Chronic Pain
What is Chronic Pain?
The International Association for the Study of Pain states: Chronic pain is pain that persists past the healing phase following an injury. Average time for back pain is 3-6 months after which it becomes chronic.
Characteristics of Chronic Pain:
Chronic pain sufferers have significant disruption of daily activities that vary greatly for different individuals. It appears to depend on patient behavior in response to pain, the ways physical and social activities are managed, and the choices made to engage in activities or not. Behavior patterns are not just a product of pain itself but are made up of multiple cognitive, emotional and social factors:
Why is it that 10% of low back pain patients go on to become chronic pain sufferers?
What are the characteristics of the other 90% that are getting better?
The International Association for the Study of Pain states: Chronic pain is pain that persists past the healing phase following an injury. Average time for back pain is 3-6 months after which it becomes chronic.
Characteristics of Chronic Pain:
Chronic pain sufferers have significant disruption of daily activities that vary greatly for different individuals. It appears to depend on patient behavior in response to pain, the ways physical and social activities are managed, and the choices made to engage in activities or not. Behavior patterns are not just a product of pain itself but are made up of multiple cognitive, emotional and social factors:
- Avoidance
- Fear
- Disuse
- Disability
Why is it that 10% of low back pain patients go on to become chronic pain sufferers?
What are the characteristics of the other 90% that are getting better?
Avoidance
The avoidance of movement or activities based on fear of pain and potential damaging effect of pain is the central mechanism in the development of long term back pain. It is also a main player in a patient reaching deconditioning syndrome. It simply means you try to avoid the pain that was initially experienced and in the long run make the problem worse.
Why is this a problem?
Fear of pain and avoidance result in the perpetuation of pain, even in the absence organic pathology. Although avoiding pain in the beginning is beneficial, when you continue to avoid the pain for an extended period of time you are not using the muscles and tissues needed to repair that area resulting in deconditioning which leaves your back at further risk for injury.
Why is this a problem?
Fear of pain and avoidance result in the perpetuation of pain, even in the absence organic pathology. Although avoiding pain in the beginning is beneficial, when you continue to avoid the pain for an extended period of time you are not using the muscles and tissues needed to repair that area resulting in deconditioning which leaves your back at further risk for injury.
Disuse
Although avoidance may be an effective and appropriate coping response in the short term, exclusive reliance on it may result in a variety of negative repercussions. Prolonged avoidance of movements and activities is assumed to cause detrimental changes in the musculoskeletal system, referred to as disuse syndrome. Disuse: a) physical deconditioning as a consequence of reduced use of the musculoskeletal system b) impairments in muscle coordination, leading to guarded movements.
Deconditioning - weakness due to non use.
Guarded Movement - chronic back pain patients have tighter back muscles at all times during physical activity.
It is important to avoid disuse and deconditioning syndrome at all cost when you injury your back. The earlier you introduce appropriate movement to the back the better the long term outcome will be.
Deconditioning - weakness due to non use.
Guarded Movement - chronic back pain patients have tighter back muscles at all times during physical activity.
It is important to avoid disuse and deconditioning syndrome at all cost when you injury your back. The earlier you introduce appropriate movement to the back the better the long term outcome will be.
What is the Solution?
There are three ways to deal with chronic pain in addition to getting treated: Pacing, Graded Exposure and Education.
PACING
A process of budgeting your energy, alternating work with rest to "pace" yourself.
Activities will be time contingent rather than pain contingent. Tasks are broken up into manageable parts with scheduled breaks. This is a great way to get you moving again but not overdoing it. As your tolerance goes up, your rest periods will become shorter and less frequent which brings us to the next step; Graded Exposure.
GRADED EXPOSURE
Exposure: the most important step.
This means gradual exposure to the situations and movements that have previously been viewed as dangerous and painful. Simply put, you have to start moving your body in ways that have previously caused pain to retrain it that you can move a certain way without causing pain or harm to your back. This needs to be done very gradually, and as you build up a tolerance for these movements your back will function so much better with less pain. This type of movement needs to be implemented as soon as possible to avoid disuse and deconditioning syndrome.
EDUCATION
Lastly is education. When you are experiencing chronic pain it is imperative you speak with a health care professional who specializes in musculoskeletal issues to get as much information as you can about your situation. Understanding and accepting your current condition is a crucial step in improving your chronic pain and increasing your quality of life.
PACING
A process of budgeting your energy, alternating work with rest to "pace" yourself.
Activities will be time contingent rather than pain contingent. Tasks are broken up into manageable parts with scheduled breaks. This is a great way to get you moving again but not overdoing it. As your tolerance goes up, your rest periods will become shorter and less frequent which brings us to the next step; Graded Exposure.
GRADED EXPOSURE
Exposure: the most important step.
This means gradual exposure to the situations and movements that have previously been viewed as dangerous and painful. Simply put, you have to start moving your body in ways that have previously caused pain to retrain it that you can move a certain way without causing pain or harm to your back. This needs to be done very gradually, and as you build up a tolerance for these movements your back will function so much better with less pain. This type of movement needs to be implemented as soon as possible to avoid disuse and deconditioning syndrome.
EDUCATION
Lastly is education. When you are experiencing chronic pain it is imperative you speak with a health care professional who specializes in musculoskeletal issues to get as much information as you can about your situation. Understanding and accepting your current condition is a crucial step in improving your chronic pain and increasing your quality of life.
Conclusion
When experiencing chronic pain it is imperative that you start moving and exercising as soon as possible with the appropriate exposure, activity and duration. It is also imperative to understand your condition and that you might have to live with a certain amount of pain but it doesn't mean you can't be active and healthy. Both of these topics should be discussed with a health care professional in order to set up the appropriate exercise protocol for your situation and to be sure you are given the right information about your condition.
I hope this was informative in understanding a bit about chronic pain. If you have any questions about the information on this page or the treatment options available to you feel free to contact me here at the office.
-Dr. Paul Merlino,DC
I hope this was informative in understanding a bit about chronic pain. If you have any questions about the information on this page or the treatment options available to you feel free to contact me here at the office.
-Dr. Paul Merlino,DC
