"Why do I hurt so much?" is a question I hear nearly every day. The answer is chronic pain, which tends to tamper with your quality of life. At the present time, there is no known cure for chronic pain. No test to diagnose it. No pill to cure it. No procedure to fix it. No surgery to remove it.
This blog is merely a commentary on chronic pain and for a better understanding of your particular situation; you may need to have several conversations with several healthcare providers.
The negative consequences of chronic pain are certainly astounding, to say the least. However, patient advocacy groups and patients themselves have demanded better care. Better care starts with a better understanding of the problem. And a better understanding begins with research. Chronic pain often co-exists with other conditions: fibromyalgia, painful bladder syndrome, chronic fatigue syndrome, chronic pelvic pain, TMJ pain, irritable bowel syndrome, dysautonomia, depression and anxiety often times go together. Although this is not good news, it is an important finding, especially if the health care team is going to manage patients effectively. First, let's take a look at what we know about pain and pain management.
How did it start?
Both biology and environment are usually in the background of the diagnosis of chronic pain.
One common factor in regards to all chronic pain syndromes is that the central nervous system (brain and spinal cord) is altered in the way it processes pain. So, the way that chronic pain is felt, is much different than the way acute, or new pain, is felt. Acute pain is usually very intense, localized to a certain area, and definable. For example, a stabbing, sharp pain in a certain spot tends to stay that way until it's gone. It's also typically accompanied by swelling, redness, or heat; there is evidence of actual damage to the body. Chronic pain is much different: there is no new tissue damage and no observable sign that there is a problem in the body. Chronic pain is generally achy and widespread, and hard to define. Pain is present, but there is no new injury.
So, if the biology of the two types of pain is different, there must be different ways to approach management.
In acute pain situations, because heat and swelling are in the area of injury, ice and compression are very effective ways to combat those problems. Medication is effective in blocking the pain from the spinal cord to the brain, and the patient will perceive a reduction in pain, while the body does its part in healing.
Chronic pain changes the way in which the brain perceives information. What might be considered a little bump on the knee now becomes a painful experience lasting much longer than what would be considered normal. The body has lost sight of what a normal reaction to pain is. The phenomenon of central sensitization becomes one of the complex issues in chronic pain. Central sensitization is the altered processing of incoming information by the nervous system. What was once normal is no longer normal. It is as confusing as it sounds! Furthermore, things that are normally effective for tissue damage that occurs with acute injury are no longer relevant with chronic pain. Ice, compression, medications are not helpful in the same way that they were before.
Environment also plays a role in chronic pain. Consciously or unconsciously, our previous life experience plays a powerful role on the situations we put ourselves into. We have amazing bodies, and our bodies - every scar, every illness, every experience we have - are ultimately a road map to how we might react to the events of each day. These things (previous injuries, surgeries, illnesses) also impact how we choose to live. This is a mind-boggling concept, but it is a very important one if you are to fully understand the mechanics of chronic pain.
Having pain has an effect on how we think, feel, and behave. These models of pain behavior are: biologic (the process actually going on inside our cells), cognitive (thinking), emotional (how we feel about it) and behavioral (how we act because of pain). Interventions need to address all these components of pain including proper medicines, psychotherapy, exercise, relaxation techniques, and education. Furthermore, the delivery of proper care in order to fully address the scope of the problem is required.
There is no cure for chronic pain, but education, lifestyle changes that incorporate a healthy diet and activity levels, and proper medications can help patients regain control over their lives and their pain. The possibility of a fully engaged, enriching daily life, is certainly attainable. It does take work, and a little discipline, but once you experience freedom from the pain, the shackles will fall off for good.
Michelle Landsverk is a Doctor of Physical Therapy at PT Center for Women, 3232 Ballard Road, Appleton, WI 54911. To make an appointment with Michelle call or text 920.729.2982.
PT Center for Women is one of the only physical therapy centers in Wisconsin that specializes in pelvic pain and pelvic muscle dysfunction, offering women of all ages comprehensive evaluation and treatment for their physical therapy needs.