Pain is an unpleasant sensory experience in response to actual or potential tissue damage.There is acute pain which lasts for less than 3 months and there is persistent/chronic painwhen pain lasts for more than 3 months.
Immediately after an injury, the body responds with inflammation to help with healing. Duringthis time, patients experience acute pain which is more short-term and is associated with possible damage to the body. This pain with usually settle after a few weeks as the injured structure is healed and no longer needs protecting.
On the other hand, persistent pain lasts longer than acute pain (usually more than 3 months) but does not indicate tissue damage. Instead, it has more to do with the central nervous system.
When we step on broken glass, the nerves in our foot send lots of ‘danger’ information up to the spinal cord to the brain. Then, the brain assesses the messages and conclude that there is danger and action needs to be taken, thereby producing pain. Therefore, it is the brain and not the foot that is telling us ‘it hurts!’
With persistent pain, the nerves becomes more sensitive and the danger threshold is owered. Over time, it would take less and less to trigger pain and it would lead to a downward spiral where people would do less activities for fear of pain, leading to econditioned and hypersensitive tissues. If a movement is painful for a long period of time, the brain would build a strong connection between that movement and pain. Hence, although the tissues at the injured site has healed, the brain is still stuck in the perception that the movement is painful, making it harder to move.
The video below is a good summary to understand persistent pain:
Emotions and pain
Emotions and environmental factors can make a difference in our perception of the intensity of the pain and how long it will persist. The chemicals released in the body when we are stressed, tired, anxious, or depressed is very similar to the chemicals released when we get injured. In a sensitised nervous system, these chemicals released during low moods can make pain worse. This pain will then make us avoid movement and activity which will then lead to weakness, fatigue and stiffness, resulting in more pain.
Some tips to manage
First step is to understand that persistent pain is not causing any damage. Although pain is not a conscious decision, we can consciously make changes to our beliefs, environment, mental and physical health to manage pain. For example we can doing things we love and enjoy to release feel-good chemicals in the body like exercising or working towards a goal.
- Increasing amount of activities
- By gradually increasing the amount of activities, we can break the cycle of inactivity
- and pain
- Pain might still be felt with increased activity, however, just remember that pain is not the same as tissue damage (do as much as tolerated)
- With increased confidence to move, our muscles would gradually strengthen and gain more endurance with more activities.
- Eventually, you will get to move normally with less pain.
2. Working towards personal goals
- Try to focus on goals rather than on how to fix the pain, bringing the attention away from your pain
- Setting goals that are realistic for example being able to walk the dog around the neighbourhood for 5 minutes in 3 weeks time.
- Gradually achieving small goals can also increase confidence and boost our mood.
3. Make positive changes
- Improve mood and address negative feelings
- For example if stress has contributed to the increased pain due to low mood, seeking help from a psychologist might provide help.
