Chronic Unresolved Pain or Injury
Why do we feel pain?
Some nerves send control signals from the brain to the rest of the body. Others send signals from the body to the brain for feedback and processing. Each of us have around 45 miles of nerves connecting all our body parts to the spinal cord. The brain and nervous system provide both the expression and transmission of pain.
One reason chronic pain (the brain hard wires pain in after 3 months) has increased is that there has been too much focus on the localised injury and not enough on the significant contribution made by the nervous system and brain.
Chronic pain has more to do with sensitive nerves and how your brain processes your lifestyle than the injury itself
Our perception of pain is related to everything we are experiencing in our lives at that time. Thus, when we move better, eat better, are happier and less stressed, we minimise the pain we feel.
Pain is a normal human experience and we need it to survive. Pain is nature’s warning system which is designed to protect us. Pain is the symptom and not the cause of a problem.
When someone brings us bad news, we don’t shoot the messenger, do we? No, instead, we listen to what the messenger has to say, and then we go and find the real cause of the problem. It is exactly the same thing when it comes to pain. It is only trying to warn us that there is a problem, and it is up to us to seek out the true reason behind that pain. Where is the pain coming from and why? This is what we have to find out. It is called the neuroscience of pain.
Unfortunately, nature’s warning system can so easily become a nightmare. Lasting pain can be caused by deficiencies and excesses in your mind, body and diet. One secret to conquering pain is to find out what you have too much or too little of. It’s all about balance, and any disruption in the delicate balance of your body can be a strong contender for the root cause of your painful life.
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We have to change the way we use our bodies as we get older
Also, as we age, we need to put more care into diet, supplementation, exercise, and our workload. It sounds simple, but many of us fail to even acknowledge that we have to change the way we use our bodies as we get older. As we age, naturally occurring enzymes are fewer, inflammation is greater, and the production of inflexible scar tissue becomes much more extensive. Therefore, long-term solutions for pain also need to address our ongoing biochemical changes.
Early evidence also shows that anxiety, depression and sleep disturbances are common reactions to the COVID pandemic. Sleep deprivation can lead to symptoms virtually indistinguishable from widespread pain, fatigue and diffuse tenderness.
What is the difference between Acute and Chronic Pain?
Acute pain is a safety mechanism located in the reptilian brain, the oldest part of the brain. It’s this ancient reflex system that makes you quickly take your hand out of the fire. Acute pain is typically pain which has resulted from a recent injury, such as a twisted ankle, bruised or torn muscle. In most cases acute pain needs immediate treatment and is usually resolved within a few treatment sessions combined with exercise prescription.
Chronic pain is long term pain, beyond 3 months as the brain hard wires the pain in by that time, which can occur because of numerous conditions, such as emotional pain, joint wear and tear (osteoarthritis), spinal disc thinning, bulging or rupture, bone thinning (osteoporosis), unresolved tendon or ligament damage, to name but a few. Chronic pain, by its nature, may not be resolvable. It may need a lot more treatment than acute pain to bring down to acceptable levels and may also then need ongoing treatment to prevent reoccurrence.
Pain is a complex issue and there are usually no simple escape solutions
Latest neuro imaging technology, which can see the electrical activity in the brain in response to different lifestyles, has allowed the world to delve deeper into the understanding of chronic pain. It has confirmed that pain is modulated by factors such as attention, anticipation, empathy, placebo, meditation, fear, anxiety, posture, emotion and movement. This, in turn, has confirmed the benefits of a more holistic approach.
Suffering is not related to the degree of injury
This new insight into chronic pain helps explain why, for example, X-rays showing the degree of osteoarthritis in joints has no correlation to the pain being felt.
How Pain Works
Your nerves transmit pain signals. Inside your nerves you have sensors for temperature, stress, movement, pressure, immunity molecules and blood flow. Similar to car sensors, any damage or fault to any of these sensors will put a light on your dashboard, to alert you of a problem. The nerve does the same thing by increasing pain.
These pain impulses travel up the spinal cord, to a part of the brain which acts like a router (called the thalamus) and as a simple analogy, this router makes phone calls to other parts of the brain. For example:
• the sensory cortex (which interprets the nature of the pain)
• the mammalian amygdala (which assesses the level of fear, is the emotional centre, and which decides if the body needs to shut down digestion, cell division, circulation etc.)
• the cortex (which is in charge of the human decision-making process).
Hence our brains decide, like a panel of judges, how much pain is appropriate for us to experience at any one time.
The pain experience is complex and involves many areas of the brain:
1. Body sensation and location
2. Movement – muscles may need to brace the area
3. Focus & concentration
4. Fear response
5. Memory area recalling previous similar experience
6. Motivation - processes pain
7. Stress response - weight, digestion, sleep, temperature
All seven areas interact to decide on the suffering experienced. This may have little to do with the degree of injury and hence makes it clear that a qualified and knowledgeable therapist is needed to properly diagnose and treat the injury.
We have explained that the pain signal is passed through the nervous system up to the brain. As an analogy of a nerve cord, imagine a tight bundle of tiny electrical wires and that each one of these wires is connected to a specific part of the body. Imagine, as an example, an injury and inflammation to your foot and that one such ‘wire’ is connected to a very small part of that injured area. It will send a pain signal to the brain and of course, the brain knows exactly where the wire is connected in the body. The result is you will feel pain in your foot.
Now let’s go one stage further. That nerve bundle travels down your spine until it reaches the point at which it exits the spinal cord and passes down your leg to your foot. Imagine I could find that exact same wire in your spine. If I were to squeeze it, your brain would interpret that as a pain signal linked to your foot. You would feel exactly the same foot pain, but the problem this time is in your back. You may or may not have a real problem in your foot, you still feel pain in your foot.
Long-term pressure on a nerve will cause it to become super-sensitive and send pain signals even when there is no injury
Now, let’s go another stage further. Imagine that nerve in your spine had previously been strangled for a period of time by a tight muscle contracture. Extended pressure on a nerve will cause it to function incorrectly and it will become ‘super-sensitive’. That nerve will now send pain signals to the brain even when there is no current injury. In effect, the previous injury is locked in. Imagine a faulty wire having a similar effect.
Pain like this is called neuropathic pain because the nerve is super-sensitive.
The Do’s and Don’ts of Exercise
It’s not necessarily the case that exercises are appropriate at the start of treatment, as in some cases exercises, incorrectly timed, will make matters worse, not better. Neuropathic pain resulting from a trapped nerve is an example where exercises should not be given until the trap has been removed, allowing the nerve to move freely.
As an analogy, imagine I grabbed your wrist so hard that it hurt. Your reaction might be to try to pull your arm and wrist out of my grip. But if my grip is too strong, all that will happen is that your arm will ache and your wrist will be very sore. Yanking on a trapped nerve by exercising will have the same result.
The Pro’s and Cons of Pain Medication
Pain may be a signal that something is wrong, but at best it’s not pleasant and at worst it can prevent normal daily living. If long term, it can cause depression and a loss of will to live. Thus, medication is an important part of our arsenal to control the pain until the cause of the pain has been established and then successfully treated.
There are, however, downsides to medication. The first and most obvious is that the medication works by masking or blocking the pain signals and does not treat the actual cause of the pain. Further, by masking the pain, it prevents us from getting the warning that something is wrong. Thus, we may continue to do the very things that the pain is trying to warn us not to do. If used long term, medication may, as a consequence, exacerbate the problem.
Opioids are ineffective in treating chronic pain
Secondly, when the pain level is severe, opioid based drugs are often prescribed, with no differentiation between acute and chronic conditions. The problem here is that chronic conditions will most likely need long term medication and opioids are naturally addictive. In fact, so much so, that opioids have caused the majority of drug addictions in the USA. To make matters worse, opioids have been recognised for some time as being ineffective in treating chronic conditions.
Thirdly, most drugs have side effects and long-term use can be dangerous.
It should be clear by now that it is vital to be properly assessed by a qualified therapist before treatment starts, otherwise totally the wrong treatment could be provided.
Qualified therapists are trained to manually assess conditions but ultimately can only come up with a provisional diagnosis. To confirm, additional scans, such as MRI, Xray and ultrasound may be needed. Even then, some conditions are invisible to such scans. Scans may thus be able to eliminate some causes, but not able to confirm the actual cause. A good example is that neither MRI nor Xray can see muscle spasm, the latter being responsible for a lot of neuropathic problems, such as sciatica.
Our ancient Doctors, called Shamans at the time, always knew that the link between mind and body was key to healing. Those same ancient Doctors would look at the whole body, the mindset, fitness, diet and lifestyle of the patient. They also knew that the level of social support the patient had was a significant factor.
Lo and behold, new research now backs this up.
It has been shown that without consideration of the whole, Long-COVID sufferers, for example, will struggle to heal.
Further, the backstory and meaning to the patients’ pain is essential to understanding the suffering. Without listening to and understanding the backstory and meaning, the minds’ healing process cannot start.
Evidence suggests that in chronic and complex pain cases, there are likely to also be problems with fear, mood and personality. The indicators are that there will be both an increase in the rate of chronic pain cases and the severity of its impact will have widespread social implications.
Pain, as we have seen, can result from a multitude of causes. Pain can be acute or chronic, physical or emotional, physical or neuropathic and is impacted by other factors including emotion, mindset, exercise, nutrition and lifestyle.
Clearly, the therapist you choose needs to be properly qualified to assess and treat you. With today’s emerging knowledge, your therapist needs to offer a holistic approach and incorporate the significance of your mindset, fitness, diet, lifestyle, and emotional support network and be empathetic to your story.
4 Keys To Health
Our clinic has long promoted an approach to treatment which embraces both physical and social aspects. Nicky Snazell has written five books on this subject and has been invited to speak on over 30 radio stations right across the USA, to promote and educate an alternative to excessive opioid use, long before the COVID-19 pandemic started. The advice is equally important and valid to treating the forecast tidal wave of chronic pain coming.
Nicky’s first book, The 4 Keys To Health, available from Amazon, described an approach which looked at every aspect increasingly considered important:
• Fitness & exercise
A simple traffic light system was included to score patients and provide a preventative road map to better health. Wellness, or prevention, was naturally incorporated into the service we offered.
Thus, the direction of Nicky Snazell’s Wellness and Physiotherapy Clinic has been consistently towards providing a capability that exactly matches the need as proposed by the latest research.