As a therapist I often come across clients that have had pain for longer than the normal expected duration of pathology or an injury. In a normal acute presentation, tissues go through a natural healing process and eventually the nociceptors (danger receptors) will stop being activated and the pain situation will resolve. In the event that pain persists beyond that we would expect for that particular tissue and injury we would classify this as chronic or persistent pain. Chronic/persistent pain is less about tissue damage and more about the physiological changes that have occurred in the nervous system at the level of the tissue, spinal cord and brain.
In Australia 1 in 4 of us currently experience a chronic/persistent pain state, which defies expected tissue-healing times. In 2007, chronic pain was estimated to cost Australia 33 billion dollars, however these figures say little about suffering. Persistent pain does not have to be the stereotypical presentation of the condition ‘taking over your life’ and stopping you from working. It could be the reoccurring back pain or the niggling foot pain or the persistent neck pain that has been there for months. Broadly speaking the literature defines any condition that has been evident for more than three months to be classified as chronic or persistent.
What is pain you ask? The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
Much of the complex pain science currently being thoroughly researched can be reduced to a simple formula, “we will have pain when our brain has increased credible evidence of danger to our bodies as opposed to the credible evidence of safety to our bodies.”
Pain is a biological event that can change and the best way to overcome pain is through education and knowledge. The best way to implement knowledge is with our brain.
When we are in pain many areas of our brain are in action at exactly the same time. Scientists used to think pain presentations within the brain only focused on one area, however, we now know that with any one pain presentation over 400 areas of the brain can light up at once. These areas relate to smell, taste, hearing, mood, previous experiences, movement, environment and many other factors including hormonal states, immunity and lifestyle. An exciting protective mechanism to ensure we survive.
What you hear and what you say directly influences your pain presentation. This information provides context to a situation however not all information is helpful.
I attended a seminar by Physiotherapist and Educator David Butler on this exact topic. Arthritis Victoria organised it and the title was “Treating Pain by Using the Brain”. Within this talk David debunked some of the language and information clients receive as individuals that could aggravate or “flare up” your pain state. He also speaks about metaphors that we typically use to describe our situation or to describe the pathology that may or may not be helpful when thinking about our personal pain state.
Below is the link to the seminar (duration about an hour) and if you are someone in pain, have had long-term pain or know someone that is in pain please take the time to watch this and I can promise you, you’ll think of the brain and pain a little differently. In order to protect us, the creation of pain within us, is now understood to no longer be created by the tissues of our body alone but also involves an intricate output from the brain and the nervous system. I think that’s pretty amazing and definitely a revolution to helping individuals further.
David Butler and Lorimer Mosely, two leaders in the treatment and management of chronic/persistant pain, have created a book to help sufferers of chronic pain. David and Lorimer created the “The Explain Pain Handbook: Protectometer” which gives therapists and clients an interactive way of exploring each patient’s unique pain story. The book introduces the concept of the Protectometer, a tool used to explore and identify how concepts and situations in your life influence your pain. The tool helps clients to identify DIM’s (Danger in Me) and SIM’s (Safety In Me), allowing exploration of things that may aggravate the pain presentation (DIMs) and the things that downgrade or quieten the nervous system or pain presentation (SIMs).
If you have been living with pain and are looking to make a change, this book will offer helpful insights to help you understand your pain, with practical advice so you can get to work on overcoming your pain. Further information can be found on the NOI group’s blog
If you wish to further discuss your own individual pain presentation or situation please do not hesitate to contact your Myotherapist who will be happy to explore this with you.
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