The Mental Challenges of Pain
Pain, however mild or severe, is clearly an extremely unpleasant sensation. It may be described as pinching, throbbing, sharp/stabbing, niggling, or aching. It can be just a short-term nuisance, or considerably more debilitating.
Its basis is the brain’s response to a negative stimulus (such as touching as a hot plate); its perception of this stimulus is what we define as pain.
Pain can be very complex. For example, there have been studies into the perception of pain, where the brain can be “tricked” into believing someone has been hurt when they haven’t. Under experimental conditions, it’s possible to make someone “feel pain” even if they are entirely unharmed.
Pain is unquestionably highly subjective as anyone who has had to define it on a number between 1 and 10 will tell you…
It is also invisible (only the individual who is affected can truly experience it), and the threshold of what one person might define as “pain” compared to another person’s definition will vary enormously within a population.
Studies have suggested that we can be conditioned over time to feel less pain, although that’s not necessarily a good thing. Ignoring initial pain (at what we call the acute stage) can lead to further damage or a delay in healing, which in turn can create longer term issues ie. chronic pain.
Chronic Vs Acute Pain
Acute pain typically describes the phase between 0-72hrs of the injury and is often accompanied by inflammation/swelling.
Chronic pain describes a point beyond the acute phase and is usually caused by either the body failing to heal properly, or by compensatory factors such as muscles tightening around the injury to protect the damaged area. This latter process can itself cause immense pain as anyone who has had a back or neck injury will testify.
About 40 per cent of the patients we treat are suffering acute pain, versus around 60 per cent of our patients who have chronic pain.
Some of the most common reasons “acute” pain transitions to “chronic” pain include a misdiagnosis of the original injury, ignoring the pain in the hope it will “go away”, or a misguided attempt at a quick fix solution.
We have a long and outstanding track record of diagnosing the underlying cause of chronic pain, treating it, and helping patients to get back to their normal lives. If necessary, we can refer patients to other healthcare practitioners, including for scans, if we’re at all concerned.
Sometimes, unfortunately, chronic pain cannot be fully alleviated, at which point, we work with the patient on improvement, management and maintenance strategies.
The Impact of Pain
It’s not pleasant to live with pain. Aside from the discomfort, pain can impact on many other aspects of your daily life.
It can make sleeping very difficult, it can stop you doing the things you enjoy and restrict physical contact with family members (such as picking up your children), plus there’s also the cost of pain management e.g. private healthcare treatment, medication, time off work etc.
All these things can have a massive impact on your quality of life.
Pain can have other health implications, including curtailing activity and making people more sedentary. It can cause people to put on weight and/or endure the side-effects of certain long-term medication. If it goes on long enough, pain can leave people seriously depressed.
We have experienced acute and chronic pain ourselves and we’re only too aware of how debilitating and stressful it can be.
For some, there is also the sense of no longer being in control of their own bodies, for example, when they can’t control the pain they are in, despite (or perhaps because of) treatment and medication.
This “loss of control” sense can be exacerbated if the underlying cause/s cannot be identified – sometimes for many years. People can be “written off”, disbelieved, inaccurately labelled as “hypochondriacs”, isolated, or left simply with a sense that “no one can help”.
The anger and frustration this can create is entirely understandable, particularly if these attitudes have come from a medical professional.
All in all, living with chronic pain can be a miserable, lonely, and exhausting space to occupy.
Supporting Patients in Pain
Our first step with patients is to acknowledge their situation, then we talk with them to understand their expectations of treatment and recovery.
It’s important to note that while some injuries heal relatively quickly and over a reasonably predictable timeframe, other injuries can take a lot longer and the outcomes may be less clear. Ligaments, for example, can’t heal by themselves; they have no blood supply, so successfully treating a torn ligament typically involves surgery that then needs to heal. That’s the point at which physical therapy and rehabilitation can start.
In addition, everyone’s needs/hopes are different so we ask at the outset, where do they need to be or hope to get to? We then work back from there.
Are Some People Told to Live with Pain?
Absolutely. We have personal experience of an older family member who suffered from a degenerative disc disease. He was convinced his spine was crumbling, and that because it was “a disease”, that it would kill him. Neither was true, but as a result of his mistaken beliefs, he refused any physical therapy that would have helped him.
Societal beliefs (even if they have been disproved) and the language we – and other medical professionals – use both have a vital part to play. We dislike hearing that anyone has been told that they have to “live with this” pain for no other reason than because of their age; this is a common perception among older generations suffering degenerative conditions such as arthritis, but pain is NOT normal!
We know that people want to enjoy their middle to later years just as much as they did their younger ones, and why not? What we can each achieve in terms of new challenges and adventures are constantly being proven to be far above what might be considered “the norm”.
If nothing else, the impact that beliefs can have proves what the huge part that the mind plays in effective treatment and successful rehabilitation. It’s true that if you tell someone they will get better, they usually will. It’s also true that if you tell someone they won’t get better, they typically won’t.
How do You Diagnose the Origin of Pain?
It can be very challenging especially for longstanding injuries. The position of the pain may or may not be where the problem lies. This is something we’re very alive to and where skill and experience plays a huge part.
We regularly see patients who present with one problem that treatment has failed to cure, because the actual cause of their pain is somewhere else entirely in their body. What’s causing them pain can be the body’s attempt to compensate – for example, dropped arches can cause chronic knee pain.
There are also phenomena such as referred pain and phantom pain, each of which would take another article to describe in full!
Because our knowledge of anatomy is so detailed we have a head’s start when it comes to musculo-skeletal pain/injury diagnoses.
What’s the Next Major Treatment Advance?
Stopping pain happening in the first place! This is an area we’re particularly invested in at Origin.
Preventative treatment is a growing trend across all generations for example, through yoga, Pilates, going to the gym etc. It’s cheaper and easier to stop something happen than to treat it once it has.
Plus, prevention avoids all the mental trauma associated with pain. That’s why we like to treat, rehabilitate, and educate all our patients – to encourage them to take some responsibility for their own rehabilitation through exercises at home, and see it as a healing process – that way, we can help prevent injury recurrence.