If you are one of the millions of people that experiences chronic pain on a regular basis, then you can probably remember a time when you did not struggle with persistent pain. At one time, you were able to do a lot more physically than you can do now.
For many people with persistent pain, there is no specific incident. They are not able to pinpoint exactly what may have started the process. However, many people develop pain because of a particular incident or injury. Let’s explore this “incident or injury path”. Someone can get hurt in many ways, so let me use a scenario that is commonly seen among health care providers.
A possible path to chronic pain
Let’s imagine that you fell at work and injured your back. After the fall, you could barely stand up due to the pain and were worried that something very serious had happened. You went to the emergency room and the x-ray showed there was nothing broken. The doctor sent you home with medication to help with pain and muscle spasms and instructed you to stay off of work and rest.
Two weeks went by and the pain was not any better or perhaps it was worse. You decided to schedule an appointment with an orthopedic doctor. The orthopedic exam did not indicate a need for surgery at that time. They suggested you go to physical therapy or acupuncture for a month while you stayed off work. Over the next month, you experienced some relief from your pain, but it came back fairly quickly after treatment and even felt worse at times. This lead you to think that your back may have a more serious injury that no one had discovered; so you moved your back less because you were afraid you would hurt it more.
The pain continues…
At the end of that month you returned to the orthopedist but not much had changed with your symptoms. He decided to perform an MRI that indicated you had a herniated disc at L 4-5 in your lumbar spine. He recommended surgery to fix the disc problem. Surgery was scheduled and you were finally relieved to know what the problem actually was and that it could be fixed.
Meanwhile, you continued to move less in order to “protect” the herniated disc. You worried about how all your bills would get paid while you were off work and your spouse mentioned their company was talking about layoffs. You also heard from a friend that her family member had back surgery and was never the same afterwards.
Surgery -“The Cure”
The next week, you had back surgery. Your doctor said you should be back at work in a couple of months. You were comforted by the fact your back was now fixed and you anxiously waited for your pain to subside. However, your boss kept calling and wanted to know when you would be back at work. He was very “insensitive” by the way, and thought you were blowing this “back thing” way out of proportion. He once had back surgery and was up and running in no time, so he doesn’t understand why you needed to take so much time off from work.
8 weeks later you returned to work, but struggled to do your job as you did before. You felt you could be making your back worse so you took more time off to let your back heal; You rested more and moved less in order to avoid the pain. A few weeks later, your boss decided to let you go because even though the doctor said you were ready to return to work, you were not able to physically perform your job. This led to depression and anxiety that your back would never get better. You continued to have pain and wondered “What if my back is not fixed? What if there is something else wrong?”
While this is a hypothetical situation, it is not uncommon. There are many other variables that could be part of this story. This includes getting second opinions from other surgeons who tell you there is nothing else wrong with your back or maybe they emphasize all the typical “degenerative” changes in your back without explaining that these are completely normal and not necessarily the cause of your pain. You may try therapy again. Perhaps the therapist pushes you too hard because they feel you are exaggerating about your pain. Your family may be getting frustrated with you because they don’t understand why you are not getting better.
As you can see there are multiple ways this story can play out, but the key is that there are many factors that contribute to pain and it is not always a clear path to recovery. Watch this video to better understand some of the processes involved in creating the pain experience.
Early Pain Education
This prolonged pain journey could have been avoided if, early on, the patient had received more in-depth education about pain. It could have helped allay the fear and anxiety that perpetuated their symptoms. They could have benefited from encouragement to move and understanding that excessive rest and not using their back actually does more harm than good. They could also have benefited from understanding how tissues normally heal and how the nerves can become sensitized. The lists goes on.
Understanding… the key
If you are someone that did not have a defining incident that started your chronic pain journey, you may still have identified with some of the examples in this hypothetical scenario. Whenever the pain process begins, there is the potential for development of persistent pain. There is a wide array of research that is being done currently on the possible biological processes that start this downhill progression. The research shows that stress and anxiety alone can produce pain. So, while a non-traumatic beginning to chronic pain has a different development and progression, understanding the factors that drive the pain you feel is very helpful in reducing your pain and restoring your function.
In this article, we have explored one path to developing chronic pain. Next time, we will look at some of the different treatment options and ways to improve your function and calm your symptoms.
Jeff Mullins, PTA, Therapeutic Pain Specialist, Hope Rehab Katy