It has been suggested that 80-90% of healthcare money is spent on 5-10% of individuals. This shows that a small portion of the population is absorbing the majority of the resources. Why is this so? Because many of these these patients suffer from Chronic Pain issues, and, as management of this situation is very poor, these people do not get better. They continue to drain funds as they attend appointment after appointment, and have surgery after surgery, hoping to one day to miraculously get better.
Let’s clarify a few things. Chronic pain, generally speaking, is any pain that has lasted for greater than 3 months. Most typically it is seen with lower back pain, neck pain or multi-joint pain.
One of the core problems with how we treat ongoing pain has to do with many peoples’ belief that pain is directly proportional to the amount of damage that is done in the area they feel pain.
Consider some of these examples: How painful can a paper cut be? Well, in reality there is actually very little tissue damage. Conversely, a soldier shot on the battle ground can walk miles to safety despite extensive tissue damage. A sprained ankle of a player in a winning Grand Final doesn’t hurt quite as much as the same injury on one of the losing players. Tissue damage is only one small part of the equation. The meaning that our brain SUBconsciously attaches to the pain is the biggest part.
With ongoing or chronic pain the relationship between amount of actual tissue damage versus perceived pain becomes even more distorted. We know that the majority of tissue injuries heal within 6 weeks. Yet many people can still experience pain for long periods after this. Why?
The unfortunate fact is, the body gets good at being in pain. In the same way that a blind person gets good at touch and hearing, so too, people in pain get good at being in pain. This isn’t a conscious choice on the part of the sufferer. Their brain makes decisions and assumptions about the threat value of the pain, without the sufferer even knowing it. The pain processes ‘up regulate’, and nerves become overly efficient at sending pain messages. Chronic pain patients suffer from a dysfunction in pain processing, meaning they register more pain sensations, than there actually is damage in the tissue.
This understanding is of core importance, and the misunderstanding of this is the reason that many chronic pain sufferers move from one manual therapist to another, achieving little more than a lighter wallet.
The key is to be able to explain, and to put into action the ‘down regulation’ of the dysfunctional pain processing. This can mean explaining to people what we know about the science of pain and how it works - the sorts of things that influence it, and ultimately use this knowledge to progressively down regulate the pain.
Techniques can include clear education, strict graded exercise programs, strengthening, biofeedback, addressing mental attitude and perception. Manual therapy can have a small role to play, but it is important that this is not seen as the solution.
One of my favorite sayings is “Pain is inevitable, suffering is optional”. Don’t suffer from Chronic pain. Educate yourself and downregulate your pain processes. We recommend an excellent book called ‘Explain Pain’ by Lorimer Moseley and David Butler.
Stay well, keep healthy.
If you have any further questions about this article, email me:
dan@physios-online.com
Dan Uden
Sports Physiotherapist
BPhys, BExSc, MSportsPhysio