By: Dr. Tanvi Maharaja, PT DPT OCS PCES, Pelvic Health PT
Chronic pain is one of those complex experiences that science still has to completely unravel. The perception and treatment of chronic pain has changed dramatically over the past few decades. This paradigm shift occurred when neuroscientists, and subsequently health care practitioners, began to see and treat pain from a biopsychosocial model rather than as a physical entity. This means that the experience of pain that an individual has, especially when the pain is chronic, is the culmination of several factors other than just the physical or biological tissues. Chronic pain is defined as any pain that lasts longer than 3 months, and this definition itself is a little fluid.
We now know that someone who has been in pain for a long time, has changes in their nervous system, which themselves become a source of pain, long after the original pain source has healed. So if you worked hard in the yard or had to shovel snow for a long time, or had a fall, and ended up with back pain, that could result in a real injury. Say your muscles went into spasm, where they contract suddenly and intensely to protect the internal organs and the spine. This would count as the initial injury. Typically, tissues heal within a short time frame. This kind of injury would completely resolve in 2 to 4 weeks.
Around this time, if you have other life stressors, they amplify the sound of pain. Say you are a few days out, and go through a relationship crisis. This causes extra stress on your system. As a consequence of this, you are not eating well, not sleeping well. You may carry over the stress to work, which can often cause other minor problems to crop up at work, which only serves to make things worse. All these factors can add to the experience of pain, and make you feel a lot worse for a lot longer.
Now this is a very simplistic explanation of chronic pain. In reality, psychosocial factors are multifold. And the consequences are many. People tend to have psychological responses varying from feeling helpless, to ruminating (constantly thinking about the initial injury and how it could have been prevented) and catastriphizing (‘what if *insert worse case scenario*” and “why me?” questions), to feeling depressed. They may tend to start avoiding things that will put the slightest stress on the injured part. The brain sees the world as a threat that is out to get at that spine (or neck or whatever was initially hurt). They feel socially isolated and aloof, or may feel like they are a burden on others. As you can tell, none of this helps with pain.
Chronic pain is the end result of this whole sequelae. It is truly a snowball, wherein the initial injury is just a tiny part, and has actually completely healed from a purely biological perspective.
Healthcare professionals are trained to treat individuals with chronic pain. You DO NOT have to live with this pain. Treatment is usually customized to a person’s unique presentation. The key is to step back and look at the whole person rather than just a body part, and offer holistic treatment.
Physical therapy plays a key role in treatment of chronic pain. PT treatment comprises of patient education, manual therapy, and exercises (neuromuscular re-education exercises and therapeutic exercises). Other treatments in the form of injections and/or medication provides a window of opportunity to modulate pain and help patients get started with physical therapy. As a spine PT and a pelvic PT, I am privileged to have walked down this road with patients and together with our excellent healthcare team at Signature Healthcare, we have empowered people to take control of their lives after years of pain. It is important to create awareness regarding chronic pain, to know that life CAN get better.
To good health and wellness!!