pain management

WHAT IS MEANT BY CHRONIC PAIN?

ACUTE PAIN

Acute pain is short term pain which may last a few seconds, hours, days or even weeks but it does stop eventually. Usually acute pain is like a warning signal that tells you something is wrong with your body such as tooth ache, overstretched muscle, and acute back pain. So acute pain is short-lived and is normally relieved by natural healing and often helped by formal treatment such as physiotherapy, surgery and medicine.

CHRONIC PAIN

Chronic pain is long term pain which can last from anything from a year to indefinitely despite treatment. Often there is no clear explanation why the pain is continuing but chronic pain is not a warning signal of new damage. Most people with chronic pain have had an injury or injuries at some stage, and for some reason, the pain associated with that injury has never really gone away although the healing process is more or less completed after three months. The reason for this is not fully understood, but appears to be due to changes in the nerves, resulting in pain signals being sent even though no new damage has occurred. In other words, chronic pain probably means something has gone wrong with the nerves.

There is no way of effectively reversing the problem at present. The treatments that work so well for acute pain are often not helpful for chronic pain and may make matters worse. For example, long term rest may simply make muscles and joints weaker; painkillers are likely to help less and less over time as the body gets used to them and may leave only unwanted side effects such as tiredness, lack of concentration, upset stomach.

Whatever the original cause of the pain, because it has been ongoing, it is likely to have led to many changes and difficulties in daily life. For most people, it has led to a reduction in certain activities which in turn has led to a loss of general fitness and strength in muscles and joints. As a result, more strain and pain is experienced when doing activities such as catching up on the housework or sitting for a long time or getting out of bed. Often this will aggravate the pain, particularly if they have overdone it and there is a feeling of discouragement and defeat. Indeed, because of reducing or giving up important or enjoyable activities such as job, hobbies, sport, spending time with family and friends, people often find themselves feeling more depressed, isolated, irritable or helpless than they can remember having felt before. This depression and helplessness may be aggravated by the repeated failure of different treatments to help and the side-effects of ineffectual painkillers. The ongoing pain, of course, adds to these problems, making it even harder to cope.

At times the pain seemed unbearable, aggravated by movement or at times by not moving. On good days the pain is there but for the most part in the background but on bad days it is difficult to focus on anything other than the pain. Chronic pain is surprisingly common; around 10% of the population suffer from it to some extent or other. Fibromyalgia is a chronic illness that causes pain in the muscles, tendons and ligaments as well as fatigue.

The kinds of exercise you need to do on a daily basis...

STRETCH

To help stiff muscles, joints and scar tissue to loosen and become supple again as stiffness adds to discomfort, poor posture and restriction of activities. Releasing tension is helped by stretch as well as relaxation. Gentle stretching is helpful to reduce muscle pain and spasms during pain flare ups.

STRENGTHENING

Strengthening builds up weakened muscles so that they support joints and help you to do more. For example, if the leg muscles are weak you cannot crouch- if you cannot crouch then you cannot lift or pick up things properly. By strengthening the legs and stomach muscles you can crouch and lift without straining the back. I believe that after the end of any exercise or activity, you should feel that you have worked but that you feel energised and not drained or exhausted. Thereby the activity is providing you with more energy than when you started.

HEART AND LUNG (AEROBIC EXERCISE)

By building up the stamina of the heart and lungs you do not easily get out of breath and tired. The main benefits of aerobic exercise are to:

  • Strengthen the heart and lungs
  • Improve circulation and lower blood pressure
  • Improve muscle tone and endurance so that you can move more easily without getting tired
  • Improve sleep
  • Improve weight control, along with good diet
  • Give you an improved feeling of fitness and well being

The Pain Management Input Clinic literature looks at an increased heart rate to a target rate for 15 minutes at least three times per week.

If the exercises become just another chore you will find it hard to keep them up. So the recommendation is to make them fun and enjoyable. The team from the Pain Management Input Clinic want daily exercises to become a routine habit that you can do at home on your own once you have left the programme. They want you to develop self-reliance.

Over-activity/Under-activity cycle

This is a common pattern of activity for people suffering from chronic pain. On better days when the pain is at a tolerable level, it is tempting to do jobs or exercise that were put off when the pain was bad. Will power or wanting a sense of achievement encourages them to continue. This is the danger time because it is easy to do more than the body and the muscles are used to, resulting in a flare up of pain. People often rest during a flare up, but this results in weaker muscles and a drop in fitness. This becomes a cycle of events with over-activity causing pain which leads to resting or under-activity; and resting causes a drop in fitness, meaning that it becomes easier to overdo. As pain is not a useful message in chronic pain as it does not signal damage and frequently it tells you to stop too late or too soon. It is definitely not helpful letting the pain tell you when or when not to do something, as in the over-activity/under-activity cycle. You need to work out what the body can easily manage, so you know you are not overdoing something and can continue on bad days, smoothing out the peaks and troughs of activity. You do this by setting a baseline for each of your exercises and activities which is 80% of your present capabilities and then gradually increase in a phased and planned approach.

On good and bad days you do 80% of your capability, even during a flare up, however, if you have a setback such as a serious deterioration in your health condition or have a serious health concern then aim to do 50%.

Success does not depend on the severity of the pain, the site of the pain, the original cause or how long you have had it. It has more to do with creating a plan, consistent implementation of the plan and adapting the plan when needed. The key to becoming more active is to stop pushing yourself, learn to relax with movement and exercise, and to build up your activity gently and gradually with pacing.
Often people are concerned that exercising may increase the amount of pain and cause them harm.
The right kind of exercises done in the correct way will help you deal with your pain. All increases in exercise levels needs to be done in a planned and steady way and in general any increased pain after exercise is most likely to be due to the effects of long-term inactivity. As your muscles and joints become fitter and stronger the extra pain and stiffness will gradually lessen. This is the same for everyone when they try out new exercises and activities after a long period of inactivity just more intense for the chronic pain sufferer.

     
If you want to see the power of yoga and Tai Chi then look no further than Marjorie. Her practise has helped her overcome a condition that would have laid most mortals low."
  Mark