It is time to change the way you think about chronic pain
Pain is not just an indicator of damage to the body.
Many people think that if someone were to hit your index finger with a hammer, your index finger would get damaged and pain would be generated. This example gives the impression that pain is a simple mechanism telling us when there is damage to the body. Today we will discuss how pain is far more complex than this.
So if you were silly enough to let someone hit your index finger with a hammer, grab yourself some ice and take a seat as I explain that the pain you are feeling is far more complex than you first thought.
More to pain than meets the eye.
Think of it like an alarm system.
In a normal pain response, the brain produces pain as a response to chemical, thermal or mechanical stimulus. If we use our hammer hitting index finger example, that would be a mechanical stimulus.
Historically, it had been thought that pain was a pure indicator of tissue health, but the last 10-20 years of research tells us that that there is far more to pain than first thought. Pain is a sensation created by our brains using signals of damage, but also factoring in our beliefs, feelings, expectations and past experiences. This is why there are people who can have similar injuries but experience different pain responses.
You may be aware, pain can be broken up into stages based on time: acute, sub-acute and chronic. Acute being the first six weeks of an injury, sub-acute from 6-12 weeks, and chronic referring to pain that lasts longer than three months. But what many people are not aware of is that the longer you experience pain for, the less predictable the relationship between your pain and the health of your tissues becomes.
So what does it mean for people experiencing Chronic Low Back Pain (CLBP)? It means that their pain is no longer an accurate representation of their tissue health. And below we discuss some of the main reasons for this.
Pain is a reflection of your mindset
The longer pain persists, the more people will begin to view their body in a negative way.
In many of the CLBP clients I see, there is an evident vicious cycle between pain and mindset. Because people with CLBP have been living with pain for such a long period, they live in a constant state of fear. Fear of movement, fear of normal daily activities, fear of pain itself. It is common for them to feel that their body is more fragile. They will often relate their symptoms to a particular activity (i.e. bending is very common in CLBP). This negative mindset convinces your brain that you are in a constant state of danger.
Pain is the initial driver of the negative mindset, but having a negative mindset then becomes the driver of more pain.
Pain becomes less accurate because your nervous system is more sensitive.
I will often hear about people experiencing excruciating pain after the smallest of movements.
To put it simply, your nervous system has a baseline level of electrical activity. It will take a certain amount of stimulus activate the local nerves to send a message to the brain. It also takes a certain amount of stimulus from the body for the brain to take the message seriously. If the stimulus is great enough, your brain will consider the message and may produce pain.
But during CLBP, and chronic pain in general, the baseline activity of the nervous system is far higher. So now the stimulus required activate the pathways that lead to pain is far less. This occurs in both the local area of the injury and in the areas of the brain that generate pain. Meaning a previously provocative activity will be even more so. Or, what I think is even more worrying, an action that wouldn’t normally cause pain will now be enough to generate pain.
This explains why even something like putting on your socks can be enough to provoke symptoms.
Your brain’s internal map of the body becomes less accurate
In a person who is not experiencing CLBP, the brain has a precise map of the different body regions. That is why pain is localised in a normal response to an acute injury.
But for someone with chronic pain, their internal map of the different body regions is less accurate. Because of this the brain starts acting like Oprah Winfrey, giving out pain to areas that were not even associated with the original injury. This is why people with CLBP will often have a broader area of pain compared to someone experiencing their first episode of acute Lower Back Pain (LBP).
Now that you are questioning whether your pain is real or accurate, let me tell you what we can do to reset your pain.
How to reset your pain using mindset
Just as your pain can become more sensitive, and less accurate, the opposite is also true.
It isn’t as easy as me giving you a magic pill and everything will be back to normal. For pain to reset, you first need to think about pain as something far more complex than just the result of damage to the body. After reading the first part of this article I hope you are starting to understand that.
So the next time you have an episode of LBP, instead of thinking you ‘slipped a disc’ (I’m not even sure what that is), think:
“was bending over to tie my shoes really enough to damage the most stable region of my body?”,
or “when I first hurt my lower back lifting heavy objects repetitively for a whole day, maybe my brain is relating that past experience to the action of bending”,
or my favourite, “does the action warrant the amount of pain I’m experiencing?”
From what you should now know about pain, chances are that the next time you experience LBP it won’t match the action that caused it. And that’s fine if it doesn’t, because you now understand that tissue damage is only part of the makeup of pain.
This isn't me saying that “it’s all in your head”, because I can guarantee you, your pain is very real. But once you understand that your beliefs, feelings, expectations and past experiences influence your pain, you can begin to understand your pain, and start to change it.
How we use exercise to reset your pain
There is no one size fits all with CLBP.
Just DOING EXERCISE is the most important part. Of course we have found that there are certain aspects of movement you should be working on to get the best long-term results. But my advice is just to start, and then slowly increase the demand over time.
This is the concept of graded exercise, and this is one of the core principles of our programs. Graded exercise is a fancy way of describing the progression in difficulty of an exercise program over time. As your body is exposed to more difficult exercises, over time it will become less sensitised, both locally and in the brain. Meaning you can do more activity before setting off your alarm system.
How to put this into action: pick an activity-based goal, break it up into smaller and more achievable parts, and gradually do more of the parts until you can do the whole activity. It is that simple.
By now, it should come as no surprise to you that reseting your faulty pain response is a huge component of any injury rehab program.
If you are dealing with a health professional who isn’t trying to help you overcome these changes to your pain response, please proceed to find a new health professional.
If you have any questions about anything in this article, don’t hesitate to get in touch.
