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Chronic-Pain-insight

What is Chronic Pain?

Chronic pain imposes a significant burden on the community, with one in five people experiencing persistent and disabling pain [1]. Chronic pain is defined as pain that has been present for at least 3 months, persisting after the normal healing time. This raises a difficult question, if the tissues (muscles, joints, bones, and nerves) are ‘healed’, how can we still experience pain?

 

This question has puzzled clinicians and researchers for a long time, and our understanding of chronic pain is continually being refined. What is critical, is to be familiar with the definition of pain, and this provides an insight into why pain may begin to persist. The International Association of the Study of Pain define pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” [2]. This highlights pain is both a sensory (location, type, and intensity) and emotional (unpleasantness, anxiety, and distress) experience. Like many human experiences how we think, feel and act influences the pain we report.

 

The Biopsychosocial Model

Chronic pain is conceptualised within the Biopsychosocial model, which describes a complex interaction of changes to our biology (e.g., inflammation, degeneration, and brain functioning), the presence of adverse or maladaptive psychological processes (e.g., anxiety, depression and stress) and considers an individual’s social environment (e.g., family life, financial position, and work situation) [3]. All three of these components interact together and influence an individual’s experience of pain.

 

Psychological Considerations

Within our contemporary understanding of chronic pain exist important psychological considerations. These factors impact how we cope with chronic pain, and more importantly, can be altered to either improve or worsen pain (see Fig 1-3. The Downward and Upward spiral of pain).

 

Mood (Anxiety and Depression)

What has been known for centuries is that our mind and body are intrinsically linked. If you are sad or anxious you will feel more pain, inversely, if you are in pain, you are likely to feel more sad or anxious. Understanding that our feelings and thoughts impact our experience of pain is a crucial first step. Just like a day filled with intense physical activity can flare up symptoms, so can a day filled with stress or sadness. Remember to take care of not only your physical body, but also your mind.

 

Fear Avoidance Behaviour

Fear avoidance is a common response after hurting yourself. Imagine if you fall and twist your ankle. Initially, it is painful and swollen, there is also an ingrained feeling of worry for walking or running. This is an important protective system generated by our brains, to reduce the likelihood of further injury to our body. Whilst this is completely reasonable initially after an injury, it is maladaptive in chronic pain. What we want to do is slowly and progressively start to move our bodies and show the brain and body it is ok and safe to do so.

 

Self-efficacy

Self-efficacy is confidence in our body to do a task or activity. Many individuals with chronic pain have an internal dialogue that may say something like “I will never be able to do that because of my pain”. It is extremely important to address this and replace that dialogue with “I can do that, despite my pain”.

 

Catastrophising

Catastrophising is an overinflation of the intensity or impact of pain. Many individuals with chronic pain may report “this is the worst pain in the world” or “I will have the pain forever”. We call these unhelpful thoughts, and whilst pain may be felt intensely and drag out over time, how we view or appraise that pain impacts our experience. What is important is to catch yourself having unhelpful thoughts and replace them with more helpful thoughts, such as “whilst my pain is bad right now, I know it will reduce with some stretching or meditation” or “this pain has gone on for a long time, but I know it won’t be forever”.

 

Downward Spiral of Pain

What happens between our mind and body is complex and all these factors may interact to worsen our pain. However, what is important to understand is that, just as it can go one way, it can also be improved the other way. The figures below highlights how a spiral of thoughts and behaviours can both improve and worsen our pain (Figures 1-3.).

 

Downward-spiral-of-pain1Downward-spiral-of-pain2Upward-spiral-of-pain

 

Central Sensitisation

Now a question that gets asked often is, “why am I in pain? The tissues have healed but I continue to experience pain”. The answer is a concept called Central Sensitisation. Everybody has been sunburnt before. The ultraviolet rays from the sun irritated our skin cells, it causes them to become inflamed and painful. What happens next is important, suddenly putting on clothes or having a shower is now painful, situations that never hurt before. This is called peripheral sensitisation. Now imagine a similar concept happening to our nervous system, if we are in pain repeatedly and/or in a constant state of stress or anxiety, it can cause our nervous system to because sunburnt or sensitised. Meaning things that never hurt before, are now painful. Now that we understanding our body has become sensitised to pain, we can start by developing strategies that desensitise pain.

 

The role of a Chiropractor

The first thing to understand is that all is not lost. Chronic pain is something that can be managed. We like to think of chronic pain, like asthma. Whilst there is no cure for asthma, you can manage it to a point where it does not impact your life. Every now and then you have asthma attack, which is distressing, but you have your inhaler and breathing strategies which can improve symptoms. Chronic pain is very similar, and a good health practitioner can help you get there. A Chiropractor can help in several ways. They include:

 

  • Diagnosis: First thing you want is a diagnosis. Chronic pain is complex and individual. Talk with your practitioner about what factors in the Biopsychosocial model may be impacting your pain experience. Once you map out those factors, we can put in place strategies to help manage your pain.
  • Exercise therapy: Exercise is always be good. Movement is medicine and this is not exception in the case for chronic pain. Sometime more guidance is needed to progress individuals with chronic pain through exercises, however everybody responds well to improving the mobility and strength of their bodies.
  • Manual therapy: Manual therapy includes a range of interventions such as dry needling, massage, adjustments and many more. These interventions are desensitising and can provide you with pain relief and improved confidence in your body. Make sure you seek a practitioner that understands chronic pain to apply these therapies, as sometimes if too much is done too soon, it can flare things up.

 

Chatswood Community Chronic Pain Program

DMC Health and Wellness is excited to provide the Chatswood Community Chronic Pain Program.

Supported by the Sydney North Health Network, this program will provide community based chronic pain education, counselling, and exercise therapy. The program is based off principals of shared medical appointments, which are ‘a series of individual office visits sequentially attending to each patient’s unique medical needs individually, but in a supportive group setting where all can listen, interact and learn’ [4]. For more information click the above link and find out how these program can help you today.

 

 References

  1. Blyth, F.M., et al., Chronic pain in Australia: a prevalence study. Pain, 2001. 89(2-3): p. 127-34.
  2. Treede, R.-D., et al., Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the: International Classification of Diseases: (: ICD-11: ). PAIN, 2019. 160(1): p. 19-27.
  3. Fillingim, R.B., Individual differences in pain: understanding the mosaic that makes pain personal. Pain, 2017. 158: p. S11-S18.
  4. Egger, G., et al., Shared medical appointments An adjunct for chronic disease management in Australia?Australian Family Physician, 2014. 43: p. 151-154.

About the Authors

chatswood chiro david mcnaughton

David McNaughton is a clinician and a researcher. He is the director and principal chiropractor at DMC Health & Wellness. He has an extensive background in the diagnosis and management of chronic pain. In addition to his clinical studies, David holds a Master’s of Research and PhD in Psychology. He regularly publishes his research in peer reviewed medical and psychology journals. David has taught both undergraduate and postgraduate studies in Chiropractic and Psychology at Macquarie University.

 

 

Isaac-Searant-DMC-ChiroIsaac completed a Bachelor of Chiropractic Science and Master of Chiropractic at Macquarie University, and is currently enrolled in a Master of Research. His research aims to understand the clinical decisions health practitioners make about diagnostic imaging. His clinical interests include spinal pain (neck and back) and sporting injuries. Regardless of the condition, his goal as a chiropractor is to work collaboratively with patients.

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