How to explain chronic pain

Today, the Longevity Exercise Physiology teams at Drummoyne, Edgecliff, Marrickville, Bella Vista, Randwick, Pymble, Balmain, Neutral Bay, Coburg – Melbourne, and Barrie, Ontario – Canada explain chronic pain, and how it is managed during exercise.

What is chronic pain?

Pain is a personal and subjective, but very real experience. Chronic pain occurs when there is a lingering pain experience, even after the initial triggering event has been resolved. In this instance, the pain has transitioned from being a marker of tissue damage, to a protective mechanism, based on a perceived need to protect the body in absence of tissue damage (Xiao, 2020). When this occurs, pain education becomes important to help the patient understand their pain and to not let pain stop them from living their lives.

 

“… the pain has transitioned from being a marker of tissue damage, to a protective mechanism, based on a perceived need to protect the body in absence of tissue damage.”

 (Xiao, 2020)

How to explain chronic pain?

There are many ways to explain chronic pain. The most important thing to emphasise is that pain is not an indicator of tissue damage. It is a learned protective response by the brain to protect the body from potential danger. As the body is now in a state of fight or flight, that protective system becomes hypervigilant. What is also important to note as a practitioner explaining pain, is that the pain the patient feels is very real, so it is important to make sure that they feel their experience is understood and validated.

One analogy to best explain this hypervigilant response, is the twin peaks model (see below). In this model, your ‘protect by pain’ line falls just below your tissue tolerance. When experiencing chronic pain, after the aggravating event, your tissue tolerance line has decreased slightly, however the protect by pain threshold decreases drastically, meaning the gap between where something causes pain, to where it causes tissue damage, is a lot greater.

   Another phenomenon that occurs is brain ‘smudging’. Usually pain, like all sensations, is localised to a specific area – cause damage to that area, and that area will feel pain. Each area of the body is also represented by a specific area in the brain, like a map, so when there is a feeling of pain, the brain knows exactly where it is coming from, and how to fix it.

 

“When the brain feels extra protection is required for the affected area, sometimes it will involve neighbouring areas to help protect it…”

 

When the brain feels extra protection is required for the affected area, sometimes it will involve neighbouring areas to help protect it, so a stimulus applied to those areas can also become painful. What happens over time, is the borders on the map become blurred, and when pain is experienced, it can be hard to tell exactly where the pain is coming from, causing a sensation of the pain radiating.

If you are interested in learning more about chronic pain, check out ‘Tame the Beast’, by Professor Lorimer Mosely on YouTube.

Why explain chronic pain?

The reason it is important to explain pain, is that understanding one’s pain is an important first step to manage that pain. Pain is typically an indicator of tissue damage, however in patients with chronic pain, the association between pain and tissue damage becomes less and less, so it is important to understand that distinction. An important first step is to decrease the reliance on scans and imaging results, as these don’t always provide the most reliable indication of function. When patients are reassured of not causing further damage to their body when they experience pain, it can help them work into their pain, pushing that protect by pain line a little higher.

 

“When patients are reassured of not causing further damage to their body when they experience pain, it can help them work into their pain, pushing that protect by pain line a little higher.”

 

Explaining pain during exercise

During exercise, it is important to include a component of pain education, as exercise is so important for everyone, and often one of the first things to be impacted by pain. Usually there are two kinds of attitudes, when it comes to exercising with chronic pain. The first is an overly protective attitude, where the client is so cautious of pain, they avoid any stimulus that might cause pain. The second, is an overly determined attitude, where patients become fixated on ‘beating their pain’, working well past their protect by pain threshold, resulting in a flare-up that leaves them incapacitated. In both cases, the amount of activity the body can tolerate decreases, and that protect by pain line drops lower and lower.

With chronic pain patients, activity pacing becomes quite important. By exercising the patient around that protect by pain line, and increasing activity gradually, it demonstrates to them that a little pain is okay, and you avoid flare-ups that may leave the patient incapacitated and unable to exercise. It is also better to use language like ‘tolerable’ and ‘intolerable’ when getting clients to describe their pain, rather than severity, as everyone’s perception of severity is different, so it can be an unreliable measure.

 

“It is important to reassure the patient that this is a normal part of the pain experience, and that you have measures in place to help them manage those flare-ups.”

However, even when properly pacing activity, flare-ups can still occur. It is important to reassure the patient that this is a normal part of the pain experience, and that you have measures in place to help them manage those flare-ups. Ultimately, what is most important is that the patient feels exercising with pain is safe, and that you create an environment that is supportive. When the patient feels safe, it helps bring them out of the ‘fight or flight’ state, helping them to manage if not overcome their pain.

How can we at Longevity Exercise Physiology help?

At Longevity Exercise Physiology, we will provide you with one-hour, one-on-one sessions to help you meet exercise guidelines, whilst helping you manage your pain as you exercise. As everyone’s pain experience is different, we can work with you to develop the best possible program to help you achieve your goals.

If you are interested in a tailored exercise program to help restore function and manage chronic pain, call Longevity Exercise Physiology Drummoyne, Edgecliff, Marrickville, Bella Vista, Randwick, Pymble, Balmain, Neutral Bay, Coburg – Melbourne, and Barrie, Ontario – Canada on 1300 964 002 to book in a session today.

 

Written by Vaishnavi Pasupati

 

References:

Butler, D. (2013). Twin Peaks Model [Image]. Retrieved 18 July 2022, from https://www.noigroup.com/noijam/explain-pain-in-real-time/.

Xiao, J. (2020). Physical exercise for human health (1st ed., pp. 233-248). Springer.