We see a lot of patients in clinic with persistent pain (pain which has lasted more than three months, also referred to as chronic pain). Often they have been in pain for years and cannot see a way for things to change. Understandably, they feel something in their body must be permanently damaged, but this is very rarely the case.

Over recent years, science has changed what we know about pain and we now know that persistent pain is usually not associated with tissue damage.

Recent research has shown us that pain is a protector, not a detector.

If pain were simply a detector, we would always and only feel pain when tissues are damaged, with the pain directly proportional to the extent of the injury.

However, as a protector, pain is a decision made by our brain outside of our conscious control, to tell our conscious mind that we are in danger and to motivate us to protect our body. If another, more important, survival priority trumps this the brain might decide not to create pain, or to delay it until later. For example, if you twisted your ankle and were lying in the road, your ankle probably wouldn’t start to hurt until you had moved yourself out of the way of an oncoming bus.

In many cases of persistent pain, the initial injury has long since healed but the brain has become overprotective and pain becomes wired in. This is absolutely not to say that pain is all in your head. It’s real, but it’s a wiring issue.

This might sound permanent, it isn’t. Your system rewired to long-term pain so you can rewire out of long-term pain.

As pain is our body’s response to danger, anything that increases cues of safety to the brain reduces pain. In order to do this, you need to persistently and consistently provide your system with evidence of safety and reduce the evidence of threat. You need to gradually calm down an overprotective brain,  letting it know that the body is safe. Conversely, anything that increases threat and reduces feelings of safety (such as stress or poor sleep) can worsen persistent pain.

So, what do you actually need to do? There are evidence based strategies for the management of persistent pain:

• Small “lifestyle” changes can make a huge difference by reducing stress, increasing feelings of safety and reducing inflammation. As with any behaviour change, make small changes that feel easy:
  • all movement helps eg walking, swimming, T’ai Chi – even knitting!
  • breathing exercises help to reset the nervous system. There are some simple techniques for you to try in this article
  • dietary changes – keep it simple – add just one more serving of plants to every meal

• In order to rewire the system, you need to understand it. Hopefully this blog has got you thinking about pain as a protector and you can learn more from Flippin’ Pain and Curable (in the resources below).

• Scientists are now looking at using virtual reality to tap into the power of the brain but you don’t have to go all high tech. The Curable app (see below) contains visualisation exercises to help manage pain.

It’s not necessarily easy to rewire the brain but it is certainly possible. We are here to support you as you learn to self-manage persistent pain.

I am sharing some of my favourite resources if you would like to delve deeper. This is a subject I find fascinating and there are a lot of great resources – so many in fact, that I have written a separate post with resources created by people living with persistent pain. You can access it here.