Chronic Pain

 

Pain can be frustrating, annoying, emotionally draining and socially isolating, limiting your ability to to participate in the meaningful activities of your life. Finding the right treatment for your pain can also be just as painful! Unfortunately pain is complex. Pain is defined as an ‘unpleasant sensory and emotional experience associated with actual or potential tissue damage’. This is a broad definition which covers a broad range of issues associated with pain. Numerous factors contribute to the experience of pain. The good news is that a great deal of science is advancing our understanding how and why pain occurs, and why it persists. This has lead to new and innovative treatments for pain.

A clear diagnosis from the doctor is always the first recommended step, although not always achievable. Quite often the cause of your pain cannot be detected on scans or x-rays, which can add to the frustration. An unclear diagnosis can often leave people feeling like no one believes they’re in pain, or that there is no reason for it, so ‘it’s all in your head’. This can be quite a disheartening and lonely time, with an uncertainty of where to turn to next. There are however a number of different types of pain, which respond to different strategies. We can work together with you and your doctors to help understand your pain and figure out the strategies that best suit you so that you can learn how to control your pain and regain control of your life.

Chronic Pain

Pain conditions typically treated:

 

  • Back pain
  • Headaches
  • Repetitive strain
  • Overuse syndromes
  • Shoulder Pain
  • Jaw (TMJ) pain
  • Muscle Tension
  • Trauma pain
  • Neck pain
  • Sinus Pain
  • Foot pain
  • Wrist pain
  • Scar Pain
  • Arthritic pain

 
 

Whether you have a long term underlying chronic condition, muscle strain, headache or acute trauma there are strategies that can help manage your pain. Pain can take many shapes and forms and can change over time. To give you an idea of the many types of pain, there is acute pain, chronic pain, neuropathic pain, nociceptive pain, inflammatory pain, cognitive pain, central sensitisation pain, primary forms of pain and secondary forms of pain. There are also new ‘types’ of pain and pain pathways continuously being researched, with the immune system and the central nervous system (brain and spinal cord) being at the forefront of many pain studies.

Every person is unique and so is your pain response. Successful treatment relies on understanding your individual qualities and ensuring your personal needs are met. You don’t need to be trapped by your pain, we can work together to find strategies that work for you.

 

Pain strategies utilised at the Perth Scar and Pain Clinic can include:

  • KMI structural integration
  • Sensory modulation
  • Jaw (TMJ) release
  • Posture rebalance
  • Breathing training
  • Scar release
  • Movement retraining
  • Sinus release
  • Stress management
  • Pacing and activity restructuring
  • Cognitive restructuring

 

 

Understanding Pain

Chronic Pain

As annoying as it is, pain is there to protect you. Pain needs to be unpleasant in order to instigate change. If it didn’t hurt, you wouldn’t stop. If you don’t stop, then you will continue to do something your body doesn’t like. This is the basic survival mechanism of pain. The different types of pain serve different purposes, some of which are functional whereas other forms of pain have evolved to become dysfunctional.

Acute, nociceptive pain results from injured tissue, such as a cut or broken bone, which sets up an inflammatory response to begin the repair process. Part of this response is sending signals to the brain via specialised nerve cells (nociceptors) to alert the brain to tissue damage. This is a fast pain signal which is local to the tissue that has been injured and is a very important and functional process. This process is relatively well accepted by most people, as we have learnt that tissue damage results in pain. However the pain does not reflect the level of tissue damage. For instance when you cut yourself, the pain may last 5-10 minutes, however the wound does not heal in that 5 -10 minutes – the degree of tissue damage has remained relatively the same, the pain has just resolved. Therefore pain is just an alert system to instigate change, which in this case is the repair process.

Another function of this acute pain, is to signal the brain to remember the event that caused the pain in order to prevent you from doing it again. This is how we learn what is safe and what is not and can be both a conscious and unconscious process.

Conscious learning involves an awareness, thought and decision making process. If for example you fell and broke your arm while skateboarding, you will make a conscious decision whether you skateboard again. You are aware of the pain, you think of consequences of the injury, weigh up the benefits and risks and then make a decision if you should do it again. If the pain and inconvenience of injury was too great, you may not try the skateboard again. However if you have a passion for skateboarding you accept the pain and will go back on the skateboard despite the inconvenience or the risk for further injury – this is a cognitive process of risk-assessment learning. The pain and the memory of the pain then develops a personal meaning for you upon which you make conscious decisions.

Unconscious learning is a little more complex. Memories are created by the brain registering all the sensory information at the time of injury. This includes the sights, smells, sounds, the sensations within the body as well as the movement patterns. At the same time, the emotions you were feeling just prior to, and at the time of the injury also go into the brain. This is automatic and usually not part of your conscious awareness, but it sets up chemical reactions in the brain which influences your pain response. If you didn’t really like skateboarding when you fell and hurt yourself, you may actually feel a great deal more pain than a person who loves skateboarding. The thrill and passion for the skateboard-lover sends chemical messages around the brain which dampens down the pain response. Anger, resentment, fear or anxiety on the other hand, sends different chemical signals around the brain which can actually increase the sensation of pain.

These negative emotions can be due to how you feel about the activity itself or due to the consequences of injury. For example a pianist may experience a great deal more negative stress and pain from a finger injury as compared to a runner. The fear or threat that the pianist may not be able to play the piano again is far greater than the runner, who can still run despite the finger injury. These fears instigate those negative chemicals which can lead to changes in the nervous system resulting in chronic pain.

Chronic pain can develop and persist long after the injury has healed, especially when the emotions associated with the injury were anger, fear, anxiety or resentment. When the negative emotions persist they continue to send chemicals around the body which can increase the number of the nerve cells in your body that ‘sense’ pain. This increase in pain cells  increases your sensitivity to pain, so that you feel pain when normally you wouldn’t. Structural changes can also occur in the brain with these chemicals activating more sensors in the brain making the pain sensation louder. Luckily these changes to the nerves and brain are reversible with the right treatments.

 

Secondary Pain Responses

Chronic Pain

The above example is a primary pain response: injury resulting in pain which may or may not lead to chronic pain. Secondary pains can develop when the body uses compensatory movements as a result of the primary pain. Pain results in an automatic change in the way the body moves in order to avoid further pain and tissue damage, which again, is a survival mechanism. If for example you tore a ligament in your knee, the pain prevents you from walking normally on that leg. Your body tenses and you recruit muscles that you don’t normally use whilst walking. Repeated use of this limp can reprogram the brain and alter your movement sequencing during walking. This altered walking pattern can then become your new ‘normal’ walk and it can persist, even after the injury has healed. Both your body and brain have adapted to the injury in order for you to continue functioning. This all generally happens without your awareness. These altered movement patterns can cause strains in areas of the body other than the original injury.

The aches and pain that you feel from these compensatory movements are generally not indicating tissue damage. These ongoing aches and pains are warning signals of tissue stiffness and strains which could eventually result in tissue damage. The connective tissue (fascia) surrounding the muscles, joints and bones have a high number of nerve cells which detect the mechanical movements of the body. If the fascial tissues don’t move through their full range of movement, such as when you are tense and using compensatory movements,  they can become dry and sticky, influencing the signals sent to the brain. These signals are actually telling the brain we need to change the way we move and move more. However, because we generally believe pain equals tissue damage, we commonly misinterpret these signals and believe the damage has already occurred. As a result we stop, tense up and worry that something is wrong, making the pain worse. These aches and pains are typically in the back, neck, shoulder, knee, hip and feet.

These secondary pain responses can also occur without any injury at all. Repetitive movements at work or in sport, a sedentary life style, long periods of texting, emotional trauma, stress or depression can all result in tensions and strains in the body due to a reduced amount of movement sequences used on a day to day basis. Your aches and pains are frequently signals that you just need to move more.

Stress and Pain

Stress & Pain

Being a survival mechanism, pain also sends a signal to the stress centres in the brain. Stress is another protective mechanism which is commonly misunderstood. Stress is a healthy mechanism which instigates change in the body. Stress mechanisms keeps your heart beating at the right speed for your current activity, it controls the size of your blood vessels to ensure the appropriate parts of your body get enough oxygen, it controls your stomach so you can digest food appropriately and it controls your breathing so you inhale enough oxygen for the body. These are all good things produced by stress.

Both pain and stress work hand in hand to protect you from danger. Pain is the signal to the brain that something needs to change and stress is the process in the brain that makes the change happen in the body. When pain and stress work well together your body can adapt to all the challenges it faces on a day to day basis. When they don’t work well together it can result in an imbalance leading to distress the body.

Stress gets a bad wrap because in order to change behaviour it can sometimes feel unpleasant. But it is only unpleasant because we have defined it as such, and we have associated it with negative emotions. For example if you see a lion in the wild, the typical, automatic stress response is ‘run’. When you reach safety you process the event and put words to the experience and say something like ‘I was scared for my life’. We are hard-wired to dislike fear because fear is designed to keep you away from danger. Therefore the event of seeing a lion develops a negative meaning for you because of the association between fear and the sensations you felt when you were stressed. However another person may process the experience differently and associate the emotion of excitement with seeing a lion and the associated sensations of that stress. The same physical response occurs in the body and brain, with running being the automatic response. However unlike the first person, the second person put different words and meaning to the experience and says something like ‘wow, I just out-ran a lion – that was awesome!’. It is the same experience, the same physical reactions in the body, but a positive association between the sensations in the body and the experience. This second person is more likely to stand in front of the lion again and possibly be eaten, because their protective fear mechanism didn’t kick in. Paying attention to the words you use and the sensations you feel in your body can help you understand your personal response to various stressful situations.

Fear and excitement are both examples of the emotions which can be associated with stress but they can also perpetuate stress. The emotion you feel with stress is part of the unconscious learning process which you are often not aware of, but it helps you decide if you want to repeat that event or not – i.e. do you stand in front of a lion again or do you avoid any place where a lion could be. The degree of your emotion will influence the degree of your behaviour.

If we add pain to this stress/ fear relationship, we can get a more complex result. Pain is unpleasant which instigates a stress response to change behaviour. We believe that pain is bad and represents tissue damage, so then we fear pain. If this belief is reinforced and encouraged then the pain response is exaggerated. If we can’t find the cause of our pain, then we believe the pain is really bad and a cycle of pain-negative stress-reduced movement-pain develops. The brain can get confused between pain, fear and stress and they can all merge into the one feeling and create similar responses in the body.  A number of things can contribute to this association.  Unravelling your story and the association between the pain you feel in your body and the associated responses from your brain can help reduce your experience of pain and regain control of your life.

Please take advantage of a free phone consultation to discuss your pain needs and whether our approach can help relieve your pain cycle.

Neurofascia and Chronic Pain

Treatments directed at the fascia network provide both a physical change in the body’s tissues as well as influencing the nerve signals to the brain. The fascia network has the most number of sensory nerve endings of any tissue type in the body making it a major player connecting the brain to the body. In addition the fascia network has a direct associated with your autonomic nervous system, which is the system controlling your stress response. Continuing research into the fascia network is providing exciting new strategies in the treatment of chronic pain. Research in the areas of back pain, fibromyalgia, plantar fasciitis, neck pain and chronic headaches is helping to develop alternative strategies to reduce pain for long term sufferers. Modifying the fascia network, with KMI structural integration releases stuck, short or adhered fascia tissues which can reduce pain levels in both the short term as well as having a sustained long term effect.

If you would like more information on KMI structural integration and how we can help relieve your pain, please call us today.

Treating Pain

The type and degree of your pain influences the treatment techniques that are appropriate for you. Treating the various types pain can involve both the body and brain, including retraining the nerves, retraining the brain, reorganising the fascia and then changing habitual movement sequences. This can involve a variety of techniques including sensory stimulation and/or desensitisation, posture realignment, mobilising techniques, fascia release techniques, neural mobilisation, movement retraining together with cognitive techniques and stress management. Identifying triggers of your pain is also beneficial so that you can pace your daily activities in order to prevent aggravating your pain.

A personalised program can enable you to gain control over your pain and improve your freedom of movement. If you have a condition or diagnosis which means you will have ongoing pain, it is still possible to use brain and body techniques to influence your pain experience. Many factors contribute to pain, we can work out a program which suits you and adjusts to your needs.

 

Release your scars and rebalance your body!

Call now to discuss your needs and find out if our approach is right for you.