Pain is a multidimensional sensation which requires a multifaceted approach. Simply put, pain is a powerful force. Pain is initiated at receptors in the periphery (nociceptors) and its real potential is harnessed by neurons within the central nervous system. For better or worse, pain is a necessary stimulus of the nervous system. Consider life without pain, a rare genetic disorder known as congenital insensitivity to pain (CIP) poses a significant risk for injury due to the inability to experience nociception. Pain is an important stimulus to the nervous system triggering a level of attention and awareness which demands a response. Pain has taught us important lessons in life, whether it be from failure or injury in emotional, physical or social settings. Perhaps the old adage is correct, No Pain, No Gain. No doubt, acute pain is an indicator of injury or danger. For without pain, we would not have the value of knowing the limits or the risks of our life ventures. A man has got to know his limitations …
Musculoskeletal pain is usually a result of injury or misuse (lack of use or overuse) to tissue (muscle, ligament, nerve). The outcome is a myriad of symptoms that involve emotional, physical, chemical and nutritional elements. In most cases of tissue injury, the natural withdrawal and protective response to the acute pain lends towards quick recovery. In acute cases of pain the tissue is the issue. If the tissue is properly treated to restore movement and blood flow then healing is expected. What about musculoskeletal pain which fails to resolve or continues to recur without any on-going injury? Throughout the US, nearly 30% of adults experience chronic pain. Don’t be tricked by the traditional time-based definition of chronic pain. It’s not just a matter of time; instead it is an adaptation in the nervous system in the presence of unrelenting painful stimulus and inflammation. In reality, chronic pain has very little to do with the true definition of pain. It is not an indicator of injury, nor is it based upon nociceptive stimulus to the central nervous system. Instead, it is a variable pattern of symptoms with broad affects upon the entire body which are driven by structural changes of the nervous system (neural plasticity). In these cases, pain must be addressed from every possible approach to achieve some level of response that borders on the edge of life altering.
Terms like neuropathic pain, hyperalgesia and sensitization are used to describe the complex changes of the nervous system in response to chronic or recurrent pain. Unfortunately, there is limited consensus on how to best manage chronic pain. Most people suffering from chronic pain have been trained by pain. Trained to avoid situations and activities which they fear could cause pain. Trained to limit social interaction due to apprehension or anxiety which is derived from a painful state. This pain-learned behavior is often accompanied by poor sleep habits, improper nutrition and reduced interest in activity. So the reality for chronic pain is no longer about the condition, instead it is all about the pain.
In today’s world of medical advances in drugs, it is possible to live with chronic pain. Still, many people are discovering the challenges of trying to live a life with less pain. There is no drug without a side effect, just like there is no risk-free surgery. Trying to live with chronic pain has been a driving force behind the three fold increase of opioid prescriptions over the past two decades. Nothing is for nothing, pain still wins. Most people do not realize taking painkillers over a prolonged period of time may actually increase sensitivity to pain (hyperalgesia). The nervous system readily adapts to opiates by increasing the number of receptors for the drug, and the body stops producing endorphins because it is receiving opiates instead. This neurophysiological adaptation requires the intake of more opiates and increases the sensitivity to pain. All the more reason why some chronic pain sufferers are convinced they have a high pain tolerance. Unfortunately, their body simply can’t tolerate pain because they have lost the natural ability to fight painful stimuli.
So the question remains, is it possible to live with chronic pain. Yes, it’s possible but it has limits and risks. The alternative is painful living. This requires a determined and consistent approach which does not involve opiates or invasive surgery. If all other forms of pathology have been ruled out and the main cause of pain is due to musculoskeletal injury or dysfunction, than painful living is a valid path towards healing. If I haven’t got your attention until now, then I’m sure to ruffle a few feathers. Painful living is the only way to bridge the divide necessary to transform inflammation into healing. It may not yield complete pain relief, but it could offer a way out of living with pain. There is far less risk, since there is no chance of addiction and no one has ever died from musculoskeletal pain. If you chose this path, it is critical to develop a step-wise process that transforms your thinking, behavior and activity in ways which are no longer based upon avoiding pain. Instead, the purpose of each day must be breaking free of painful living by rebuilding the health of your nervous system and body. It’s no easy task. It requires retraining normal movement patterns, rebuilding relationships, restoring nutrition and resuming exercise. The best course is to seek help from friends, family and therapists. Surround yourself with people who support a positive perspective on life and help you ignore the pain which will be present as you resume activity and return to healthy nutrition habits. Choose a competent physical therapist who understands natural healing methods like manual therapy and motor learning to restore freedom of movement in a healing manner. You can’t expect results in a couple weeks; instead it may take months to recover from the detrimental effects of chronic pain. Just keep reminding yourself that there is no other alternative because this is your chosen path towards healing and a full life.
Dr. Keith Poorbaugh has completed specialty certifications, internships and a residency fellowship to develop mastery of manual therapy skills and clinical expertise. Throughout 20 years of clinical experience, he has discovered that clients consistently heal faster when the provider is both compassionate and skilled.