Take Control of Your Pain

This post is dedicated to the management of pain (and is more appropriate for chronic or persistent pain conditions. Acute pain management is slightly different, although the foundational physiology is the same.) Go back and read the previous posts about pain and the physiology behind pain here and here.

Management of Pain

When it comes the management of pain, you have the most power. Different medical professionals will have different theories on why you are having pain, and multiple explanations can add to the confusion and ultimately make the pain worse. Just remember, that as medical professionals we are offering possible explanations for why your body is experiencing the pain. All health professionals have different frameworks on which their work is based. You will have more power over your pain if you understand the science behind pain. 

Before we get into specific management techniques, here are a few guidelines with managing pain.

  1. 1. Make sure that any injury or disease which requires urgent medical attention is dealt with appropriately.
  2. 2. Make sure that any prescribed help makes sense to you and to your understanding of the problem. Try to get all of your questions answered.
  3. 3. Avoid total dependence on any practitioner. Youmust take control.
  4. 4. Always have goals that are understood by both you and your clinician. These could be physical, social, and work goals which allow some quantifiable way of measuring progress.

These are basic guidelines. Managing your pain can be complex. One thing that tends to happen with complex situations is fear of the unknown. Fear is a powerful motivator and can dictate how you move, how you behave, and even how the pain is experienced.  Facing the fears is important, and the first step in facing the fears associated with your pain is to understand as much as possible about your body. 

Coping strategies for the pain can also be an issue. There are two main types of coping strategies: passive coping and active coping. Passive coping examples include avoiding activity, doing nothing, waiting for something to happen, and believing that someone else has the answer. Active coping examples include learning about the problem, exploring ways to move, exploring and nudging the edges of pain, staying positive, and making plans. An article written in 1996 in the Pain journal showed that active copers manage pain (and many other health issues) better than passive copers. Let’s discuss how to become active copers.

The Tools

Management tools can be useful for actively managing pain. The first, and best, tool is education. This involves being educated as much as possible about your body. Certain movements/activities may hurt, but if you understand why they hurt, then you have more power over your pain. Use the knowledge about the science behind pain to try and understand why you are having your pain.

The second tool involves applying the knowledge you have learned about chronic/persistent pain and the nervous system. Remember, with persistent pain the messages sent from your brain can become altered and the amount of pain you feel is not necessarily due to the amount of tissue damage. So, the second tool is to understand that with persistent pain your hurts will not harm you. The idea is that your pain has persisted longer than it would normally take the tissues to heal, which means that just because you are hurting does not mean that the tissue is being further damaged. It is more likely that your tissue is healed, but your brain is “smudged” in areas and is still operating under the assumption that there is danger to those tissues and therefore it sends out pain signals. A warning though, this does not mean that you go crazy with activity and start doing unwise things. Your body is still very sensitive and will protect itself. Simply put, do not fear your pain (but do be wise about it).

The third tool is pacing and graded exposure to activities/movements. Movement is great for your body. It is even great for the brain because wise movements can help to re-program fine functional sensory and motor areas of your brain. However, the return to activity needs to be deliberately planned and appropriately progressed. You should pick one activity that you would like to do more of, or need to do more of, and find your baseline. Your baseline is how long you can do that activity without having a flare up (i.e. “I can walk for 3 minutes on a flat surface without a flare up,” so 3 minutes of walking on flat surface is your baseline). Start at your baseline and DO NOT exceed it. If it goes well, next time progress it a little (i.e. 3 minutes and 30 seconds of walking). It is a process not an over night fix. You will have “flare ups” along the way, but remember the knowledge that you have about pain. A “flare up” does not necessarily mean you have re-injured the tissues. Your alarm system is extra sensitive. As you slowly progress, your threshold of pain increases because you are re-training your brain and increasing the tissue tolerance to activity.

The last and final tool that we will discuss is slightly more complex to put on paper. It is accessing your virtual body. Your virtual body is the map of your body that is in the brain. In other words, there are specific areas of your brain dedicated to specific areas of the body. Those areas that are more sensitive (like the lips, or finger tips) have a larger area dedicated to it while those areas that are less sensitive (like the nose or ears) have a smaller area dedicated to it. The idea behind accessing your virtual body is that you are retraining your brain to perform a movement that is normally painful. An example may be bending forward.  The first step would be to imagine yourself bending forward pain free or to watch someone else bend forward. This simple task (although surprisingly tough at times) begins to activate areas of the brain associated with the movement and teach it that it is okay to move in this way without sounding an alarm. Next you would do different variations on the movement to further retrain the brain. This is where it may be beneficial to seek out a qualified healthcare professional to guide you through specific strategies for your situation.

I hope these posts on pain have been enlightening to you! Remember, we as physical and occupational therapists, can be valuable tools for you as you manage your pain. We are not perfect and do not claim to have all of the answers. The body is amazingly created (indeed fearfully and wonderfully made) yet too complex for us to understand everything.

(The information presented here has been adapted from Butler and Moseley. Explain Pain.2008.)