Persistent Pain Service

 Why is my back so persistently painful?

Pain is not just a physical thing and persistent pain is not just a back thing affecting almost any part of the body.  In this article we will talk about back pain.  Our Chonic pain services are available at both our Reading and Swansea Physiotherapy clinics.

What is pain?

It’s a physical, chemical, emotional and behavioral response to either an external stimulus that can be noxious or non-noxious, or it can be a pain that is emitted without any form of obvious stimulus.  Pain is even stored in memory, linked to places and is certainly linked to an action.  We often see people who are terrified to bend.  We see a spike in muscle activity rather than a reduction………pain is also learned and stored in movement.  Essentially, everything is processed through the brain and therefore in chronic situations it is linked and processed  in every part of our lives.  This is the reason pain can become chronic or persistent.  Pain is a sensation. But the process of pain generation is very complex. Pain is also a protective response.  If we continuously adapt our movements to a pain response, we will always move in a protective manner.  More muscle spasm, continuous adaptive and mal-adaptive postures.  This perpetuates pain and re-designs our pain and movement systems. We develop persistent pain and become our own self-fulfilling prophecy!

Quite often people see us after they have had countless tests and interventions.  MRI scans, injections and even operations – and still they are in pain. Healthcare professionals are often guilty of making promises of a cure when sometimes the silver bullet is elusive.

Now, this is where we can help.  Diagnosis is key here.  When, after many tests, the doctor gives you a shoulder shrug the patient can feel very down and upset.

“its all in my head!” – well, every sensation has to be processed by the brain, so pain is always “in the head”.  However, as stated above……it is not that simple. Pain must be rehabilitated.  We guide patients to unlearn pain and teach them how to slowly change their response to situations and movements. 

This does not mean that manual therapy treatments can’t help or needling (like acupuncture or dry needling) the skin not offer pain relief.  They must be delivered as a package of care.  Simple and acute back pain responds to manipulation.  Longer, well-established back pain is seldom relieved beyond a few hours or days.  Motor re-learning, graded exposure and strength training are the corner stones of the current thinking and practices of pain management.  If we consider that a patient may suffer pain when they do something specific or when doing just simple tasks, then we must teach them to re-learn movements in a non-painful manner.  Re-training the spinal muscles to both be stronger and behave in a non-protective way is key. 

 Our approach is bespoke, to each unique patient we see.  There is no one method fixes all.  Every regime and treatment plan written for the patient so that it matches when they get pain, how often and what it is that drives it.  More importantly, we want to know what the patient thinks.

Imagine if you thought your spine was weak, brittle or fragile.  Would you bend with confidence or would you stiffen when you move? Making your muscles work harder.  Would you avoid movements, making your muscles weaker? If the muscles are weaker and out of condition, then we must consider the other structures will be less resilient to loading.  Less resilient structures will fatigue quicker.  They will give off a stronger signal. 

When we have pain, the filter channeling information from the body to the brain becomes less selective leading to an over stimulation or sensitisation. We don’t respond to wearing socks.  We know they are socks and they are not harmful. However, when we are in a persistent state of pain, even simple and non-painful tasks become painful.  This is because there is less information required to stimulate our brain and central nervous system.  Our threshold to pain changes and for specific tasks linked to the region or pain becomes lower.     

It is almost like we must convince the body and brain that it is ok to move. If we make the body stronger and make the brain more resilient then we do see a marked improvement in pain. However, it is not simple and is often very challenging. We are dealing with pain.  Quite often there is two steps forward and 3 back!  We work out a plan and a realistic time frame.. We also set expectations and set goals so that the patient can gradually expose themselves to increasing levels of load and more complex movement patterns. This is our approach and luckily – it is evidence based and backed by research.

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