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Hurt is not Harm: Pain & Damage

13% or 1 on 8 of the entire Irish population is in chronic pain at any time. Being in pain, acute or longstanding, is among the most common reasons for visiting a G.P. and is certainly the most common problem reason for patients attending musculoskeletal physiotherapists.

Pain itself is extremely complex. In the past it was believed that pain was a clear sign and consequence of trauma or tissue damage. The idea was that the body sent chemical and electrical messages to the brain, producing pain as a warning sign to alert attention to the injured body part and prevent worsening damage. The brain then signalled muscles around the damaged tissues to go into spasm thus preventing movement in the body part, protecting it from further damage.

This body-brain-body pattern above is an excellent adaptation to damage in an acute situation, like in the immediate aftermath of breaking a bone in a bad fall.

The main function of acute pain is to alert us to tissue damage. However damaged tissues invariably heal in standard healing times: skin in 5-7 days, soft tissues in 3-8 weeks, depending on type, bone in 6-12 weeks. As the body heals, pain usually eases away.

However in some cases, often where initial injury is much less than life threatening, pain can sometimes persist long after it should have ended. Chronic pain is defined as longstanding pain for a period of three months or more or frequent episodic pain that may vary in intensity over many months, even years.

The reason for this is not fully understood. In recent years researchers across medicine, science and psychology are now beginning to get a handle on the incredibly complex presentation that is chronic pain. G.P.s, pain consultants, pharmacists, chartered physiotherapists, occupational therapists, clinical psychologists and others are pooling knowledge and expertise to address and assist patients ‘stuck’ in chronic pain.

Some widely observed patterns emerge in studying the effect of persistent pain.
Research from all around the world is coming up with the following two simple pieces of advice to begin the process of actively dealing with and reducing chronic pain.

The first is: “Act as Normal” or MOVE. Normal movement is what the body was used to before the pain came on and what it craves even when in persistent pain. Normal movement places normal strain and stress on tissues.

Movement loss is a common consequence of longstanding pain. The body persists in holding the hurt area as if to prevent further trauma even though the actual tissue trauma may have healed months before. Holding the body part abnormally rigid for too long is in fact detrimental. It places strain on adjacent areas and probably actually sustains pain rather than curing it.

A self strategy to address this is to try looking or listening/ feeling.
Looking involves a mirror. If you can see that you hold the sore area differently to the opposite side, look at and focus clearly on the ‘good’ side. Ask your body to mirror the posture of the ‘good’ side. Watch how this changes your overall posture. Do not think about sensations coming from the side of pain. Instead only dwell on making both sides symmetrical. Try to repeat ‘good’ positioning several times a day, initially in front of a mirror, then as you gain confidence, without the visual clue of the mirror.

The other method is to do exactly the same by monitoring local internal sensations. Again, instead of ‘listening’ to the sensations from the sore area, ‘listen’ or feel the ‘good’ side. Try moving to replicate what is happening on the ‘good’ side. Get your brain used to listening to ‘good’ sensations rather than constantly thinking about the sore area. Repeat this frequently

In either case taking on a new posture causes change. Change is rarely easy. However hurting from good change, from new and normal movement does not mean that you are harming tissues, in fact quite the opposite! Improving movement is crucial in the challenge of reducing chronic pain.

The second simple piece of advice to try to move at the same rate as everyone else. Slow guarded movement seems to be a universal unconscious adaptation to pain. However over time, slower than normal movements add to the problem. Perhaps surprisingly, abnormally slower movements can cause stress to muscles, ligaments and joints, making them more pain sensitive. So watch other people: get up quickly and naturally, walk a little more quickly. Mirror how the 87% of the population move.

Try it. It just might be the first step in dealing with persistent pain.
Mairead O’Riordan, MSc, MISCP is a senior Chartered Physiotherapist & CEO of TherapyXperts, an allied health network dedicated to clinical excellence.
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