Understanding
Pain

First things first: get yourself thoroughly checked out by a qualified health professional. They will know the right questions to ask and tests to do to make sure you have not got a serious condition. Most people reading this will have seen not one but many health professionals. Having a serious condition doesn’t mean that this stuff doesn’t apply, it just means you have to do other things as well to treat the condition.

Once you have been cleared of a serious condition, you are set to go!

Practice makes perfect! If you have had pain for more than a few months, then your pain system will be more efficient at producing pain. This is what happens over time – your system becomes more sensitive. It learns pain. Nerve cells in your spinal cord and brain change their properties to be more responsive. Exactly the same thing happens when you learn a new skill, such as playing the piano – nerve cells change their properties to be more responsive. The process is the same. The nerve cells involved are different.

You will know your pain system is becoming overprotective when:

• Your body starts to feel more sensitive than it did.
• Activities that used to cause a little pain now cause a lot of pain.
• Activities that were usually not painful, start to become painful.
• These things also happen straight after an injury – you might be able to see how excellent they are at protecting your tissues. They often resolve when the tissues heal. However, when the pain remains and the sensitivity sets in, it can feel like your injury is getting worse, but that is actually very unlikely.
• Other signs your pain system is becoming over protective include:
• Your pain might spread, or it might move from one side of your body to the other, or from one location to another, or new spots become sore.
• Your movement system starts to get in on the act. Remember that movement is another great way to protect. You might find some movements become more difficult. You might feel stiff.
• You might have muscle spasms. They can be really frightening, particularly if you don’t understand them or know what caused them. They are another way your body protects a painful area. They are almost never a sign that you have damaged something.
• You might even find you become more sensitive to things that don’t seem related to your body – loud noises, unusual smells – slightly annoying people can become very annoying people.
• All these things show that your system is ‘on alert’. Pain can actually be turned up and down by your thoughts, feelings and other things going on in your life – things that actually have nothing to do with the painful body part!

Pain scientists understand how this works and it actually makes terrific sense. However, many people don’t understand it – even some health professionals. One thing that we know absolutely for certain, 100%, is that an over protective pain system is NOT a sign you have a weak personality or a weak mind; it does NOT mean you are going crazy and it does NOT mean your injury is getting worse or your body is falling apart.

It means your body is doing too good a job of protecting itself.

When our pain system becomes over protective, it stops us doing the movements, activities and other things and that are actually necessary for recovery.

But we know you can’t ‘just beat pain’ because this sensitive system that is producing pain is also the system that helps to make you you! Everyone can learn new ways of retraining their pain system to be less protective. So, now is as good a time as any to get started.

There are actually many ways to retrain your pain system, but they all begin with understanding your pain. In fact, understanding that pain is much more complex than a signal from damaged tissues is one of the best things you can do to start your journey to recovery – many people say that their pain began to reduce as soon as they understood it better.

The goal is to re-train your pain system back to providing protection when you need it, but not when you don’t.

Start by developing an accurate understanding of your pain system and how it can become overly protective. This overly responsive pain system is the result of the amazing ability of all of our body systems to adapt. Sometimes when injured tissues heal, they don’t look the same as they did before your injury – think of a scar from an old cut – but they can still adapt to being stronger and fitter and less painful.

Understanding is very important when it comes to pain because pain depends on what it means to you. If you can change the meaning of your pain, then you can change your pain!

Knowledge is power and really knowing that your system is overprotective, and really understanding that pain is affected by thoughts, feelings, moods, sayings – the list of things is just way too long – pain can be turned up by anything that can trigger a protection response and turned down by anything that makes your system feel safe. You might find that with understanding comes a renewed confidence to move – even when it hurts – and to nudge your system little by little.

Find a good coach. A good coach will help you understand your pain better and to identify the things that make your pain worse and things that make it better. A great coach, with training in pain science (you can ask your physio, OT, doctor or nurse if they have this), will teach you how to plan your recovery, one week at a time, and encourage you to persevere and ‘train smart’. Remember your coach can guide you, but this is a journey that you have to take.

You can start without a coach too – moving just a little more than you normally would and doing something that lifts your heart rate – little by little – is actually the best way to train your system to be less protective. You might have to be patient – sometimes it is slow going and you can have set-backs – but remember pain is protecting you, not telling you that you have damaged yourself.

Being creative in managing your journey is likely to help. Our brains love to get new information or to be reminded of situations or activities that are full of safety messages.

Never forget that your brain is always looking out for you. Even thoughts and feelings, social interactions, and life’s day-to-day events can powerfully influence your pain. Remember too, the trick is not to avoid all life’s challenges but to retrain your system to cope with them.

Sounds challenging right? Well it is, which is why you might need some coaching. Take a long-term approach – this is a journey. You might have to teach your nearest and dearest about pain too – they might not realise it, but the way other people understand your pain, can affect your pain

Movement is the most critical pathway to recovery and it is almost always safe to move.

Get a health professional to check you over and give you the ‘OK’ to move. A health professional will be able to tell you if you are the very rare case for whom it is not safe to move. A health professional who understands modern pain science can talk you through why it is safe for you to move even though you have pain. They can tell you how much you can push it, how you can start to ‘read the signs’ that you are getting close to triggering your pain system. Remember – the pain system will protect the tissues of your body!

They can also help you understand that many things found on scans are perfectly normal and common, even in people who do not have pain.

Start with something slightly more intense than you currently do. If you are like many people with persistent pain, you are not doing much in the way of activity and movement. It is usually best to start gently with a simple movement such as walking. Some people with persistent pain already do a massive amount of exercise (some are Olympians!). Then it can be a case of mixing exercise with other cues and ‘training smart’.

Injuries heal, and your body’s tissues adapt amazingly well to the demands of life. Even if things don’t heal perfectly, they nearly always return to close to normal function. That doesn’t mean we stop hurting. Back pain in particular can be really severe even when there is no detectable tissue damage at all!

Here are some facts that have helped other people gain confidence to get moving:

‘Disc bulges’ are so common in people WITHOUT back pain that many scientists think they are not abnormal but a common and normal part of ageing? 50% of 40 year olds WITHOUT back pain have a disc bulge! You can learn more about common back scan findings in people without back pain here.

If you were injured more than two months ago then a vast amount of healing has already happened. Don’t underestimate how magnificent and irresistible this healing capacity is.

Knowing and believing that you are safe needs repetition and practice, and ‘stacking up the wins’, as you teach your overprotective pain system that it does not need to be so protective.

Ask them these questions (they should say yes to each one!):

• Do you understand and believe the biopsychosocial model of pain?
• Can you help me understand my own pain system?
• Can you teach me how to manage my own recovery?
• Can you give me skills to master my situation?

An over protective pain system reduces your risk of re-injury. This is because your pain system will alert you to danger much sooner than a normally protective pain system would.

An over protective pain system gives you a big buffer between when your pain system cuts in to protect you and when your body actually needs the protection. That is the whole point of your body learning pain.

No one can completely eliminate all risk of injury – we can’t control everything. But if you are not very unlucky or very stupid, then your chances of injuring the painful body part are very low. Remember, even if injury does occur, then your body is perfectly capable of healing and re-adapting again. Consider sportspeople who have multiple injuries and re-injuries, and yet in most cases return to their sport.

As you begin to challenge yourself physically it is important to realise that an increase in pain does not mean an increase in injury. An over protective pain system will often alert you as you try new tasks, but remind yourself that it is protective, not a sign of damage. If a flare-up lasts longer than usual, or you have had a significant accident and you are concerned, ask your health professional to give you the all clear.

Rest and avoiding activity and movement tends to make an over protective pain system even more protective. The chance of ongoing pain is higher if you stop moving – your system adapts to being stationary. Exercise and movement are the best way to reduce your pain. As you load your tissues you will become stronger, and your stronger body will be more resilient to injury. Exercise and movement turns down your protection setting.

Many people don’t realise how much patience, persistence and courage it takes to get better. But if you stick at it, remain patient, and be brave when you need to be, then all the evidence we have tells us that you will slowly get better. Belief in this, and building your own sense of optimism about the future, are important for your recovery.

The most common reasons that people don’t get better is that they avoid everything that hurts or they do everything regardless of how much it hurts, until they give up because it is too horrible. The first is called the ‘avoidance pathway’. The second is called the ‘boom-bust cycle’.

The third way is the best. Understand your pain. Get a plan to slowly increase what you are doing and stick to it. Be patient. Be persistent. This is the best thing you can do to recover.

Your body has an in-built recovery system – you just have to help it along. To make it as quick as possible is more about avoiding things we know slow it down. For example:

Don’t go looking for a quick fix magic pill or injection or online gimmick to fix your body for you – you need to retrain your system and no one else can do that.

Eat fresh fruit and vegetables and limit your sugar. Vegetables are anti-inflammatory. Sugar slows down recovery.

Get enough sleep and get a good sleep habit. Sleep is anti-inflammatory. Poor sleep slows down recovery.

Learn new ways to reduce stress. Anxiety and depression slow recovery. A good psychologist can give you effective methods to reduce anxiety and depression.

Stick to your plan.

Ask your doctor ‘Can you help me slowly reduce my pain medications?’ Some pain medications actually slow your recovery.

Keep testing your new sense of what’s possible. Aim to be active on most days – even if just a bit. Track your progress, set some goals, and think about the things you will be able to do when your pain is better. People recover at different speeds, with persistence, most people will get better.

Amazing as it sounds, learning new things – skills and information – is anti-inflammatory! Keep up your journey of understanding of pain by reading new things, watching (good!) YouTube clips like those listed below. Keep learning!

Read blog posts and books. If you don’t read – that is ok – listen to podcasts or audiobooks and watch videos to stay fresh on the information – but choose your information carefully. Look for information that is backed by good quality research.

Usually a website that has “.org” or “.gov” in it is likely to have more accurate information. These sources will paint a positive picture for your recovery.

Once you start to understand pain and you notice you are recovering, then you might want to spread the word that recovery is possible. You might want other people to know what you now know. You might want to inspire the millions of people out there still suffering. Well we say – Do it! You can do this via social media, via volunteering at your local pain clinic, helping out at public events etc

People who have been through it make great coaches. No matter where you live, there is likely to be some way you can ‘give back’. The coolest thing about this? Giving back keeps your system fit, lively and healthy.

Did you know that volunteers live longer? 🙂