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:
- 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 there will be a part 2 soon.
Lorimer Moseley is a leading pain researcher. This 5 minute video explains how pain protects you from harm.
Deepak Ravindran is an NHS pain consultant. His book draws on his vast experience to give you the tools to manage your pain.
In this pod, Dr Rupy chats to Dr Monty Lyman about all things pain and how his views changed as a result of personal experience.
Download the Curable app (we can set you up with a 6 week free trial) and follow the recovery program of easily accessible education and exercises to help you break the pain cycle and find relief from persistent pain.
Flippin pain is a public health campaign encouraging people to reframe pain – you can follow them on all social media channels or check out the helpful resources section on their website including a great webinar on lived experiences (under events).
If you would like any further information or resources, or have any suggestions on how I could improve this blog, please let me know.
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