What is Chronic Pain?
The International Association for the Study of Pain has defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” This definition indicates that pain may result from actual injury to a tissue (ie, bone, muscle, tendon) or the perceived threat of injury to a tissue. Whether actual tissue damage or perceived threat of injury has occurred, people will experience pain as real.
Understanding Pain
Pain is one of the most common symptoms that lead a person to seek the help of a physical therapist or other health care professional. Physical therapists are experts in the management of pain.
Successful management of pain relies on an understanding of why someone feels pain. Although much is still being discovered about the sensation of pain, our understanding of how and why pain exists has changed over the past several decade.
A New Understanding of Pain
Pain was once thought to be an indicator of injury to body tissue; it is now known that pain also can be a warning signal designed to alert us to potential damage and to protect us from injury. As a result of this new understanding, we now know that feeling pain does not necessarily mean a physical injury has occurred.
When a tissue is injured or the potential for injury occurs (such as with an ankle sprain), special nerves called nociceptors send information toward the brain to warn of damage. The body responds in order to minimize damage (ie, sends pain signals to make sure the person doesn’t step on the affected foot), and to begin the healing process (ie, produces swelling to bring healing cells to the area).
However, we now know that injury-warning pain signals can increase or decrease based on specific situations. For example, if you sprain your ankle while trying to get out of a burning building, you may not be aware of your injury until you are safe, because the warning signals are overridden for a more important reason: survival. Science has shown that this decision to rank the importance of warning signals occurs in the brain, which has led to the conclusion that the sensation of pain is triggered by, and occurs in, the brain.
Science has also shown that no two human brains are alike. Therefore, it follows that each person’s pain experience will be unique—influenced by specific situations such as the one described above, as well as by a range of other factors that make each person’s life unique. These factors can include life experiences over time, psychological histories, living and work environments, and even the social structures in which we live. These past experiences can help to decrease pain in life-threatening situations, but can also increase pain in people with persistent or chronic pain.
Major Implications for Pain Management
The recent shift in the understanding of pain has several major implications. First, it changes the way a physical therapist may approach your care. In the past, many health care fields focused treatment on the healing of damaged tissue. Although this approach helped many people who had experienced an injury, others reported pain that lasted well beyond the time necessary for tissue to heal.
Based on the new evidence regarding pain, physical therapists are today using methods of treatment and of managing pain that do not solely focus on injured tissue, but also address other factors such as environment, stress, psychology, and social considerations that may be influencing the amount of pain experienced. This “brain and body” approach to the management of pain is an important shift that has occurred in response to the new and evolving understanding of the purpose and nature of pain.
Pain and Opioids
The misuse of opioids has become a public health emergency in the United States and beyond. The origins of the current crisis date back to the late 1990s, when the medical community had no evidence of the addictive properties of opioid-based pain-relief medications. As medical providers began to prescribe opioids more frequently, because they successfully eased pain in many patients, evidence of addiction began to surface.
In response to the crisis, measures including better addiction prevention, treatment, and recovery services, better data, better pain management, better targeting of overdose-reversing drugs, and better research have been implemented. The crisis will likely have its solution in new approaches to the treatment and management of pain. Physical therapy is proving to be one of the safest methods of treating and managing pain.
How Can a Physical Therapist Help?
Treatment for Acute Pain
If you have acute pain, your physical therapist will help identify the injured tissue (eg, bone, muscle, tendon) and devise treatments to help promote healing and reduce stress on the injured area.
Your physical therapist will offer guidance as to how to safely return to your normal activities without further damaging the injured tissue. Research demonstrates that people who return to their normal daily activities more quickly following injury recover faster and have fewer long-term problems than people who do not return to activity in a timely manner.
Your physical therapist may help you identify positions that hurt and positions that do not hurt, and provide treatment and exercises to help the injured tissue move more efficiently. Physical therapists are movement experts.
Treatment for Chronic Pain
If you have chronic pain, your physical therapist can help you identify factors that may be leading to the prolonged pain. These factors may include faulty movement patterns, muscle weakness, areas of stiffness that prevent normal motion, previous injury and past events that may be contributing to your pain, fear, negative emotions, and other behaviors or social factors that can lead to long-term pain.
Your physical therapist will design a treatment program to fit your specific needs, which may include manual (hands-on) therapy, and gentle exercises to relieve pain.
Your treatment may emphasize education about the latest findings regarding pain, in addition to healing exercises and manual therapy. Research has demonstrated that positive changes occur in the brain after patients are educated about the purpose and causes of pain.
Your treatment may emphasize education about the latest findings regarding pain, in addition to healing exercises and manual therapy. Research has demonstrated that positive changes occur in the brain after patients are educated about the purpose and causes of pain.
Treatment Techniques:
• Manual Therapy
• Movement and Exercise
• Modalities
• Graded Exposure
• Psychologically Informed Physical Therapy
• Home Program
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