In Limerick we have a slang saying that something is ‘chronic’ meaning hopeless/crazy/mad so I need to give you a medical explanation of chronic! Chronic is anything that lasts longer than 3 months.
Are you feeling a bit less mad about your chronic pain now?? Let’s have a bigger look at what chronic pain entails and how we see its recovery pan out in clinical practice.
The Faulty Lamp
Imagine you’ve got a lamp and it’s not working.
Let’s have a look at how you go about sorting this ( stay with me…..this has everything to do with chronic pain)
1) Firstly, you look for the obvious and check the bulb, trying a new one. If the lamp is still not lighting, you deduct that something other than the bulb is at fault.
2) You next check the lamp for loose attachments where the cable goes into the lamp and other nearby attachments. Bulb is still not lighting.
3) Your attention spreads towards the cable and plug : any tethered cables or faulty wiring. But still no luck.
4) It’s now looking likely that the problem is a bigger one: you check the power source: are all your other lamps in the room working? If all the others are working and your lamp is the ONLY faulty one, then you know that somewhere along the lamp and its cable/plug you’ve got a fault and you must go back and double check all of these, looking for something that you missed the first time.
5) However, if all the other items in the room are not working, then you know there is a bigger electrical fault with your system: a power cut or a fuse has blown on your circuit board.
Well, you’ve just gone through the basics of how we clinicians work out if chronic pain (longstanding pain of over 3 months) is a problem at the source OR if it could be referred pain from another area OR whether there is a wider systems issue at play. In the body, however, it’s a little more complex and sometimes more than one thing can be contributing.
Example of Hamstring Pain:
Here’s the scenario: You’ve got a pain in your right hamstring ( back of thigh) and let’s use the same powers of deduction, using this analogy:
bulb = your hamstring
Lamp = the entire leg, including foot, hip, knee joint
Electrical cable = your nerves ( sciatic nerve, spinal nerves coming from your back)
Plug & socket = your back
Electrical circuit board = your brain and neuro-endocrine system
So, you’ve got hamstring pain ( the bulb won’t light). First port of call is to check the hamstring itself: what movements are sore, how did the pain first occur, is it sore to the touch?. Does the mechanism of injury match the findings? If the problem is, in fact, an injury to the hamstrings, the solution is aimed at the hamstring itself with exercises, stretches, massage, strengthening. This is the equivalent of changing your light bulb: local problem, local solution.
But let’s say the hamstring itself seems fine on examination – our search spreads wider…this time to the rest of the leg ( the equivalent of directing your search to the lamp itself). Is there perhaps a biomechanical problem with the feet that are feeding in to the hamstring problem? We check the calf muscle, knee joint, ankle joint, hip joint. There might be one or 2 things to address here, but if it’s not making total sense, then it’s time to direct the search to the back.
The lower back ( also called lumbar spine) can refer pain to the leg. Quite frequently a ‘trapped nerve’ in your lower back gives pain in the hamstring area. So we check all the nerve stretches, we do a full check on the lower back joints and muscles and see if we can reproduce the same pain. If we can find the pain, then we direct our treatment at the lower back and its nerves, and not the hamstring. This is the equivalent of you checking the plug and socket ( back) and cables ( spinal and sciatic nerves) and fixing a fault here.
If the pain does not get fully better with the usual forms of exercise/ physio/rehabilitation to the back (plug and socket), then there might be some damage or irritation to the nerves themselves (electrical cable problem – Nerves are actually electrical cables in real life too). You may need to address the nerve injury with medications/injections or we may prescribe a period of rest and stretching in order to let the nerves heal and recover. You may even require back surgery. The recovery process takes longer than your average joint or muscle problem, but in most cases full recovery is possible.
But what happens if you’ve done all the back rehab/ surgery/ injections/ medications and you STILL have pain. In this case, you are now dealing, to some extent, with a sensitised nervous systems. Even though a back injury might have been the ORIGINAL source of the problem, if pain goes on long enough the nervous system gets sensitive.
You may now even have pain spreading to other parts of your body.
Remember our lamp analogy: if you had 2 lamps not working, you would be checking the main circuit board: well if you have more than 2 pains related to each other, then you need to be at least considering that a sensitive neuro-endocrine system is now a possibility. In this case, directly the treatment at the back alone will not fully improve the problem, you may well have to consider bigger changes that will reduce the sensitivity of your nervous system. Some of these can be bigger lifestyle changes, which you might resist strongly. But is you’ve been in pain for a long time, then you would be foolish not to consider them.
Now, luckily for you, I’ve done a full blog on this recently. Have a read here.https://www.yogaphysiozone.com/post/have-you-got-a-sensitive-nervous-system
But can I recover from chronic pain?
Look, there’s all kinds of miracle stories about people getting better from longstanding pain. So never give up hope that you’ll find the answers, because a lot of people do. But keep your expectations reasonable and ask yourself: what % improvement would I be happy to get? Then aim for that, and you might get better than what you were aiming for.
Remember that with anything chronic (long-standing) recovery is slow and not always steady. This goes for chronic fatigue, chronic digestive problems, chronic stress and ( yes) chronic pain.
Treat your nervous system:
Because you are likely to have some percentage of the problem coming from a sensitised nervous system, treat your nervous system as part of the equation. Do NOT confine yourself to treating the sore area alone, or you will be forever changing bulbs, when you need to check the fuse-box! See my suggestions in blog on sensitive nervous system (see above link), including breathing techniques, stress reduction and relaxation techniques. These sound a bit woowoo, but they are not: there are sound physiological reasons for them working.
Multi-pronged approach and % improvements
- There’s no magic bullet that ‘cures it’ – do not look for someone to magically cure you unless you are ALSO willing to take steps towards curing this yourself. It give you greater control and power over the situation.
- There are likely to be a number of interacting factors making your pain persist, so a multi-pronged approach is required, including lifestyle changes.
- However, you may only have the energy to tackle one change at a time, so be patient.
- Don’t use a scattergun approach and try everything at once because then you won’t know what worked or what made you worse. You’ll also run out of juice and enthusiasm really quickly.
- Look for percentage improvements with lots of approaches instead of one massive improvement with one thing.
For example:
if reducing your stress gave you 5% improvement
changing your job that you hate 10%
following an anti-inflammatory diet 8%
doing a regular exercise regime 10%
That’s a total improvement of 33% - not bad, eh?
Not a gradual steady improvement:
With chronic pain, things don’t get better in a smooth and gradual curve. It’s a bumpier ride for sure, but if you understand it, you won’t panic and you’ll keep going.
It’s the typical two steps forward/one step back approach: Things get better, then worse , then better, then worse and so on.
You know that you are improving NOT when the pain is gone but when the following things start to happen:
- You can do more without aggravating the pain ( your tissue tolerance improves)
- When it gets painful, it recovers quicker e.g. instead of taking 2 weeks to settle, it takes one
- You are getting more pain-free hours in a day or pain-free days in the week than you were 2 months ago, for example
- Occasionally you realise you have done something you hadn’t been able to do in ages. That doesn’t mean you’ll be able to do it next week again, but it was a glimpse of the future!
- Keep tipping away at your % improvements, don’t exhaust yourself and take mental health breaks every few weeks or you will definitely give up.
Thanks for reading. Don’t give up hope.
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