Here at Baton Rouge Physical Therapy-Lake, we see patients every day who are in chronic pain. Some of these patients have had pain for 6 months; some have had pain 10, 20, or even 30 years. Louis Gifford wrote a paper listing the four questions that patients with chronic pain want to know about before beginning physical therapy.
(1) What is wrong with me?
(2) How long will it take?
(3) What can I (the patient) do?
(4) What can you (the PT) do?
Today we want to talk about the first of these questions, which anecdotally is the question I get asked the most in our chronic pain population. The short, unsatisfying answer is that it depends, but the reason ‘it depends’ is because pain is so complex. Pain is a multidimensional construct that has components that are physical, emotional and cognitive, and all of these factor into your pain.
The International Pain Science Institute has developed pain stories that help to answer some of these questions proposed by Gifford and give clarity to this complicated problem.
Today we would like to share with you one of these pain stories.
If you step on a rusted nail, would you want to know about it? Why? Well, to get help, to get a tetanus shot, to take the nail out, etc. How do you know that there’s a nail in your foot? The message travels from the foot to the spinal cord, then on to the brain.
Your body’s nervous system contains 400 individual nerves, totaling 45 miles. All of the nerves are connected like highways.
All 400 nerves have a little bit of electricity flowing through them. This is normal and shows that you’re alive. Nerves are like our alarm systems, designed to send us danger messages when there’s a threat, such as stepping on a rusted nail.
So, when you step on a rusted nail, the alarm in your foot goes off. The alarm sends a danger message to your brain. The brain produces pain to grab your attention and get you to take care of the problem.
Once you take the nail out, the alarm should go back down. The alarm goes down slowly. You will likely feel discomfort or pain in the foot for a day or two. This is normal. Once the alarm is back to its normal level, it’s ready for the next danger.
This is key: in approximately one in four people, the alarm does not go back down. The alarm (nervous system) stays extra sensitive. If pain lasts beyond the normal healing time, it is likely due to an extra-sensitive alarm. Your extra-sensitive nervous system may be a big part of your pain, limited movement and sensitivity.
An extra-sensitive alarm system can impact your life considerably. In the days before pain you had lots of room for movement and activities without causing pain. Since you developed pain, it takes far less activity or movement before you experience pain. The limited activity and movement is not necessarily due to injury or tissue damage but an extra-sensitive alarm system.
Why did your alarm system stay extra-sensitive? Everything you have gone through during your pain experience has kept the alarm system extra sensitive. For example:
Dealing with pain every day adds stress and can cause issues at home or work
Treatments are not working; otherwise you would not be here
You’ve been given several different explanations for your pain, which causes confusion
As long as you are stressed, confused, afraid, etc., your alarm system is likely to remain extra sensitive.
If you want to know more about why you have chronic pain, contact one of our physical therapists at BRPT-Lake.