In previous posts, we explored how chronic or persistent pain can develop. We also explored some important factors that contribute to the process of developing persistent pain. Before discussing the treatments that can help ease pain, there is one thing that we NEED to understand about persistent pain in order to be successful in treating it.
The concept of Neuroplasticity.
This is a pretty fancy term. Simply explained, it means that as long as you are alive, your brain and nerves have the ability to adapt to the stimuli you encounter.
In the previous “Why don’t they believe me?” post, we touched on the understanding that research demonstrates that your body makes adjustments and adaptations as you develop persistent pain. This is where Neuroplasticity comes in. Your brain and nervous system become more efficient at producing a pain experience. So efficient, in fact, that it can create a pain experience even when the action or activity should not be painful.
When it comes to treating persistent pain, we must understand that our main goal is to get your brain and nervous system to adapt in a positive manner. We must guide it to remain calm and feel less threatened when you move and are active. If your nervous system feels that your body is in danger, it WILL produce pain in order to persuade you to change your behavior. However, your system may try to “persuade” you to avoid things that are not dangerous or harmful, such as walking around the block or playing cards with your friends. You must understand why this occurs and what you can do to change it.
If you go through different types of treatment just to improve your pain but you don’t understand the purpose or goal for that treatment, you may feel like you are spinning your wheels.
That brings us to “passive” vs. “active” treatments.
A passive treatment is one that is being done TO YOU. An active treatment is one which you are an active participant. You engage physically, cognitively and emotionally. A couple of examples of passive treatments would be having your muscles massaged or a joint mobilized by your therapist. Another example would be applying a TENS unit to the painful areas of your body. These treatments can be beneficial in easing your symptoms and allowing you to move better. However, their effects are frequently temporary.
Examples of active treatment would be exercise, focused breathing and relaxation. It could also include education on changing sleep habits or working with a counselor to learn stress management skills. These treatments require active engagement from your brain and your body. They stimulate various body systems. Over time, this can help decrease the sensitivity of your nervous system. This promotes neuroplasticity which makes positive and lasting changes.
There are THREE key elements to treating persistent pain successfully.
- Once your doctors and medical professionals have ruled out any serious structural issues or disease processes, then you must trust that your body is able to get stronger and experience less pain.
- It is important to educate yourself about pain processes so you can understand what is going on inside your body. Knowledge is power and can ease the uncertainty and fear that there is something seriously wrong. Pain catastrophizing, or being over focused on your pain, keeps your nervous system on high alert. The more you understand about why you feel the way you do, the easier you can confidently face those pain obstacles.
- Probably most important, is that you need be ready to get to work. Overcoming persistent pain is not easy. It requires commitment and dedication. You must put in time and effort to achieve those neuroplastic changes we mentioned earlier.
There are multiple options when it comes to treatment, but one thing that needs to be in everyone’s program is physical activity.
If you wait until you start to feel better to implement an exercise routine, the persistent pain has already won. I’m not saying to force yourself to do something that your body is not physically ready for. You do need to move. You must become more active even when you feel that you can’t do it. This does not have to be an elaborate workout routine. It may be as simple as taking a brisk walk or riding an exercise bike. You can also do some simple stretching or strengthening exercises that your physical therapist has given you.
There may be times when performing even these mild exercises causes pain. However, the more you understand what is going on with your pain, the easier it is to stop fearing or avoiding pain. You can start to become more objective and recognize these skewed inputs and outputs. Remember, your nervous system is going to let you know what it thinks about your ventures in becoming more active, but now, you know how to respond because you know what’s better in the long run.
If you are ready to really take control of your pain and your life then you CAN be successful.
You CAN see the change that you have been longing for. Whether you are working on the social and emotional part of pain, the physical activity, the education aspect or maybe other areas, just make sure you remember, your nervous system is “plastic” and it can change for the better.
Keep fighting, keep working and keep learning! Each day provides the opportunity to be better than the last.
Jeff Mullins, PTA, Therapeutic Pain Specialist