Even 3 months after a patient has suffered from a painful incident, there can be ongoing pain despite healing of injured tissue. This highlights the complex nature of chronic pain and suggests that pain can continue long after tissue has healed. Interestingly, there is little or no relationship between those with Chronic Pain of the Neck, Lower Back or Knee and findings on XRAY, MRI or CT Scans.
Why does pain continue?
There is now enough evidence available to indicate that chronic pain conditions such as low back pain, persistent whiplash, and fibromyalgia share the same changes that increase the pain sensitivity in our nervous system (nerves, spinal cord and brain) and changes to our normal systems that modulate or control pain.
Sensitisation of different parts of the nervous system and changes to the way the system usually modulates pain increases the perceived pain out of proportion to the source of the pain. Stimuli that ordinarily are not perceived as painful, such as light touch, can be amplified or changed by these sensitised pathways and experienced as pain. Sometimes, even after the original injury or disease process has healed, sensitised pathways continue to send signals to the brain. These signals feel just as real and sometimes worse than the pain caused by the original injury or disease process. Imagine an old television set or computer screen on which the same image is continuously projected. This image is eventually “burned” into the screen. Even when the screen is turned off, the image can still be seen on the screen. In the same manner, after the original source of pain is healed or no longer present, chronic pain patients may continue to feel pain. This can also lead to reduced mood or even depression and avoidance or fear of normal movement and activities. This can then lead to more pain. Although this is an oversimplification of what may happen in chronic pain, it helps explain the basic concept.
Where Physiotherapy can help
- Graded exercise programs – slowly increase exercise tolerance without the “boom-bust”
- Education about pain processes
- De-sensitisation of painful tissues
- Pain coping strategies so that you have effective tools to manage episodes of pain
- Re-education of normal posture and movement patterns
- Workplace assessment and addressing ergonomic factors
- Advice and education about how and which exercises can help
- Address movement behaviours that you may have developed that are not helpful
- Liaison with GPs, psychologists and specialists where required
Australian Pain Society: Useful Links
The Australian Pain Society is a group of health professionals, scientists and researches who are interested in advancing the field of pain management. They have a collection of links to useful videos, flyers and other websites. Click here to visit this collection of links.