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Persistent Pain

Pain is part of our in-built alarm system and it often warns us that something could be wrong. Pain is vital for our survival and without it, we would not be able to tell if we were doing serious harm to ourselves. Those who are born without the ability to feel pain, often do not live to adulthood.

We experience pain when our brain processes the incoming messages (from our body and from lots of other sources, such as what we can see, hear, remember, predict, where we are and who we are with), and decides that we need to do something to protect ourselves from possible or further damage. In the moment, that could be to quickly move away or stop what whatever we are doing. Once we are out of immediate danger, pain could promote protection by prompting us to see a doctor or avoiding using the body part or area that is affected.

Like hunger, thirst and fatigue, pain is an experience generated by the brain and felt in the body - 100% of the time. Although pain is not ‘all in your head’, it’s not all in your body either: pain is always an interaction between mind, brain, body and environment.

After an injury, once sufficient healing has taken place, usually the nerves will stop sending the messages that indicate that there is a problem. However, sometimes there are changes to the nervous system that can contribute to ongoing pain. When the nerves send messages more easily than they used to, people can experience more pain from the things that would usually hurt most people (such as twisting your ankle), and we can experience pain from things that shouldn’t really hurt (such as the touch of a feather on your skin): the system has become ‘sensitised’. Pain is said to be ‘chronic’ or ‘persistent’ if it persists beyond the normal healing time, which is usually only a few weeks and even for major injuries should usually be no more than six months.

Injury is a common initial cause of persistent pain, although many people are unable to identify a specific trigger event. Other causes include arthritis, post-surgical persistent pain and ongoing musculoskeletal pain such as lower back pain. Regardless of the initial problem, for some people additional factors such as stress, decreased activity, and worries about the pain or the future, can lead the system to become sensitised and more prone to experiencing pain.

Some people with widespread persistent pain are diagnosed with a condition called fibromyalgia. It is a widely misunderstood condition because it can be difficult to diagnose. Like with Chronic Fatigue Syndrome (CFS), there is no specific test for fibromyalgia, and the symptoms can be similar to a number of other conditions.

As well as widespread pain, people with fibromyalgia may also experience:

  • sensitivity to things that would usually provoke pain
  • a pain response to things that would not usually provoke pain
  • fatigue (extreme tiredness)
  • muscle stiffness
  • difficulty sleeping
  • problems memory, concentration and thinking clearly

People are often told by well-meaning professionals, “there is not cure for fibromyalgia” and, “I’m afraid that you just need to accept it”. This would obviously be disheartening to hear, but while – strictly speaking – it is true that there is no tablet, injection or set of exercises to ‘cure’ fibromyalgia, it is not a completely accurate message.

Psychological therapies that have been found to be effective for pain management. The aim is to reduce the focus of attention on pain and respond differently to pain and thoughts about pain, as well as to increase your pursue pleasurable activities and sense of connection with others. Relaxation strategies such as imagery, progressive muscular relaxation or breathing techniques have also been found to be effective in getting relief from pain, and decades of research and clinical practice have consistently found that meditation and mindfulness can also help people to feel more in control of their pain, thoughts, emotions and life.

It is possible for people with persistent pain to improve their quality of life and unhook themselves when they caught up in the distressing physical and psychological traps that pain can weave.

In my current work in rheumatology and persistent pain services, I have helped many people to change their mindset by explaining how modern neuroscience about the interaction between mind, brain, body and environment applies to them, and by using psychological therapies that enable people to break free from patterns of thinking and activity that are dominated by pain. When people understand more about pain and how to respond to it differently, they can reduce avoidance driven by fear of pain, manage thoughts and worries that get in the way, develop patterns of activity that work for them, and do more of what they enjoy and gives life meaning.

For more information about how to deal with persistent pain, contact Dr Alex.

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