Pain Management

What is pain?

Pain is an essential part of human experience. That’s why we require pain management.

It is the body’s ‘alarm system’ to tell us that something is going on in our body in order to protect us. However, pain is really complex because it is influenced by many things including our genetics, our previous pain experiences, our beliefs, our social context, our lifestyle, our sleep as well as our general and psychological health.

We learn about ‘pain’ from a very young age. We also learn about it from those around us.

One simple example of this is: we know that the way a parent responds to a child receiving an injection (i.e. if the parent is worried and anxious about the injection), this hugely influences how much pain the child feels as well as their level of distress. We know if the child is happy and distracted they feel less, but if they are worried and fearful they feel a lot more. So, our social environment and levels of worry and anxiety can influence our levels of pain and the distress it causes.

There are different ways of pain management

It is common to believe that pain is always a sign of damage to our body. However, it is important to understand that there are different types of pain.

The most commonly understood type is called nociceptive pain. This is pain linked to tissue damage (e.g. a sprained ankle, fracture) or a burn (e.g. sun burn). The crazy thing about this is that the degree of tissue damage doesn’t always relate to the degree of pain we feel. For example, a paper cut or graze is often much more painful than a deep cut. This is partly because there are so many nerve endings in our skin – called nociceptors or ‘danger’ receptors. These receptors also exist in our muscles, joints, ligaments, nerves and discs and are activated by mechanical force or chemical irritation. Inflammatory pain often follows an injury that is associated with tissue damage. Swelling occurs and lots of different chemicals arrive at the injury site to begin the healing process. This can be very painful, although the good news is that this pain usually reduces within a week or two and then gradually subsides as tissue healing occurs and the person is back to normal function (usually 4-12 weeks depending on the severity of the injury).

Nociplastic pain is different. This is pain that arises when the nociceptors or ‘danger’ receptors are activated – but in the absence of tissue injury. Take the example of a headache. A headache can be caused by a blow to the head (nociceptive pain) or it can occur from being tired, run down and stressed causing tension and sensitivity in our tissue (nociplastic pain). Both headaches may cause serious pain – but the causes and the way to manage them are very different. For a blow to the head it may be important to get a scan, whereas with the latter a good sleep, relaxation and some exercise would be helpful. Back, neck and pelvic pain can present in the same way. Nociplastic pain may also develop from an injury when pain persists after normal healing time (8-12 weeks). This is called persistent or chronic pain. This usually occurs when changes to the nervous system and body occur, linked to over protection of a painful body part. This may be linked to factors such high levels of stress, emotional distress, fear of pain and movement, and poor lifestyle habits (such as activity avoidance, poor sleep and carrying excessive weight) (see chronic pain condition). There are also a number of chronic conditions where people can experience pain without any specific injury and where pain is part of the symptoms e.g. Fibromyalgia, chronic fatigue, endometriosis and vulvodynia.

Recurrent pain is pain that recurs and settles. This is common in back pain, neck pain, pelvic pain and headaches and is usually precipitated by things like being tired, fatigued and being sedentary linked to some mechanical load.

Neuropathic pain is less common and this occurs where there has been injury to a nerve. For example, this can occur in diabetic neuropathy or injury to a nerve due to trauma. This may lead to burning constant type of pain.

How we understand pain management influences its impact on us

At Body Logic Physiotherapy, we treat many kinds of chronic pain problems. This includes common conditions such as back pain, neck pain, headaches, joint pain, nerve pain (e.g. sciatica), arthritis, muscle pain, tendon pain, bursitis, widespread pain and more (see conditions).

Pain associated with our muscles, tendons, joints, discs, bursa and nerves can be really unpleasant and distressing. This can have a major impact on our physical and emotional well-being. Pain can be very scary when we don’t understand it and / or can’t control or predict it. It can result in uncontrolled muscle tension in the body. It can also stop us from doing the things that we value as well as things that keep us healthy. Common examples of this include: good sleep, normal movement, regular physical activity, sexual activity, social engagement, work, play and activities of daily living etc.

Sometimes pain can arise from an injury (nociceptive and or inflammatory pain), but many times it doesn’t (nociplastic pain). Sometimes pain persists well beyond healing time, or becomes recurrent, and for some people pain is a daily part of their life that they try to manage.

Our assessment and pain management treatment is aligned to the latest research available.

1: We first work as a detective

First, we will ask you to fill in a short questionnaire to ask you about all aspects of your pain experience. Our job is to take a careful history and examine you to determine a number of things:

Is it a serious or life-threatening condition?
What structures are involved i.e. nerve, joints, muscles, tendons etc?
What caused your pain?
What type of pain is it?
If it is an injury, how much tissue damage is involved?
If it is not an injury, what other factors have caused the pain?
How is it impacting on all aspects of your life (e.g. physical, work, social, emotional)?
What do you understand about your pain?
What strategies do you have to manage or control it?
What are your short and long term goals, and treatment expectations?
Can physiotherapy treatment help your condition? If so, what kind of treatment is best for you to meet your goals? How much treatment will you need and over what time frame? What can you do for yourself? Can we work with your health care team?
If physiotherapy is not indicated, who else should you see?
If you need further investigations (such as scans), we will refer you for them or communicate with your doctor.

2: We then work as an educator and a coach for your pain management

Understanding your pain

Our next role is to explain to you in simple language regarding what’s going on in your body. In some situations, pain in not complex and is linked to a simple sprain or strain which can be easily and quickly managed and we can set you up with a plan to prevent it recurring. However, if pain is distressing, disabling and / or long lasting, it is usually more complex and most often it is related to a number of interacting factors. A good example of this is pain and functional limitation associated with osteoarthritis. While it often involves changes and inflammation to the joint’s structures, it is also influenced by a person’s muscle strength, confidence in using their joint, mobility and functional capacity, lifestyle factors such as sleep, activity levels, body weight as well as things such as stress and mental health. The same is the case for other chronic pain conditions such as back and neck pain etc. Understanding the unique factors that are related to your problem is really important to provide the best care to address your whole health. Often simple things make a BIG difference.

‘Hands-on’ treatment

If pain is linked to muscle spasm/tension and movement is limited, sometimes ‘hands-on’ approaches such as massage, joint mobilisation, manipulation and needling can help to relieve your pain in order to restore function. These effects are often short lasting, which means we will always give you exercises and strategies for you to do to maintain/mimic the gains made with “hands on” treatment, relieve your pain and restore your functional capacity as fast as possible.

Body relaxation

When pain is linked to stress, tension and or very sensitive structures, it may be important to first teach you to relax your body before you engage in movement and activity. We do this is through relaxed postures and breathing techniques. These can be very effective to relieve pain and create a sense of calm before engaging in movement.

Movement and exercise

Graduated movement of pain sensitive structures is important for their health. Exercise has been shown to relieve pain and increase function in all muscle, joint, spine and nerve pain conditions (both acute or chronic). We will graduate your exercises so they are safe and tolerable for you. We will also make them simple and relevant to your condition. Sometimes moving and exercising can be scary and unpleasant, and we will take some time to build your confidence, strength and functional capacity to get back to living again. Exercise is like a drug – getting the right dose for the right person is important. Sometimes it takes a while before the benefits become apparent so we will encourage you to hang in there while we support you through this process. We will always give you a few exercises you can do at home, and in some cases it can be really helpful to do supervised exercise in our rehabilitation studio. This enables us to work closely with you and determine the right dose of exercise for you. We offer one on one and group classes to support our clients. (see exercise rehabilitation)

Breaking habits

Persistent pain can often be associated with habits we develop within our body (that often we aren’t aware of) such as: breath holding or rapid shallow breathing, tension, guarded movement and avoidance or certain movements or activities. These habits can become very unhelpful and are important to break. We will coach you on simple ways of breaking these habits. A common example of this is with back pain, which commonly results in tension in the back and belly muscles, stiff and guarded movement and avoidance of movements such as bending, lifting and twisting. Breaking these habits reduces tension and stress on the back and allows for healthier movement and loading patterns.

3: Then we address lifestyle factors

Sleep disruption is very common in pain problems and can be addressed in a variety of ways. This may be with developing healthy sleep habits, engaging in physical activity, relaxation techniques, learning how to move easily in bed etc.

Physical activity is one of the most important things for a person’s health. This has been shown to reduce pain and the risk for pain recurrence and chronicity. It also helps with sleep, mood, anxiety and energy levels. We are interested in building your confidence to get you back to the physical activity that you enjoy and that you will persist with. This may take some time and coaching. Do you know what the recommended amount of physical activity is for adults? (See this infographic to learn more pain management strategies).

Work is really important for people although sometimes pain can become a major barrier for work. We will explore all the barriers that prevent you from working and develop a plan to address them.

Stress management is also very important for pain management. There is strong evidence for the role of chronic stress can have on pain. Developing strategies to manage stress can be very important. These can include engaging in regular physical activity, relaxation / meditation techniques, social engagement and good sleep habits. These factors can reduce the impact that stress has on our body.

Maintaining a healthy body weight is important for the health of our spine, joints and tendons. Carrying extra weight around our belly leads to increased inflammation in our body that can affect our bodies structures such as discs, joints, muscles and tendons, and make them more sensitive. Reducing this weight has been shown to reduce pain associated with chronic pain conditions.

Working as a team for your pain management

It’s really important that health care practitioners don’t work in silos. At Body Logic Physiotherapy, we know that the best care is linked to team work. This involves your GP and may also involve your psychologist, dietician, pain physician or surgeon.

How long does treating pain take?

For simple sprains and strains we usually only need a short consultation with you (30 minutes). We will examine and treat you and set you up with a plan to self-manage your condition.

For others with more complex, disabling or long-standing problems this journey may take up to 3-4 months. We strongly recommend 60 minutes for the initial appointment. Our approach is to put you in the drivers seat, and this may take 4-10 sessions over this period of time. It takes time to build confidence and trust in the body and reduce sensitivity in our body’s structures when they have built up over time. At Body Logic Physiotherapy we have a number of specialist, post-graduate and senior physiotherapists who can take you on this journey.

We know that the best way to manage pain is to understand its complexity, develop strategies to control it, and learn ways to get back to the things in life we enjoy.

For more information on pain management and to get in touch with our pain management clinic, contact us today!