Pain, pain... that doesn't go away.

​Last month we laid out the basics of pain. Talked about what it is, what it is not, why we experience it, and a bit about how it works. We ended with a teaser about what happens when it becomes persistent. That’s what we’ll be covering today! 
 
Persistent pain is pain that lasts beyond the healing norms; most injuries heal within 3-6 months. It can be related to an initial injury but lingers even after we know that injury is healed. Some common complaints that come with persistent pain include feeling like it spreads or moves around; noticing that it increases with stress or decreases when you’re feeling good; and it often affects your ability to sleep. People with persistent pain may also notice that tests don’t always explain their symptoms, medication doesn’t totally control it, or people disregard the pain as not being real. This is when the pain is no longer associated with an obvious “tissue issue”. It can make it very frustrating to understand, as well as to control if we only target the tissues that appear painful. 
 
Acute pain related to an injury can become persistent as our nervous system adapts to the presence of pain and begins building neural connections within this ‘new normal’. We mentioned last month that pain is produced from the brain using information from your body. When pain is persistent, your brain forms more and more of these pathways that can create the sensation of pain. It ultimately becomes really good at sensing pain; something we might describe as being hypersensitive. The pathways and creation of pain are influenced by information stored and sent to the brain. Things that might worsen this sensation of persistent pain include worry, decreased activity level, stress, anxiety, depression, injuries, or disease. 
 
This may sound overwhelming and complicated. Pain is influenced by so much going on within the brain, how can we go about changing that?! Just as those listed above can make persistent pain worse, there are many things that can make it better; lots of which are in our control! These include knowledge of pain, restful sleep, fun activities, friends/family, healthy food, and positive thinking. Bringing these into our lives can decrease the sensitivity of those neural pathways, resulting in less pain overall – without even addressing anything tissue related! Not only can this improve pain but think about how those bolded items above can positively influence many aspects of our lives! 
 
Persistent pain my not be directly related to tissue damage, but we can see decreased tissue tolerance in the presence of persistent pain. This can happen due to activity avoidance related to the pain, decreased activity levels overall, and deconditioning related to this. When we work with the knowledge we’ve discussed surrounding stress, education, diet, positive thinking etc. we can decrease pain activity and the sensitivity of those neural circuits; however, this doesn’t always mean we can hop right back into our previous workout routine, activity, or sport. Our tissues may still be sensitive to this because it’s been a while since they’ve participated, and they may have lost some of their capacity to do so! To totally complete the picture, we also need to address these developed deficits in strength, mobility, or motor control. That’s where the combination of education and addressing life factors discussed above, PLUS specific movement and exercise prescription can be the magic bullet! 
 
Next month, to round out our 3-part series, we’ll be talking about how to get back into those activities you love, while working to calm your persistent pain at the same time! 
 
If you experience persistent pain yourself, or this information resonates with, check out the resources here: 
 
https://www.oregonpainguidance.org/paineducationtoolkit/
 
Cheers, 
 
Dr. Elle Carlson, PT, DPT