Chronic pain is intractable pain that has not responded to mainstream therapeutic treatment and for which there is no obvious physical cause.
Research suggests that chronic pain can be relieved by working directly where the pain sensations start from, and that is in the brain. Using the sensory motor approach, it is possible to calm the autonomic nervous system and stimulate the parasympathetic nervous system to return the body to stasis. Low-frequency delta waves are generated by sensory motor input and this has a direct effect of changing the receptors in the amygdala resulting in removal of the emotional charge of a memory.
In addition to the hands-on sensory motor approach, a key ingredient to managing chronic pain are self-regulation techniques.
Helping patients become aware of their own inner experience of pain can remove the fear associated with pain sensations. A relaxed autonomic nervous system will not conduct this strong pain sensations. Deep attenuation of the amygdala through the use of touch and movement can create healing. It is now well known that the mind/brain/visceral communication is the route to emotional regulation as this demands a radical shift in our therapeutic assumptions. There is plenty of research that points to chronic pain being a secondary result of a traumatic experience and once the trauma is resolved, the pain often disappears.
As a physiotherapist, I am qualified to deliver the full range of therapies required for trauma associated pain conditions. I can treat just the pain, or alternatively, I can treat just the trauma. However, typically they are interrelated in the treatment process which targets both in a gentle and supportive approach.
Chronic pain is pain that has lasted for 3 months or longer, even once the original injury or cause has fully resolved. It is also known commonly as persistent pain, fibromyalgia, neuropathic pain, somatoform/somatosensory disorder, and complex regional pain syndrome.
As a physiotherapist, I am qualified to deliver the full range of therapies required for trauma associated pain conditions. I can treat just the pain, or alternatively, I can treat just the trauma. However, typically they are interrelated in the treatment process which targets both in a gentle and supportive approach.
Chronic pain is often felt as ‘all body pain’ and can lead to exhaustion and mental health issues.
Pain is complex, and not all health professionals understand the way chronic pain manifests. Chronic pain results in neuroplastic changes. Neuroplasticity is the ability of the brain to change its connections and neurogenesis means the ability of the brain to make new connections. Chronic pain leads to changes within those connections, which ultimately make the body more sensitive to pain, and the brain can create sensations of pain even without external pain stimuli.
For example, people can feel pain from a breeze or clothes touching their skin. This is called pain sensitisation. Research suggests that chronic pain can be relieved by working directly where the pain sensations start from, and that is in the brain. The reasons why some people develop chronic pain and others don’t are not fully understood. But we do know that underlying beliefs about pain and illness, and belief in the capacity of the body to get well make an enormous difference.
There is a range of secondary symptoms/conditions to Chronic Pain including:
• Sleep issues
• Cognitive issues: short term memory loss, poor concentration, ‘brain fog’, hypersensitivity to light and sound
• Stress, Anxiety, Depression, Anger, Helplessness
• Issues with weight regulation
• Hypersensitivity to weather changes and light touch
• Recurrent flu-like symptoms
The longer pain remains untreated, the greater the risk of the body becoming sensitised to pain, and the pain becoming chronic. Therefore, timely and effective treatment of acute pain is essential to prevent transition to chronic pain.
Chronic pain and pre-existing trauma
As a physiotherapist who is also an experienced trauma therapist, I am particularly interested in clients who have experienced extreme trauma where fear, stress or anxiety can manifest as physical pain. The relationship between chronic pain and trauma is well documented.
Who gets it?
Research suggests that 1 in 5 of us has chronic pain. It affects men, women and children of all ages, cultures and socio-economic backgrounds. The challenge is that it is unpredictable and is personal. No two people will ever feel the same pain. One in five GP consultations involves a patient with chronic pain and almost five percent report severe, disabling chronic pain.
It is estimated that less than 10% of people with chronic non-cancer pain gain access to effective care, despite current knowledge would allow 80% to be treated effectively, if there was adequate access to quality pain services.
Chronic pain is the most common reason people of working age drop out of the workforce—with back problems and arthritis alone accounting for 40% of forced retirements—while 90% of people with severe or very severe pain report some interference with work.
Pain can also affect you mentally: One in five Australian adults with severe or very severe pain also suffer depression or other mood disorders. One in three Australian adults with severe or very severe pain have high or very high levels of psychological distress.
There are high rates of generalised anxiety disorder, post-traumatic stress disorder and substance misuse.
There are high levels of suicide ideation, plans and attempts in people with chronic pain, and physical health problems have been implicated in over 20% of suicides in Australia.
There is no one simple solution because chronic pain is complex. It’s not uncommon to see people resort to increased medications, social/illicit drugs, alcohol, and other harmful substances just to escape the pain. The good news is, there is a better way.