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Pain is complex. It is as unique as your fingerprint. Pain is difficult to describe and quantify. This can often result in people feeling alone in their experience and misunderstood. Because of the complexity of pain, other people can unintentionally invalidate your experience.
Everything you experience - pleasure, pain, temperature, touch - is ultimately the result of your brain interpreting the data received from the nerve pathways throughout your body. The degree to which you experience that information depends on how sensitive the nerve pathways are and on the size of the stimulus. We all know someone who has such solid calluses on their hands that they can’t feel much on that spot ie. less sensitive. Similarly, when a scab is pulled off and the new skin underneath is exposed, we know that it will be extra sensitive. A non-threatening item like an ice cube applied to either area will yield a vastly different experience for the individual. Both experiences are equally valid and accurate, they are just entirely dependent on the history and sensitivity of the skin to which the ice is applied.
Persistent (previously called ‘chronic’) pain is experienced in a similar way. When pain lasts longer than expected or is more intensely experienced, people with persistent pain sometimes hear your pain is “all in your head.” However, the pain is very real, but not easily traceable to a visible injury. It is actually coming from an oversensitive nerve pathway problem just like the callus and scab scenario. Pain BC has a wonderful brochure explaining how persistent pain starts (link at bottom of page). In summary, after an injury, illness or surgery, (ie. a threatening stimulus) a person feels an expected amount of pain. Threatening events to the body should result in pain as a warning signal. If that pain is well managed, it should slowly go away and you should return to whatever “normal” you were before the event. Unfortunately, when pain is not well managed through medication and movement, persistent pain can become the new “normal.” This happens because the sensitivity dial is turned up, so that any stimulus starts to be interpreted by the body and brain as being threatening even when it’s not threatening. For example, when the body experiences lots of feelings from a safe activity, like walking, the brain can misinterpret those feelings as threatening and then inaccurately fires off a bunch of pain.
In a persistent pain downward spiral, an individual often reduces their everyday activity level as these activities can hurt and cause more pain. Unfortunately, not doing regular activities can result in a loss of strength, endurance and quality of life. This spiral worsens as less and less activity results in more pain. The longer this cycle repeats the more isolation and stigma a person faces, as they may struggle to relate to others who have not experienced the invisible injury of persistent pain. Pain and the loss of connection often comes with mental health side effects, like depression.
What can be done to reverse the pain spiral? The first thing to do is to understand the info given above about how pain works. This means that everyone has to recognize that pain is real, but not all pain is telling you accurately about the threat level of an activity. You may also require more pain education, guided return to safe activities and some mental health support.
Start with meditation and calm deep breathing strategies to effectively turn down the body’s sensitivity dial. Then start to introduce gradual increases in your overall activity so that you can tolerate more movement without experiencing an increase in pain. Over time you will see gradual improvements in strength and endurance while resuming activities while noticing that your pain is better managed and plays a lesser role in your life.
Be kind to yourself through the challenging process, ask for support and get help as needed, but know that you can change your pain, regain self confidence, make meaningful personal connections and return to life before persistent pain.
Pain BC Brochure