What’s Different About Chronic Pain and What to Do About It!

As we continue into 2015, many will make resolutions to exercise and be more active, lose weight, and adhere to healthier lifestyles. About one in five will be dealing with chronic pain which restricts their function and tolerance for exercise (Butler D, 2003 Explain Pain).

Many in this population are confused, anxious, and discouraged; most don’t understand how acute pain and chronic pain differ, as well as how they need to be managed differently.

First, consider the mind & the body aren’t exclusive; how we think can be a significant part of a chronic issue.

For some, good mental health counseling and/or support groups (i.e. Al-Anon) can help in addressing thought-like viruses which lead to catastrophic thinking & can threaten & overwhelm the brain.

It’s a stressful world, and distorted thinking certainly can make our lives unmanageable (Courage to Change, Al-Anon, 1992). To contrast, having knowledge about how and why our body produces pain can help reduce threats & actually be a pain liberator (Moseley L, 2003).

Second, pain is a normal body expression in response to what our brain perceives is a threatening situation. The brain produces discomfort to protect and preserve us, as well as to promote healing behaviors with injury (Butler, 2003).

Acute pain (i.e. after an ankle injury) involves localized pain & swelling around the damaged tissue; the body responds by sending inflammatory & immune cells to the area to clean up the mess, deal with any bacteria, and repair injured tissue.

The whole process is designed to get you back functioning as closely to normal as quickly as possible. Chronic pain usually involves more global discomfort (often with considerable weakness, tightness, and deconditioning) which has persisted more than three months and is not useful.

The primary driver behind it no longer is tissue damage; it’s due to changes in neurological biology and heightened sensitivity as a result of abnormal brain processing; the nervous system is more ramped up and sensitized. For many it is a cycle of increased maladaptive fear, frustration, weakness & dysfunction often leading to disability.

Third, it is often possible to break the cycle. Besides pain biology education, chronic pain and dysfunction can be greatly improved or eliminated with appropriate and consistent lifestyle and activity modification along with skilled physical therapy.

As a general rule, treatment in chronic states needs to involve reducing threat (real or perceived) and progressing with graded activity and therapeutic neurological interventions. This requires the individual to be courageous, committed, & disciplined. Quick fix approaches often provide temporary if any relief.

Next, consider David Butler’s general guidelines for recovery:

1) Get a medical physician workup to rule out any sinister pathology

2) Make sure you understand the risks versus the benefits of any medication and that the usage makes sense to you

3) Ask if your provider has any research articles which support their recommendations.

4) Avoid total dependence on any provider and set goals with them.

A doctor of physical therapy focused on an active approach can be a great problem solver in getting you on the recovery road to moving more freely and functioning better. Often they must address multiple regions of pain, weakness and tightness.

Finally, we are designed to move & our nervous system needs appropriate movement to stay healthy. Consider a resolution of improving freedom in how you move and function.

It’s been said that freedom is not free; it comes with a cost and requires us to commit and effectively fight for it. In that spirit, Happy Free and Active New Year!

Dr. L. Voigt Smith, PT DPT CredMDT

About Dr. L. Voigt Smith, PT DPT CredMDT

Dr. Smith is a state licensed Doctor of Physical Therapy, owner of the Backsmith Advanced Physical Therapy clinic in Weston, Wisconsin, and inventor of the Backsmith Selective Stabilization Support. Dr. Smith prides himself on advanced and high value physical therapy care. He has been exceptionally effective with many outlier chronic pain patients. Dr. Smith is often able to save patients significant time and money, while restoring mobility and reducing chronic pain. Dr. Smith can be reached at the Backsmith Advanced Physical Therapy Clinic in Weston, WI (by appointment) or at (715) 298-5888.

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