brighton, Sandringham, Highett, Cheltenham, Black Rock, Beaumaris, Elwood Elsternwick and more generally across Melbourne.
Bodywise Health contact details can be found by googling chronic pain management Melbourne, chronic pain management Bayside, chronic pain management Brighton, chronic pain management Hampton or chronic pain management Cheltenham.
Bodywise Health will work with any chronic pain specialist or chronic pain management doctors in Melbourne to ensure that you experience the best results possible.
The Bodywise Health chronic pain management program has had great success in assisting hundreds if not thousands of people over the past 20 years. It can help you too.
For more information or an appointment, please call Bodywise Health on 1 300 BODYWISE (263 994).
You have nothing to lose except your pain.
• Rebates are available through your private insurance extras cover;
• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.