Part 3: Thoughts to consider when treating pain.

If you have read the previous posts in this series you will have an appreciation for the complexity of pain. It is not a simple cause and effect, 'stub-your-toe-and-it-hurts' phenomenon. Instead, pain is an intricate protective mechanism. It is generated by your brain to look after you, and will protect you from real or perceived danger. And because of this, pain can exist with or without tissue injury. This is really significant. Just because it hurts, doesn't mean there is injury. Injury is not required or sufficient to cause pain. Pain, and this includes all pain, is an output of your brain.

A re-cap on pain biology: Injured tissues send 'danger messages' to the brain via the spinal cord. Theses messages are then interpreted by the brain to determine how dangerous the messages really are. To do this the brain uses all of the information available to it. It draws on memories and past experiences, the stories you've heard, the knowledge you have, and thoughts of how the injury could impact your life. If the brain has enough evidence to suggest that you are in danger or damaged, and decides that pain will protect you, it will make pain. This can occur with or without messages from the tissues, and with or without genuine danger.

Because of this, tissue based treatments can sometimes fall short of relieving pain. This is especially common with long term pain. If you have been in pain for a long time it is useful to develop an accurate and non threatening understanding of your injury, and provide your brain with proof that you are safe to move. Active strategies to restore mobility and improve function are extremely useful to accomplish this. Shifting focus to what you can achieve and working toward realistic goals is often more effective than focusing on your pain. Over time your brain gathers information to support movement as a useful and safe strategy, and pain tends to reduce.

This can be challenging information. It goes against what for some seems intuitive, and asks that you take an active role in your recovery. But at the same time it offers significant hope, and helps to direct treatment to the cause of your pain. 

DAVID MOEN

Dave MoenForm Physiotherapy