Chronic Pain is a Pain in the A$$

Chronic pain.

Do you have it?

Do you know anyone that struggles with it?

If you polled 10 friends about their experiences with chronic pain, over 80% of them will say they have dealt with it at some point in their lives (ACA reference). With those statistics, you could consider it a real epidemic in our country. Whether you have pain, have had pain, or know someone struggling with pain currently, you can bet your bottom that they think this is the way it will be forever. And boy, they could not be more wrong!

What is pain?

Pain is a signal from the area of tissue that has been assaulted, through nerves in the spinal cord, to the brain which are then translated into actions, perceptions, and emotions regarding that stimulus. Complicated? Yep!

We know if we stub our toe, we feel the pain, and we follow by rubbing our foot. However, we are then acutely aware to avoid the object that caused the toe stubbing in order to prevent pain. Secondarily, we associate “toe stubbing” with the pain sensation we felt the first time. So a friend stubs their toe and you immediately empathize by remembering your experience with that pain stimulus.

We can gather that pain’s purpose is to provide life saving information to the brain to force the body to change its environment whether that be to move positions, to avoid certain foods, to stop performing aggravating activities, etc. It is extremely useful information and should be paid attention to in appropriate situations.

But what about chronic pain?

Here’s where it gets dicey. You see, our perceptions and understanding of pain happen long before our development of language and conscious awareness. Think about an infant. Infants learning to walk may fall down and cry out due to pain, but we are told as parents to cheer them on as to dissociate said stimulus with the pain signal. The ability to perceive pain is hardwired into our brains as a survival mechanism. It is useful, until it becomes overwhelmed with consistent, unmitigated stimulus, in which we term it “chronic pain”.

Chronic pain is defined as consistent pain lasting longer than 3 months. Pain we feel day in and day out, all day, for 3 months, where no changes to the environment relieve us of the stimulation. This sounds awful, but I’m sure you’ll be surprised that a majority of American adults reported chronic pain being ever present in their lives.

The problem is, acute pain has a tangible cause. One we can put a date and time to. Chronic pain may or may not have a tangible cause and the impacts on our lives is great. Not only does it affect our daily lives and prevents us from doing the things we love, it also has an economic effect on the country’s work hours lost, wages, medical visits, and prescription medications, better known as the opioid crisis.

The common story is this:

“I was working in the yard a few years ago when I felt a pop in my low back and it caused so much pain I had to take 800 mg ibuprofen and lay on the floor for a week. Once I was able to go back to work, I have this constant low back ache. For years I haven’t been able to sit or stand longer than an hour without back pain. Every few months it “goes out” on me and I have to stop exercising/gardening/etc. because it just hurts too bad. My doctor gave me ibuprofen and told me ice. I went to physical therapy and it helped a little, but once I stopped it came back.”

Ever heard this story?

So here’s the timeline: doctor visit for prescription anti-inflammatory and painkillers, wait two weeks, referral for physical therapy, 12 visits, and low back pain improves substantially. A few months pass, low back pain comes back and we revisit this cycle over and over again. WHY?

This acute pain progressing to chronic pain happens because we don’t interrupt the pain cycle and re-educate the new tissue regenerating after the original damage. Remember, pain is a signal to change the environment, but if we are always only ever changing our external environment and never our internal environment, then the pain signal is always humming along at a low frequency until we receive another stimulus that increases the signals volume again. And around and around we go.

I’ve got news for you. YOU DON’T HAVE TO RIDE THIS FERRIS WHEEL! You don’t have to agree to the terms of chronic pain. You don’t have to be on team chronic pain. See chronic pain is deceiving because it’s wrapped up in the constructs of the bio-psycho-social model. All this means is that there’s a body part, a mental part, and a social/community part to chronic pain. Think about the last time you spoke with someone about your struggle with low back pain and they responded “I totally understand. I have been dealing with the same thing.” All of a sudden you’ve got a colleague in the struggle against low back pain. The psychological portion is multi-faceted. It involves your perceptions of pain personally and from programming, it involves your reaction to pain consciously and unconsciously, and it involves your beliefs surrounding pain. Beliefs can look like “I can’t bend over because it will hurt my back.”, or “I don’t do that anymore because it’s bad for my back.” Just a few examples of belief systems around pain.

So here’s how we get you off this ferris wheel:

1. Move more in a capacity that you can tolerate. Grow that capacity consistently.

2. Hydrate. More fluid in = more fluid for the joints

3. Seek out professional help and stick with it. It took you this long to be in pain, consider giving yourself that same amount of time to get out of pain.

4. Trash the bad habits. Inflammatory factors, poor sleep, high stress, use of steroids and opioids are tissue damaging and will continue the pain cycle.

5. Question your pain. Question your fears around pain. Questions the environments that cause pain. It may not be painful to bend over, if it’s done correctly!

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Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives.