written by osteopath Della Buttigieg

A quick recap on what you need to know to tame your pain so far…

1. Knowledge is power so if you haven’t done so yet, get back to the last blog and follow the links in the resource section. There is some real gold in there. Get schooled and get in control of your recovery.

2. Pain does not equal tissue damage, and more pain does not equal more damage. That does not mean that the pain without tissue damage is not real, and it definitely does not mean the pain is in your head. It just means that the pain itself is the problem, the pain is the pathology that needs treating. We need to treat the pain, not just the part of the body you feel the pain in. There is a subtle but critical difference there.

3. Pain is protective and when we work with our nervous system to decrease the perceived threat it’s responding to, pain will typically subside. When it doesn’t, we have chronic pain and chronic pain is different to acute pain. It is a totally different beast.

Chronic pain is different to acute pain

4.  Acute pain is usually in response to a tissue injury or another immediate threat, and it subsides as the injury heals or as the threat retreats. It’s typically quite local or specific, short lived and helpful.

Chronic pain on the other hand is persistent beyond the time taken for tissues to heal from injury. Or in some instances it may occur entirely without illness or injury. This persisting pain is not an indication that your back or shoulder has failed to heal but rather it is due to structural and/or functional changes that make the nervous system more sensitive and more responsive to stimuli from that body part.  Meaning the nervous system produces more pain and inflammation with less or sometimes even no provocation at all.

These changes largely occur throughout the spinal cord and brain, and they essentially heighten our ability to perceive and respond to any perceived threat. Because these areas process information from the entire body when they become hypersensitive and hyper-responsive they escalate signalling and perception throughout the entire body. This explains why chronic pain tends to spread from the back to the legs or the neck to the shoulders.

These changes don’t just affect our physical bodily perceptions though, they frequently jack up our perception of sounds and smells and chemicals also. This starts to tie in a range of seemingly unrelated issues like irritable bowel or chronic fatigue syndromes and even endometriosis.

So, whether you have chronic back or neck pain, knee arthritis, recurrent headaches or fibromyalgia – it is important that you understand that the problem is pain, and that to a large extent, the same mechanisms are at play in all of these conditions.

Why does it matter? Put simply – if you only ever treat the back or the neck or the knee – you’ll never get better and you may in fact go on to get worse. You need to look at the pain as its own entity and address that.

Multiple pain sites and recurrent episodes of familiar pain are still chronic pain

5.  Your dodgy hip that plays up from time to time, hangs about for a few weeks and then seemingly goes away again. That’s chronic pain, it’s just not constant pain.

Your lumbar disc that bulges and makes your low back ache when you sit too much. Never enough to stop you doing things but enough to distract you by the end of the day. That’s chronic pain, it’s just not debilitating.

When we experience recurrent pain we often think of these episodes as separate injuries in an area that is inherently weak from a previous injury. In actual fact however, the majority of injuries heal very well. Previous injuries tend to cause recurrent pain because the area is persistently sensitive, not because it is fundamentally weak. We really only see failure of tissue healing in patients with connective tissue disorders and the like – these are quite uncommon. Persisting sensitivity on the other hand is very common.

Some people tend to experience pain in multiple places. You may have low back pain and neck pain. They might be on the same or opposite sides, they may tend to occur in a particular pattern, or they may be unpredictable. But, if they recur or they tend to kick one another off – they are probably connected by these same underlying neuro-immune mechanisms. They are not caused by your fascia, muscles or other biomechanical mechanisms.

So, both recurrent pain and multi-site pain are types of chronic pain. They need to be managed as such.  This will give longer lasting relief, but it will also (very importantly) limit progression of the pain condition. Meaning you’ll tend to accumulate fewer new pain sites, the episodes will be less frequent and hopefully also less intense. It will also limit the likelihood that your pain will become unresponsive to pain medications.

Chronic pain does not have to be constant.

Chronic pain does not have to be severe.

It does not have to be debilitating.

The aim is to identify it and to treat it before it becomes any of those things!

Pain will create musculoskeletal findings

6.  Lastly for today – Pain will create musculoskeletal findings such as tension, tenderness, stiffness, and weakness. The presence of these findings does not mean that these structures or phenomena are causing your pain.

Remember that chronic pain is the result of changes in nervous system structure and/or function. The nerves and neurological structures that send signals to your muscles and joints to create tension and movement are those whose function is altered.  Same goes for those that send signals about the sensation of muscle tension and joint stiffness.

These musculoskeletal findings, like your pain, are very real. They are just not the root cause of your problem – they are a symptom. An output of a dysfunctional nervous system. Treating them can bring relief and can be a useful strategy in the short term (we LOVE manual therapy!) but manual therapy alone will not ‘fix’ your problem.

To learn more about your pain and the best ways to tackle it, stay tuned to our blog for the next part in the series. If you’re struggling with pain and need help to tame the beast, come visit us at Eureka Health - call us on 03 5333 2232 or book online now. We’re here to help!