Persistent Pain: What is happening and how we can understand it.

Our Nervous system is an amazing network that generally keeps us in a balanced place.  When you are in balance, your sense of touch, movement, temperature and general feeling of being safe and sound are normal. An example of this would be spraining an ankle. When this happens it really hurts, and then your brain reminds you that it is just an ankle sprain. It isn’t a big deal, it will heal, your are fine, you are safe.

However, If you sprain your ankle and are in a very stressful time, or are dealing with anxiety or injured your ankle in an accident that was traumatic, your brain may not tell you that you are safe. In this situation, the ankle may continue to be painful for longer than normal healing time, around 3 months. Beyond 3 months, pain that persists is considered chronic, and is due to your nervous system being ramped up.  Now, a stimulus that would normally not be painful—your sock—is interpreted as pain.  How do we calm this fussy brain down so that is not interpreting everything as pain?

The first thing we must do is educate patients about what pain is and how our brain interprets stimuli and interprets that stimulus as pain.  When our brains start being able to understand what pain is, the alarm bells start to quiet, and the pain stimulus can start to be more effectively interpreted.  As our patients start to understand pain and how our brains interpret this pain, we can start to introduce movement.  Even small movements can help begin to calm the nervous system, by bringing more oxygen to the nerves. This helps to relax your whole body.

Many people worry that movement or exercise might increase pain or cause more injury.  We have to bust that myth. Hurt does not equal harm.  You may feel sore, but you are safe. Remember, your nervous system is sensitive and it is just letting you know that you did something new.

This does not mean we should ignore pain when we introduce movement.  We should acknowledge pain and move to the point of pain, respect it.  Often, people will have increased pain after activity because the return to exercise was too intense.  As we add movement and activity, we want to pace it so that we are introducing a gradual climb.  Taking it slow, a 10 minute walk that leaves you a little sore is better than a 30 minute walk that sets you back 3 days.

Adding an exercise program with a patient who has a long history of pain, should always begin with education. When there is understanding about what pain is, and how our brain interprets the pain, they can begin movement. When we do this, they are able to say and understand “I am sore, but I am safe.” 

It is important to work with a PT who understands persistent pain and how the brain changes with that pain.  A PT who understands persistent pain will also be able to build an exercise program with in a paced setting to work within a safe environment and with a decreased risk of flares. We offer a free 15 minute phone consultation to help answer questions for you and ensure you are in the right place for your healing!