Did you know that no less than 25% of Belgians experience pain on a daily basis? Despite follow-up by various therapists in the healthcare landscape, some patients continue to experience long-term pain. The explanation is often found in the physical damage and a treatment strategy that is not successful. This is a difficult and frustrating situation because you experience pain, do not know what the cause is or what you can do about it.
Fortunately, the knowledge of chronic pain has improved a lot in the last decade! This makes it possible to develop better treatment strategies and to actively involve patients in the recovery process. It is also important to talk about persistent pain instead of chronic pain, because the term chronic suggests that the pain is permanent. This is certainly not the case.
Magnus selected some key points to help improve your understanding and confidence that persistent pain need not be permanent!
1. Pain is a protection mechanism and does not require physical harm
Have you ever heard of phantom limb pain? After amputation of a limb, a person may still experience sensations or pain from that limb even though the limb has not been present for a long time. This is partly because there is still a representation of that limb in the brain. It takes some time for the nervous system to change until the limb can be physically and mentally released. With persistent pain, a similar process occurs. The initial cause of pain from an injury has actually been healed for a long time but still the nervous system has formed a strong image of that pain so that signals are still being communicated that there is damage, even though it is no longer there. The variability of your brain and nervous system thus plays a crucial role in the process of developing chronic pain. Fortunately, because of this it is also possible to reverse this process!
Do you still find it hard to imagine that you sometimes feel pain without damage? Then we invite you to watch Professor Moseley's video below about the difference between pain and physical damage.
2. Acute pain differs from persistent pain
It is dangerous to lump all experiences of pain together. There is, after all, quite a difference and, in most situations, pain is actually good for us because it acts as an alarm signal warning us of potential danger. We would like to clarify the difference between acute and persistent / chronic pain.
Acute pain is of short duration and arises quite directly when there is damage to the body. Please note that there does not have to be an injury for acute pain to occur! When your body anticipates pain, it can also send out acute pain signals to protect you, even if there is no damage yet. When this factor disappears, the pain also disappears. So there is a direct relationship between the (potential) damage and the experience of pain.
Persistent pain is a long-lasting pain, which may have had a cause in acute pain. The pain is still there, but the injury or triggering factor is now absent or has long since disappeared. The cause of the pain in this case are changes in the nervous system. It became hypersensitive and protects us excessively by continuing to send out a pain signal. This means there is no longer a direct relationship between the physical damage and the pain. Only when the pain has been present for more than three months one can talk of persistent pain. We prefer the term persistent pain instead of chronic pain because it is changeable.
3. Dare to let go
When the necessary examinations proof that there are no abnormalities directly linked to the pain, it is sometimes difficult to accept that the causal explanation cannot be found immediately. However, this is an essential step in the rehabilitation process! As long as you keep looking for a physical cause, recovery can be difficult. Attention! The absence of a clear cause does not mean that pain must be permanent. It is a persistent pain that, despite the absence of a clear physical cause, is still changeable.
4. No, the pain is not "between the ears".
It is important to know that persistent pain is the result of a change in the sensitivity of the nervous system. This change can be positive (e.g. a top athlete who experiences less pain during high intensity exercise) or negative (e.g. persistent pain). Do not be fooled into thinking that the pain is between your ears, it really is present but, more importantly, it can change.
5. Dare to acknowledge persistent pain as a diagnosis
This can be a difficult step because it suddenly seems that you no longer can influence the cause of the pain. This is sometimes difficult for both the patient and the healthcare provider. The patient wants to get better and together with the care provider, you keep searching and want to put your finger on a biological cause. This strategy does not help you in the case of persistent pain; after all, it is an illness in itself without a well defined biological cause. Only when the patient and the care provider recognise it in this way, the correct treatment strategy can also be started, tailored to the persistent pain.
6. Believe in yourself and the plasticity of your brain
Yes, you can play a big role in reducing the pain. After all, with persistent pain there is a change in the experience and processing of stimuli. Fortunately, this change is not permanent and can evolve in a positive or negative direction, just like the pain. Keep in mind that this change takes insight and time. You can think of it as training your brain. Like any training process, the first steps are the hardest but with the right guidance you can achieve unexpected results!
7. Identify elements that influence your experience of pain
Persistent pain can have a cause in a trauma experience or a condition that seemed trivial before. When there is persistent pain, more elements come into play. After all, the pain is an experience that is influenced by other things than the physical damage. Since they can either alleviate or worsen the pain, it is important to understand which ones they are and how they affect your experience.
Consider the following elements that negatively influence the pain experience:
- Decrease of physical condition
- Attention focused on the pain
- Depression, anxiety, anger, guilt
- Medical factors
- Origin of the initial pain
- Sleeping problems
- Loneliness, relationship problems
- Alteration in nervous system: hypersensitivity, pain memory
- Professional and financial difficulties
- Contextual factors (e.g. life course, explanations and beliefs, ...)
8. Get (multidisciplinary) guidance
More and more healthcare providers are being trained to recognise persistent pain but also to treat it accurately. It is important that the caregiver dares to consider persistent pain as a diagnosis and seeks multidisciplinary help when there is no short-term progression. For quite a few patients, a multidisciplinary team of care providers is useful to achieve an effective approach, but it is not always necessary. It is important to identify which elements have an impact on persistent pain (see list above) and to weigh up where professional support is needed.
The role of the physiotherapist in persistent pain
Persistent pain is often accompanied by restrictions in movement and activities. In order to resume these activities, the physiotherapist will have to look for movements that are bearable and can be built up progressively. It is also important to explain why you experience pain with certain movements or activities and whether or not they are dangerous for you. The information provided by your nervous system is not always 100% accurate due to the changes incured. Together with your physiotherapist you will find a progressive, safe way to become active again. Do not hesitate to actively ask your physiotherapist if you have any questions so that you can be reassured and can gradually increase your movement threshold.
Warmed up and ready to read more about persistent pain?
We would also like to refer you to interesting information to help you on your way:
Factsheet 'Why does my pain persist. And what can I do about it? (in dutch)
Digital information brochure Why does my pain persist?
Download PDF • 932KB
Do you recognise yourself or someone you know?
Please do not hesitate to share this information, to contact us or the pain centre. Magnus Kinesitherapie is part of the first chronic pain network in Flanders, embedded in the first-line zone in Antwerp and will be happy to help you.
If you have any other questions, please do not hesitate to contact us!