Understanding persistent pain

Pain is one of the hardest symptoms to endure, especially on a daily basis. And it is particularly galling when you are told all your tests are normal and there is no physical cause for your pain.

So, what is going on?

Here is a brief description of how to understand this sort of pain, which is extremely common: about one in four people have it.

I have researched pain for decades and the following is the result. A five minute video might provide a quick understanding https://www.tga.gov.au/chronic-pain-management-video-resource-brainma. 

A more complete explanations is found on the website painrevolution.org.

How to understand persistent pain

Everyone understands ordinary pain, for example, when you sprain your ankle. Pain is your body’s way to warn you to protect yourself against further injury and to rest the painful area to allow healing to take place. All good so far. And usually pain will settle when the ankle is better.

But sometimes, for reasons we don’t understand, pain not only fails to settle, but can increase its intensity, spread to other parts of the body and be associated with other symptoms such as pain on light touch or other normal stimuli.

This usually occurs after 3 months of pain and is called ‘chronic pain.’

What is Chronic Pain?

Ø  There is no ongoing injury, despite the very strong feeling that there is.

Ø  The pain is more severe than the original pain.

Ø  The less the painful area is used, the more the pain.

Ø  Sometimes the painful area is cold and clammy and can become very stiff or wasted.

Ø  Even strong analgesics don’t help much.

If this describes your pain, it is critical that you get the right information to get better. Usual treatment just won’t work.

Remember I mentioned that pain is the way your body protects you? Imagine now that the protection has got extreme. Somehow, the pain signal becomes exaggerated even though the site of injury or pain has healed.

This type of pain has been studied and we know the following:

-          This type of pain arises in the brain – that is why you find it hard to point to exactly where the pain is coming from. It can stop and start, sometimes be like electric shocks or burning.

-          The more you focus on the pain, the more intense it becomes. That is why Mark (see previous post) was able to briefly ease his pain by focusing on something else.

-          Creating pleasant sensations at the site of pain can help to distract from the pain.

-          A lot of factors can play a role to increase or decrease your pain:

o   How much sleep you get

o   Relationship problems

o   Worries about work or finances

o   How much physical activity you get

o   Relaxing or creative activities

o   Even what you eat!

In other words, chronic pain requires you to pay attention to all aspects of your life and to really prioritise what your body and your brain needs to recover. This is very challenging and, sadly, is sometimes the reason the pain continues.

But I can think of many patients I have treated over the years who have made the necessary changes to overcome their pain.

For some, it has been as simple as the patient understanding the nature of chronic pain. Amazingly, they were able to simply let go of it. This can happen, but, more commonly, people need to do the hard work of finding what is burdening them, or leaving them in a bind, where their situation is on some level intolerable, but they have felt they had to persevere.

It was like that for Julie who had suffered frequent headaches for years. She eventually came to the conclusion that, while her work with a charity was valuable to her clients, she could not continue to endure the abuse from her boss. Her headaches ceased when she changed jobs.

For others, it is much more difficult. Bill has a long list of symptoms, including numerous pains he has put up with for years. He relies heavily on his wife and together, with a shared sense of humour, they somehow manage. But it is clear from his story that something went terribly wrong in his early family life. He  remains dependent on his family and it might be catastrophic, or at least totally disruptive to Bill’s support system to delve too deeply.

So what can help ease chronic pain?

 Start with doing your best to get all the basics of a healthy lifestyle with good natural sleep, nutrition, some form of physical activitiy, and social connections or relaxing hobbies.

Then simply ask yourself what has happened in your life that led you to the point where pain developed. It’s a good idea to write a journal and allow yourself to record all the things that were happening in your life prior to when your pain started.

It might help to also write down how these events affected you. This is a good time to be completely honest with yourself. Some of us find it difficult to express certain emotions like anger or shame or guilt. And yet these powerful emotions can cause havoc in our bodies if not dealt with.

If you can, write down the things that trouble you the most about this situation. And what are the possible sourcs of help or support you can ask for.

These tasks can be very difficult and so having a counsellor or psychologist may help.

In summary, chronic pain is very difficult to deal with so build a support team around you to ensure you get the help you need.

Best wishes on your journey to recovery.