Managing Chronic Pain
I once attended a course where a cognitive behavioral therapist was explaining how people with anxiety perceive the world. There were three simple characteristics applicable to anxiety in everyone who has ever experienced it. These characteristics include:
1) “Something bad is going to happen”,
2) “Something catastrophic is going to happen”, and
3) “I don’t have the tools or means to handle whatever happens.”
As I reflected upon this information, I could immediately apply it to scenarios in my own life. In the same instance, it also felt directly applicable to the population of patients I see who struggle with chronic pain. Oftentimes, the example plays out as
1) “I feel pain so my body must be injured”
2) “Since I am injured if I move or recreate pain I am causing more injury, which could eventually cause me to become disabled, lose my job, not afford my bills, not be able to support my family, not be able to live a full life.”
Characteristic #3 is where things get tricky for patients with chronic pain. What tools are available to help manage pain? The amount of possible treatments for chronic pain are endless. Oftentimes, the sheer number of options on how to treat chronic pain make it seem impossible to decide how to best tackle the problem. This reinforces a helpless feeling that leads to inaction. If you have struggled or dealt with chronic pain, you likely have tried or been offered a combination of different treatments including surgery, injections, pain medications, massage therapy, acupuncture, chiropractic care, modalities, and hopefully, physical therapy. Choosing or utilizing the RIGHT tools for managing chronic pain allows patients to take back control of their life, reduce anxiety and fear avoidance, and overcome or reduce chronic pain in safe and effective ways. I would argue that physical therapists are clinicians whose goal it is to give you the tools to conquer your chronic pain.
The following treatments should be considered as the first line of defense for management of chronic pain. They are non-invasive, inexpensive, and effective. Unfortunately, they are not what typically recommended as initial options in modern medicine today. They are not the “easy way out” and require commitment, trial and error, and allowance of grace to yourself. When tackled with the help of a trained physical therapist, they CAN and WILL change your life.
- Understand Pain: The more you understand how pain is perceived in the body the more likely you are to “reduce the threat” of your pain and remove fear and catastrophe from your mindset. Understand that pain is a detective mechanism to cue your body to take some sort of action. Pain is useful to us and we would not survive for very long if we didn’t have the ability to feel pain. It is perceived in the brain and is affected by multiple factors including stress, temperature, inflammation/illness, psychosocial factors, and lifestyle. Pain does not equal injury in many cases. Just because we feel pain with specific movements does not mean that an activity is bad. There is a world of evidence and a ton of science behind how and why we feel pain. Studies show that the more we understand about the neurobiology and physiology behind our pain the less pain and disability we have.
- Utilize Aerobic Exercise: Aerobic exercise has been shown to decrease the sensitivity in your nervous system, which in turn, reduces pain intensity. It improves blood flow to your spinal cord, brain, nerves, and muscles which also diminishes pain intensity. It can provide analgesic effects more effective than morphine or opiod use due to the positive effects of endorphins. The goal is to achieve 10 minutes of consecutive, aerobic exercise and then gradually increase your tolerance until the general exercise recommendations are met (150 minutes, weekly).
- Progressive, Task-Specific Exercise: Initiating a gentle strength training program with a goal of increasing tolerance to movement and improving neuromuscular control of your body is useful in returning you to the activities you love. Often, patients begin cutting out activities in their lives that they feel might be causing or worsening their pain. Patients’ lives go from big and full to narrow and limited due to the fear of activating their pain. The goal of progressive, task-specific exercise is to choose an end goal like lifting up your grandchildren, returning to golf or tennis, or being able to perform your household chores. Then you will begin working progressively toward that goal through specific exercise. You and your therapist will choose reasonable and achievable exercises that may cause some discomfort but do not significantly exacerbate your pain. Once you have mastered these exercises, they will progressively get more challenging. Dosing these exercises is important so as to not activate the “Boom or Bust” phenomenon. We want to avoid doing too much too fast but rather allow your body and your nervous system to slowly adjust to new activities.
Other important factors in managing chronic pain which can be included in your treatment plan include:
4) Diet changes,
5) Good sleep hygiene,
6) Mindfulness and Meditation,
7) Social interaction,
8) Hands on manual therapies performed by a skilled physical therapist, and
9) Developing coping skills.
Pain is multifactorial and a treatment plan for managing chronic pain needs to be individualized and specific. What works for one person may not work for another. But what we know for sure is that you need to understand how pain works in the body and then take action to try to reduce the pain through a combination of the aforementioned, non-invasive, conservative techniques. There is a time and place for medical interventions like injections, nerve medications, and sometimes even surgery. However, we are consistently seeing these treatments fail our patients and know that in many cases, a better option exists. We want to help you to remove the fear of something bad happening, reduce the fear of something catastrophic happening, and provide you with the tools you need to handle whatever is happening in regards to your pain experience!
Written by: Courtney Dedda PT, DPT OCS, Vestibular-certified Specialist