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Persistent Pain

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Introduction

There is a big difference between ‘acute pain’ and ‘persistent pain,’ even though they might feel the same. Acute pain is short-term and tends to be more associated with damage or possible damage to your body. As an example of acute pain, if you sprain your ankle it is likely you will experience pain associated with the soft tissue damage, swelling & inflammation. Usually it will settle as your body heals because the affected part no longer needs protecting. Healing usually takes less than three months. 

Signs & Symptoms

Persistent pain lasts longer than acute pain and often does not indicate ongoing damage, even though it may feel like it. Historically, we assumed that this was because we had not healed adequately after injury, but for most people we now know that this is unlikely. Instead, the symptoms experienced are hypothesised not to be associated with injury site, but from changes in our central nervous system. It’s like the volume dial on our pain system has been left turned up like a radio stuck on ’loud.’ Persistent pain can take over a person’s life.   

Causes

Persistent pain is different to acute pain as it is a poor indicator of damage. Persistent pain involves the nervous system and heightened activity. This doesn’t mean that pain is a conscious decision, but we do know that conscious decisions and thoughts can in turn, influence the ‘volume’ of our bodies pain response. 

 

The brain is interconnected and forms patterns. Sometimes the brain associates pain with certain movements so that it pain is experienced during movement or even thinking about moving. “Unhappy” chemicals are released when people are tired, stressed, anxious or depressed which reinforce out negative pain responses. These chemicals are similar to ‘danger’ and ‘damage’ messages and which can influence the sensitivity of the nervous system. 

Assessment & Diagnosis

At Pure Physiotherapy, our team will take a comprehensive history to ascertain key factors that may be linked to the underlying cause of your pain to help manage it effectively. Whole-of-life factors such as emotions, beliefs and environment affect pain and need to be addressed to turn down the volume effectively. We will work with you to create a series of personal goals to aim for and to help direct your treatment and management. We value regular re-assessment for monitoring your progress and to make any beneficial adaptations to your treatment, supporting you in achieving the goals you set yourself. 

Self-Management

It’s really important to understand that you can ‘turn the volume down’ again, but it often takes effort, persistence and time. It won’t happen by itself and you need to be patient in working towards it. Physiotherapists can help to guide you in this process, however ultimately, you have to take charge.

 

You can regain control and begin the positive cycle by increasing activity, working towards personal goals and thinking differently about your pain. A health professional trained in persistent pain management can be helpful as you work through these changes to turn down the volume on your pain.

Physiotherapy

Smith et al. (2017) state that ‘exercise that addresses psychological factors, such as fear avoidance, kinesiophobia [fear of movement] and catastrophizing, and that is set within a framework of “hurt not equalling harm”, will reduce the overall sensitivity of the central nervous system, with a modified pain output,’ 

 

Our Physiotherapists our skilled in exercise prescription and will design an individualised home exercise plan for you, tailored to your physical ability and goals. Your Physio may also use treatment modalities to help with your pain levels such as manual therapy techniques and acupuncture. You will be given ongoing support so that you are able to confidently manage your symptoms.

References

Smith, B.E., Hendrick, P., Smith, T.O., Bateman, M., Moffatt, F., Rathleff, M.S., Selfe, J. & Logan, P. (2017). Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. British Journal of Sports Medicine51(23), 1679-1687.

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