This article is going to discuss chronic pain, which, as the name suggests, is not a very fun topic; it is a serious problem that changes the lives of millions of people worldwide. However, helping those with chronic pain is a very large part of my job as a physical therapist, and it is important for people to know what chronic pain is and what makes it better.
So, if that interests you, or you think that you would benefit from more information on chronic pain, please, read on!
First, Context
The brain, as well as the rest of the nervous system, is an incredible thing. It is the reason we feel pain, among other things, and there is a good reason for this. Without pain, life becomes more dangerous, not less, as losing the ability to feel pain is losing the ability to detect danger in an environment. For instance, our brain sends us a signal to let us know that the stovetop our hand is on is hot, letting us know we need to get our hands away from danger. How the nervous system operates is useful context for understanding chronic pain.
The brain senses pain through a complex system that involves nerve fibers called nociceptors, which detect and transmit pain signals to the brain. The brain then processes the pain signals and interprets them as painful, leading to our perception of pain. This is a common process, but the operation changes slightly when chronic pain is introduced.
Chronic pain can change the way the brain processes pain signals, making it more sensitive to pain, leading to a greater perception of pain over time. This is another defense mechanism our brains employ to let us be cautious of existing injuries, but it also is, well, painful for us to experience, and can cause further problems down the road.
What is Chronic Pain, Technically?
That’s one of the hard things about chronic pain: it can be hard to define. The Cleveland Clinic offers what I feel to be a solid definition for chronic pain, saying that “Chronic pain is pain that lasts for over three months. The pain can be there all the time, or it may come and go. It can happen anywhere in your body.”
Chronic pain can be caused by an injury, such as a ligament tear or broken bone, by a disease, such as sickle cell, or by a condition, such as fibromyalgia or arthritis. As you might guess, the high amount of potential causes for chronic pain leads to a rather high amount of people experiencing chronic pain. The International Association for the Study of Pain found that over 50 million Americans reported significant pain in a localized area on a near-daily basis, meaning that about 20.5% of the United States population suffers from one form or another of chronic pain.
You would think that, with all the medical advancements modern science has produced, as well as the high number of people suffering from chronic pain, we would have created ways to get around such a large problem. There are several things that help people recover from chronic pain (including physical therapy, but that will be discussed in a moment), but one of the factors in this equation is something called the pain cycle.
The Pain Cycle
Now, many people know what the pain cycle is intuitively, but they may not have heard it described in more detail. Essentially, the pain cycle is the process that we naturally go through when dealing with serious pain. To explain this, I’ll use an example of someone with a bad ankle sprain.
Let’s say there’s a young man, Jim, about twenty, who suffers a high ankle sprain while playing basketball with friends. He goes to see a doctor about the injury, who tells him that he will have to wait some time for the ankle to heal. While Jim waits, he tries to manage the pain best he can, using things that the doctor prescribed, like ibuprofen and ice, but also by slightly changing the way he walks.
By changing the way he walks, he avoids the pain of his high ankle sprain, but Jim’s body also begins to change; now he is limiting his range of motion, and the muscles and tendons he usually activates for walking may not get fully used, causing them to become weaker. Jim begins to compensate, putting more weight and stress on other parts of his body rather than his ankle, and, as our bodies are good at allocating resources, he builds muscle strength in those other areas.
As time goes on, this deterioration gets worse, and while the injury may have healed, now there are a new set of problems revolving around the ankle. Jim attempts to run, but it hurts to run, play basketball, or fully engage his ankle at all. This is stressful, because the ankle should have healed by now, but the muscle atrophy and decreased function that have come about with Jim compensating for not using his ankle have caused the pain to continue, just differently than it did previously.
Due to the stress and pain, Jim doesn’t sleep as well as he normally does, and starts to feel frustrated. People going through chronic pain are far more likely to suffer from poor mental health and depression, which only adds to the ongoing problems that Jim is already experiencing. He doesn’t enjoy playing basketball anymore because of the pain, fatigue, and depression, and so he isn’t as active, and he never gets his ankle back to full health.
If he does try to get going again, he may suffer another injury, or just have increased problems with his ankle, as it is still weak, and this begins the cycle all over again.
Now, that was a very somber explanation, but it is something that happens to millions of people. The pain cycle is real, and, unfortunately, is what makes chronic pain so hard to handle. However, there are treatments that can break the pain cycle, making them invaluable to those who need them.
Getting Better Sleep
Physical therapy can help improve sleep in individuals with chronic pain by addressing the underlying physical and psychological factors that contribute to poor sleep. Physical therapists may teach individuals relaxation techniques, such as deep breathing and progressive muscle relaxation, to help them manage stress and anxiety and fall asleep more easily.
In addition, physical therapy can help improve posture and body mechanics, which can also contribute to poor sleep in individuals with chronic pain. Physical therapists may teach individuals how to properly position themselves in bed to reduce pain and discomfort and improve sleep quality.
Exercise and physical activity are also important components of physical therapy for individuals with chronic pain. Regular exercise can help individuals sleep better and improve their overall physical and emotional well-being. Physical therapists may develop exercise programs that are tailored to an individual’s specific needs and limitations, helping them safely and effectively manage chronic pain and improve sleep.
Other Physical Therapy Techniques for Chronic Pain
Massage and joint mobilization are manual therapy techniques that physical therapists use to improve the function of joints and muscles and reduce pain.
Massage involves the manipulation of soft tissue to reduce muscle tension, improve circulation, and promote relaxation. Physical therapists may use massage to improve the function of affected muscles, increase range of motion, and reduce pain. Massage may also help improve the overall health of the affected area by promoting the flow of oxygen and nutrients to the tissues.
Joint mobilization, on the other hand, involves the passive movement of a joint within its normal range of motion. Physical therapists use joint mobilization to improve joint mobility and reduce pain. Joint mobilization can also help reduce muscle tension and stiffness, improving overall joint function.
In both massage and joint mobilization, physical therapists use their hands to apply gentle and specific pressure to the affected area. These techniques are safe, non-invasive, and do not require any special equipment.
Physical therapists may use massage and joint mobilization in combination with other manual therapy techniques and exercises to help individuals manage chronic pain. They may also use these techniques to help individuals recover from injuries, improve physical function, and enhance overall physical and emotional well-being
Breaking the Cycle
Chronic pain can be devastating, and often debilitating, but there are things that help. Physical therapy, as mentioned above, can be extremely useful in combating the causes of chronic pain, which can help individuals to get out of the chronic pain cycle.
Breaking free of the chronic pain cycle is more than just eliminating pain, it is a quality of life improvement that has long-lasting ramifications on the lives of those who do so. Finding help is important, which means that anyone who is in the chronic pain cycle, or believes they are experiencing chronic pain, should meet with a licensed physician to see what help they can get to improve their lives.
