Pain is a natural part of our lives. Our bodies use pain as a warning signal for our brains to sense danger and act to avoid it. However, sometimes an injury or traumatic experience can cause pain that lasts for a long time. Over time, this pain might grow and morph into something that affects different parts of your life. We call this phenomenon “chronic pain”. In this article, I want to provide you a fresh perspective on chronic pain, and how we can help to manage or reverse the pain and its effect on your life.
What is chronic pain?
To talk about chronic pain, we must first ask ourselves, what is pain? The basic answer is that pain is an unpleasant sensation that happens when we injure ourselves. It gets a bit more complicated than this, however, so bear with me. Your brain creates pain to shift your focus to something that might be harmful or dangerous. If you touch a hot stovetop, your brain creates pain to have you take your hand off the stove. If you get injured, pain reminds you that the injury is there so you don’t hurt yourself more. The key message here is that pain is created by your brain to warn you about something harmful.
The body is great at healing injuries, and part of its process is making the injury painful. If you still feel pain after an injury is healed, however, there is a chance your pain system is dysfunctional. When an injury stresses your body’s pain system for a long time, it starts to change. The pain you experience might become more intense, or more sensitive to pain triggers. Other areas of the body may become sensitive to pain, or you might get other symptoms like fatigue or headaches. These are all examples of the effects of chronic pain. These symptoms occur because your brain is making changes and rewiring itself to focus more on the pain, and the more “real estate” your brain devotes to pain the more sensitive your pain system becomes. With chronic pain, your brain “learns” to be more sensitive to your pain!
Is it all in my head?
This is a tough question to answer! The brain is responsible for creating pain in the body, and chronic pain can rewire the brain’s pain system. Technically this does occur inside your head, but that doesn’t make these symptoms any less real! This is not something you can just get rid of by changing your thinking – it will take time and effort to rewire your pain system.
What can I do about my chronic pain?
We’ve covered that the brain rewires itself in response to pain to be more sensitive. For us to improve the symptoms and experience of chronic pain, we need to reverse the rewiring and desensitize the brain. Instead of reinforcing the idea that movement = pain, we need to find movements and activities that show the brain that movement is safe. We use an approach called Graded Exposure, which is a slow and gradual progression of movements and activities that involve the painful areas. The key with these activities is that they may or may not be painful, but they need to be safe. As you repeat these movements, your brain adapts to progressively more challenging movements and shifts the focus off pain. Your physiotherapist will work with you to create a plan for this Graded Exposure, as well as ways to adapt the program in response to flare-ups.
Exercising with chronic pain
Exercise is a very important piece in managing chronic pain. As we’ve discussed, movement helps to reinforce normal function in the brain. Exercise also provides a ton of benefits for overall health and well-being through improving blood flow and heart health, strengthening muscles, and releasing chemicals into the body that help relieve pain and make you feel good! Exercise is great for improving negative mental and emotional states like depression, which often comes together with chronic pain.
If you are having challenges starting exercise, talk to your physiotherapist on how to make it work! Here are some general tips to get you started:
- Find the motivation to start: For some, the idea of lifting yourself up out of pain is enough to motivate you to start exercising. For others, it may take more convincing to get motivated. Think about the things you want to get back to, like spending time with your family or doing activities you’ve stopped. Taking the first step is hard but believing in yourself can help start your journey!
- Set yourself up for success: Nobody runs a marathon in their first week of running. We all have to start somewhere! Work out some lighter activities out with your physiotherapist, and then set measurable and consistent goals to hit.
- Manage your symptoms during the activity: Your exercise journey will not always be pain-free. During these activities, it’s ok to feel a certain amount of pain if the movement feels safe for you to do. Work with your physiotherapist to develop strategies to manage the pain or discomfort, like breathing techniques or meditation.
The journey to get through chronic pain can be tricky but knowing how it works and where to start are great steps in the right direction!
About The Author
Jonathan Rankin obtained his MSc in Physiotherapy at McMaster University, and also completed both a BSc and an MSc in Human Kinetics from the University of Ottawa. He has a strong background in exercise, from working as a personal trainer at the University of Ottawa to conducting research on exercise during pregnancy in his master’s degree.