Persistent pain and what to do about it

How pain doesn’t always mean injury

By Laura Furneaux | The Adaptable You

Buckle up and prepare to enter the confusing world of persistent pain.

In my last column, I talked about what acute pain is. Persistent pain is different in that there is no clear cause and not necessarily an injury. Let’s talk more about what persistent pain is.

Pain: Your body’s fire alarm

We know that pain is one of our most important defences. Pain changes how we move and behave.

To simplify things, let’s say your fire alarm goes off in the middle of the night. You are startled awake. You hear the alarm and you get up to see what’s going on. Staying in bed and assuming there’s no fire and that the alarm will stop is a dangerous choice. The alarm going off doesn’t tell us if there’s a fire, just as pain doesn’t always tell us if we’ve injured ourselves. Pain grabs our attention and we have to respond appropriately.

SEE ALSO: 4 ways to reduce risk of injury


Persistent pain vs. acute injury

It’s easy to understand pain when it makes logical sense like when we’ve injured ourselves. Let’s say a bee stings you. You expect pain and you feel pain. It lasts for a short period of time, then you get back to normal. Pain reflects some kind of tissue damage and tissue sensitivity.

In the case of persistent pain, there is not always a clear cause. You may not remember how the pain began as in an acute injury and you didn’t do anything new to explain it either. X-rays or other diagnostic scans are all normal. Your doctor assures you there is no actual damage.

Persistent pain — when the fire alarm isn’t doing its job

Persistent pain is a case of heightened tissue sensitivity without tissue damage. We don’t know why things are more sensitive, but we have to listen and act appropriately. To return to the fire alarm analogy, it’s as if the alarm is being triggered by a mouse running over the alarm wires. For the person experiencing this kind of pain, it can be very frustrating and confusing. The pain does not improve with rest or any of the usual things we do when we injure ourselves.

By now, you can see that persistent pain is a little complicated. The best way to navigate through starts by looking at how we are moving, thinking and behaving in our daily lives. This is how we start getting the alarm to go off when it is supposed to.

How to help yourself

These are some key behaviours that I encourage my patients to adopt when dealing with persistent pain:

  1. Use the Goldilocks principle: Not too much, not too little. Just the right amount of the right thing. Stay active in as many ways that don’t aggravate your pain. This means getting creative with what you do and how you do it. Staying active and strong is important to your physical and mental health as well as your recovery. My general rule of thumb is that it is OK to feel some small amount of pain during your activity but 24 hours later you should be back to your normal amount of pain. In this way, we can gradually increase what you can tolerate and de-sensitize the alarm.
  2. Don’t poke the bear. It can be a challenge as an athlete to listen to pain because we have learned to push through pain. Even though we know there is no damage to protect, we still have to listen or we risk the bear getting very angry. This is why the Goldilocks principle is best.
  3. Get support: This is a bumpy ride. It’s important to have support from your friends and family as well as your health-care practitioners. Physiotherapists can be great coaches through this process and can also help with pain management.
  4. Take good care of yourself: Consider easy behaviours like getting good sleep, spending time relaxing, having fun and eating well.

Recovery from persistent pain has its ups and downs but it is fun and rewarding to see your world opening up again. Over time and with good support, you will see just how strong and adaptable you are.

Laura Furneaux is a physiotherapist and former national team sprint kayaker. She works in Dartmouth, N.S., and her clinical interests are pain science, orthopaedic manual therapy and concussion rehabilitation.

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