A 7-part Series on Chronic Pain
by Josh Meyers, PT, DPT, OCS
Pain is good. It helps one to avoid danger, survive an injury, and protect oneself when confronted by physical or emotional threats. The problem arises, however, when pain persists after a danger is removed, an injury heals, or a threat is no longer present. Medical providers call this persistent type of pain chronic pain, and it is the leading cause of disability in America.
Hope, however, lies in the fact that chronic pain is treatable. Through this series, readers will learn how chronic pain develops, recognize common symptoms, and understand how chronic pain is treated. Our goal is to empower readers to take action and regain control of their pain. Comments at the end of each post are welcome. Be sure to ask questions and share experience to help others with similar symptoms.
Part 6: The Right Mindset
There are two different ways medical providers approach pain; pain management and pain treatment. Pain management helps a patient make the best of a pain condition although expectations of pain change are minimal. Pain treatment, on the other hand, expects pain to change and utilizes interventions to best accomplish that goal. With pain treatment, the person, not the intervention, becomes the “active” part of the process. As a result, the patient mindset changes from, “What can you do for my pain?”, to “What can I do for my pain?” This powerful distinction is subtle, but completely changes a patient’s level of control.
Passive Treatment – “What Can You Do for My Pain?”
While passive treatment can be helpful at times, patients that rely on its long-term use develop a dependency during the recovery process. Not only does passive treatment remove a patient from active participation in recovery, it transfers control of pain from the patient to the provider. Passive treatment also perpetuates a mental disconnect from the healing process, and as a result, many have poor compliance when challenges occur.
Passive treatment is common and even appears helpful at first glance. Hot packs, ultrasound, electrical stimulation, medication (Tylenol, ibuprofen, steroids, opioids), massage, and spinal adjustments are all common forms, and all are easily found in most medical clinics. When providers choose passive treatment for chronic pain, however, it sends the message that something must be done to a patient in order for recovery to take place. It takes control out of the hands of the patient.
Hotly debated opioid use is at the forefront of these “passive” treatment discussions. Aside from the fact that opioids have been shown ineffective with long-term pain control, they steal control of pain from patients as well. As opioids lure patients into the futile thinking that rest and medication will resolve chronic pain, they actually make these patients more sensitive to pain. Not only do opioids slow major body functions, they deprive one of restful sleep. They do not improve activity tolerance either. Since the human body essentially needs to work hard and rest well to maintain good health, opioids counteract the basic needs that one requires to be healthy.
Active Treatment – “What Can I Do for My Pain?”
Active treatment, on the other hand, promotes healing. When patients with chronic pain take ownership of recovery, pain changes. Patients find motivation for recovery and take steps to ensure that positive changes occur. In addition to the obvious strength and mobility benefits of activity, active treatment offers other advantages:
Pain Relief – Activity releases “natural” pain killers in the brain called endorphins. With as little as 10 minutes of walking, patients can utilize these endorphins to “self-medicate” when a pain experiences presents.
Nerve Health – Activity also ensures that nerves receive adequate circulation, avoid compression, and maintain mobility. All of these factors help to keeps nerves from causing a pain experience.
Coordination – When the brain has an accurate image of the body in its “mind’s eye”, it decreases a pain response as well. Movement reinforces the accuracy of this image and helps to recalibrate that image after an injury occurs. Movement also promotes nervous system health by coordinating what one experiences with the movement one performs.
Activity Tolerance – Activity decreases sensitivity in nerves as well. Just like a psychologist utilizes gradual exposure to help one overcome a phobia of dogs, gradual exposure to movement desensitizes pain. Nerve sensitivity that is caused by stress or fear of movement decreases as one gradually performs tasks (or parts of tasks) that were once avoided. Practice of non-painful movement retrains the brain to perceive less threat with movement (and produce less pain) as well. Regardless of where one starts, gradual exposure to movement builds activity tolerance and allows one to increase the frequency, duration, and intensity of daily activity.
Let’s Hear From You
What are your experiences with pain? How have you viewed activity in relation to chronic pain? Share your experience in the comments below.
If you suffer from chronic pain, there is hope. Call us today to find out how physical therapy can help treat your chronic pain.