What is Chronic Pain?
You may have heard about Chronic Pain when it comes to a prolonged injury. Chronic Pain is pain that persists for an extended period, typically longer than three to six months, beyond the normal healing time of an injury or illness. It can vary in intensity and may occur continuously or intermittently. Chronic Pain is often considered a condition in itself, alongside the original injury, as it can impact physical, emotional, and mental well-being, due to the brain and nervous systems involvement.
For the below discussion let's use low back pain as an example in Chronic Pain pathways.
Key Features of Chronic Pain:
Duration:
Lasts beyond the expected healing period, often for months or even years.
Complexity:
May not always have a clear or identifiable cause.
Impact on Life:
Affects daily activities, mood, and quality of life.
Physical and Emotional Components:
Involves both sensory and emotional aspects, as pain is processed in the brain.
Symptoms of Chronic Pain:
Symptoms can be related to the injury, however as chronic pain is a complex situation involving the nervous system and how the brain interprets pain, some symptoms of chronic pain are not necessarily a “worsening” of the original condition, but our body’s own feedback loop of handling pain has changed. In the example of low back pain, just because you feel a bad sensation in your back, doesn't mean the injury has worsened. It's a very fearful and normal response for us to think this way, however the original injury is usually OK in this situation, we are just heightened to the pain.
Persistent pain (burning, aching, shooting, throbbing, or sharp).
Fatigue or sleep disturbances due to discomfort.
Reduced mobility and physical activity.
Emotional effects, such as anxiety, depression, or irritability.
Types of Chronic Pain
Nociceptive Pain:
Caused by tissue damage or inflammation (e.g arthritis).
Neuropathic Pain:
Results from nerve damage (e.g sciatic pain, diabetic neuropathy).
Mixed Pain:
Combines elements of nociceptive and neuropathic pain (e.g chronic back pain).
Why does Chronic Pain Happen?
Chronic pain occurs for various reasons and often involves complex interactions between the nervous system, the body, and the brain. Unlike acute pain, which is a direct response to injury or illness, chronic pain persists beyond the normal healing period and may not always have an identifiable cause. Below are some reasons why chronic pain happens:
Central Sensitization: Increased sensitivity to pain signals in the nervous system.
Prolonged Inflammation: Ongoing immune response in tissues.
Neuropathic pain: Neural involvement
Psychological Factors: Stress, anxiety, or depression can amplify the perception of pain.
1. Nervous System Changes (Central Sensitization)
Heightened Sensitivity: In some cases, the nervous system becomes overactive, amplifying pain signals even after the original cause has resolved. Our nervous system interprets a movement as “dangerous” when the body isnt in a pathological state. An example of this is with low back pain and bending forward. In the initial stages of your low back injury, it may be challenging to bend forward. Your nervous system has learnt this cue over the 3 months to be overprotective and stop you from bending forward as a protective mechanism, however in the lower back injury, the leaning forward motion has been healed and the low back injury isnt worsening by doing this, our brain has “preempted” the movement for us - unnecessarily.
Rewiring of the Brain and Spinal Cord: Prolonged pain can lead to changes in how the brain and spinal cord process pain signals, making the body more sensitive to pain stimuli.
2. Prolonged Injury or Inflammation
Unresolved Tissue Damage: If an injury or condition (e.g., arthritis, surgery) does not heal properly, pain signals may continue to be sent to the brain.
Chronic Inflammation: Long-term inflammation, common in autoimmune disorders (e.g., rheumatoid arthritis), can perpetuate pain.
3. Neuropathic Pain
Nerve Damage: Injury to nerves (e.g., from diabetes, shingles, or trauma) can result in ongoing pain signals even without a physical trigger.
Misfiring Nerves: Damaged nerves can send incorrect signals to the brain, causing pain sensations. (Multiple Sclerosis, disc injury)
4. Psychological and Emotional Factors
Stress and Anxiety: Chronic stress can increase the perception of pain and contribute to its persistence.
Depression: Emotional distress can lower the threshold for pain and make symptoms more severe.
Pain Memory: The brain may "remember" pain and continue to produce pain sensations even after the original cause has resolved.
This is particularly important in a back injury that we see frequently in clinic. How we interpret our pain can have a big difference to the duration of discomfort. Your Osteopath will talk about your particular set of circumstances to help you understand why things may be more amplified for you. An example may be if you are under external stress - family, work, relationships, health - then if this injury occurred during a time that the external stress wasn't there, a few months earlier, maybe your body would have had a better healing response than what it is currently dealing with.
5. No Clear Cause
In some cases, no definitive cause is found. This is common in conditions like fibromyalgia or chronic primary pain, where pain itself becomes the main issue. In cases like this, communicating with your GP to a pain specialist can be wonderful.
Cycle of Chronic Pain:
Chronic pain can create a vicious cycle:
Pain leads to reduced activity.
Reduced activity causes muscle weakening and stiffness.
This exacerbates the pain and contributes to emotional distress.
Emotional distress amplifies the perception of pain.
Understanding why chronic pain occurs is crucial for developing effective management strategies, which often involve a combination of medical, psychological, and lifestyle approaches.
What is the difference between Acute and Chronic Pain?
Acute Pain
By definition, Acute pain is short-term pain that serves as the body's immediate response to injury, illness, or surgery. It is a warning signal indicating that something is wrong and needs attention. It typically lasts for a limited period, up to 3 months with the body’s natural healing mechanisms. Acute pain is protective. It stops us from further injuring ourselves and is a normal part of pain. For example, back spasms in the first 1-2 weeks of a low back injury is needed to help the body to heal, and prevent you from further moving in a way the body doesn't like, so the body can help to heal itself.
Chronic Pain
By definition - Chronic pain is long-term pain that persists beyond the expected healing time of an injury or illness. It may continue without an obvious cause or ongoing injury. As mentioned above Lasts for more than 3 to 6 months and will require a multi faceted approach to healing.
Both types of pain can affect physical and emotional well-being. Acute pain can sometimes transition into chronic pain if not effectively managed or if the nervous system becomes sensitized.
Ways to manage Chronic Pain
Managing chronic pain often requires a comprehensive, multi-faceted approach tailored to an individual’s needs. Here are some strategies and methods commonly used:
Manual Therapies
Osteopathy Manual Therapy:
Tailored exercises to improve strength, flexibility, and mobility.
Techniques like stretching, soft tissue techniques, joint mobilisation and articulation.
Lifestyle Modifications
Regular Exercise:
Low-impact activities like walking, swimming, or yoga can reduce pain over time.
Healthy Diet:
Anti-inflammatory foods like fruits, vegetables, whole grains, and omega-3 fatty acids.
Sleep Hygiene:
Creating routines to improve sleep quality, as poor sleep can worsen pain.
Stress Management:
Relaxation techniques, such as deep breathing or progressive muscle relaxation.
Psychological Support
Discussions with your GP for further referral as mental health and wellbeing can be affected with Chronic Pain
Medical Treatments
Medications:
Over-the-counter pain relievers
Prescription medications
Topical analgesics
Interventional procedures:
Corticosteroid injections, nerve blocks, or trigger point injections.
Referral to specialists if the above methods are limiting.
Chronic pain requires a multifaceted and individualised approach. It is a complex and unique situation. Not every injury is the same injury, just like your life and lifestyle factors are not the same as your friend with the same injury.
Your Osteopaths can help you manage your symptoms and will refer as necessary to help you on your pain journey.

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