AGAIN – CHRONIC PAIN IS NOT ALL IN YOUR HEAD
It is not a psychological problem, not like a dream, not like a memory, not imaginary.
Unfortunately, it is all too physical and all too real.
In fact, chronic pain is so real that it can lead to serious and permanent losses to a person’s independence and capacity to work, among many other things. If you have been a faithful reader of Pain And Loss, you will already know what I am talking about.
But, is chronic pain ONLY physical?
Is chronic pain totally unrelated to the stresses going on in a person’s life – even stresses caused by the pain and injuries themselves? If you lose your job or your marriage, wouldn’t you have more difficulties coping with whatever medical problem you might be struggling with? If that medical problem caused a lot of pain, wouldn’t that make it even harder?
This is just common sense really.
Of course, stresses, fears and losses all play a role in chronic pain and its effects on your life. Stress does not cause chronic pain. This idea has been debunked long ago. But, stress can make almost any physical medical problem worse.
It is important for people in pain to understand how this works and how it affects them – essentially how stress and pain make each other worse. This is true for heart disease, diabetes, and blood pressure, as examples. And that is why stress management is such a vital part of the treatments for such medical problems.
Treatment programs for chronic pain help people, not only with physical and medical treatments but also with education and tools for coping and managing stress. Chronic pain is a complex problem needing a comprehensive treatment approach.
Education is a core component of almost all treatment programs for chronic pain and fibromyalgia. All treatment team members should embrace this, including physiotherapists. (In a previous post, I discussed a new book and website, by Gloria Gilbert, which emphasizes this comprehensive approach.)
Physiotherapists, such as Gloria Gilbert, realize that it is important to teach their patients about the injuries that cause them pain and to help them continue with their exercises even when more pain is triggered. This education helps patients feel less afraid of the higher pain levels and to keep being as active as they can.
Some physiotherapists have been promoting this education as a new approach. And, it has been given a catchy name, Pain Neuroscience Education, or PNE for short.
Here is a summary of the PNE approach.
In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain.
PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more.
To their credit, PNE practitioners go beyond the traditional education provided by physiotherapists (and even doctors) to patients. Traditionally, patients are shown and explained the mechanical and medical details underlying their painful injuries and illnesses.
The PNE approach goes further. It involves detailed explanations of how chronic pain works in patients’ bodies and how long-term pain can change the way their spinal cord and brain process pain signals. PNE practitioners focus on more comprehensive explanations of how our injured body parts, spinal cord and brain all work together to produce long-term pain.
Some recent studies have shown some promising results.
Here is a summary of a recent meta-analysis
This review demonstrates moderate level evidence that the use of pain neuroscience education alongside physiotherapy interventions probably improves disability and pain in the short term in chronic low back pain. These results provide greater support for the addition of pain neuroscience education in routine physiotherapy practice in chronic low back pain.
For any problem in any area of your life, it is important to learn as much as you can about the problem itself and about how you are going to manage it. Sometimes, this is a difficult pill to swallow, when people are suffering and just want their pain to go away – as fast and as simply as possible.
But, knowlege really is the key to power. And if more knowledge about your injuries can give you even a little more power to overcome, surely it is worth it. Until a simple and easy fix comes along for chronic or long-term pain, or for any chronic health problem, more learning may be your best bet.
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Thank you for reading. Thank you to Sharon McCutcheon (image above) and Rachel Walker (image below, both from Unsplash) for your creative work. And, please feel free to steal, share and join our growing list of subscribers.
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