- by Laura Collins, Physiotherapist

Chronic pain is defined as pain that lasts longer than 3 months. In Australia more than 1 in 5 people have chronic pain, costing us $33 billion every year.  Chronic pain conditions can include generalised pain states such as fibromyalgia or rheumatoid arthritis, or they can be more localised such as in osteoarthritis of the knee or ongoing low back pain. So why in this modern age can they put a man on the moon but we can’t seem to conquer chronic pain?

Pain is a complex experience. It is an output of the brain and depends on many different inputs. One of these inputs is nociception (danger messages) from the body tissues, but there are many others. This distinction, in pain being an OUTPUT of the brain, and not simply an input from the body, is the key to understanding chronic pain and how to fix it.

One of the first problems is that the strength of the danger messages coming from our body tissues is not very reliable. There are many points, from the nerve ending to the spinal cord to the brain, where the message can be turned up, or turned down. We know that in chronic pain, the messages get turned up a lot. This happens subconsciously and is called central sensitisation.

As well as any danger messages coming in, the brain also evaluates all other available information. This includes messages from the other senses, sight, sound, smell, memories of similar circumstances, beliefs and attitudes, knowledge and logic, social consequences and culture. There are thousands of other inputs. Using all of these inputs the brain has to answer one question “How dangerous is this really?” Depending on the answer the brain may, or may not, produce pain as an output. Note – There are also many other outputs, such as producing adrenaline to increase your heart rate, using your muscular system to run away, or activating your immune system to produce inflammation.

If the brain decides it is not dangerous, it will not hurt. If the brain decides that it is, even if there is no actual damage to your body, it will really hurt. This also happens subconsciously, and is amazingly powerful. It is what allows people to do extreme things despite tissue damage – think walking on hot coals or running ultramarathons. However it is also the cause of torturous unrelenting pain that serves no purpose, or pain from benign stimuli such as light touch.

The best example of the power of the nervous system to produce pain is phantom limb pain. If the brain thinks a situation is dangerous, (and it will start to think this more and more easily as pain persists) it can produce pain without even having to have the anatomical part!

Knowledge and education are key to rehabilitating chronic pain. Once you understand your pain you can begin to make sense of why it hurts and make productive steps towards getting rid of it. If we can convince ourselves that “it hurts, but I’m safe”, the brain will gradually produce less and less pain as it learns “it’s not really that dangerous”.

If you want to learn how to LIVe despite pain and eventually (it will take patience and persistence) conquer it, come and see us at LIVe Physio. We offer clinical personalised studio Pilates to help get you moving again, group classes for spinal pain and personalised explain pain education, as well as traditional physiotherapy services.

Keen to learn more? Here is a great little entertaining TED talk on ‘Why things hurt’ from eminent Australian pain scientist Lorimer Moseley.

http://www.youtube.com/watch?v=gwd-wLdIHjs