Chronic Pain: What you should know

What is chronic pain? 

Chronic pain is a complex medical issue and is defined as pain that persists past normal healing times. Acute pain is directly related to tissue trauma and subsequent inflammation. Traditional healing guidelines suggest that the bulk of the inflammatory and initial healing process occurs within approximately 3 months during normal healing. While this is not true for all tissues, and there are numerous variables that affect these timelines, this is a standard “ballpark” estimate. 

Therefore, clinically we loosely define chronic pain as pain that persists past 3-6 months and is not improving. Chronic pain affects approximately 20% of the global population and is a major contributor to healthcare costs and disability. Unlike acute pain, which is primarily associated with tissue trauma, chronic pain can exist with, or without actual tissue trauma. 

Persons suffering from chronic pain often have fear or apprehension associated with certain movements or activities that may increase their symptoms. This fear often results in decreased activity which can lead to deconditioning, decreased social interactions and impaired mental health.

What is Central Sensitization? 

A primary component of chronic pain is the presence of central sensitization. Prolonged painful conditions disrupt sensory and processing pathways in the brain and spinal cord. This results in a hypersensitive state where non-threatening movement and touch is perceived as threatening. Put simply, the bodies pain sensors are too sensitive and interpret harmless sensations as painful and potentially harmful. 

Having insight regarding the causes of central sensitization allows us to develop more optimistic thought patterns and healthier coping strategies. We can strategize a long-term approach that will promote healing and address fluctuations throughout the rehab process. If it’s understood that our body is misinterpreting harmless interactions as potentially harmful, we can work to improve our bodies understanding. 

What should I do? 

Research has evolved over the past decade giving us a general framework for best treatment guidelines. It is widely understood that pain is multifactorial and is the result of many variables. In addition to our physical health, we should also consider other factors including:

• Socioeconomic status

• Activity levels

• Sleep

• Diet

• Relationships

• Emotional state

• Trauma

• Stress

• Anxiety

• Depression

A holistic approach to treatment that is focused on improving overall well-being is best when taking steps to recovery. An easy first step to progress would be to take care of the “easy” variables first. For example, make sure you’re sleeping enough, eating well and staying active. Once you achieve the easy steps, try and break down the more difficult changes in small manageable steps. 

Chronic pain is a complicated, debilitating condition. But this does not translate to hopeless. Take charge and be committed to improving your health. 

Tiara Dunson, PT, DPT

Tiara is a physical therapist at Kauno

References

1. Nijs, J., Paul van Wilgen, C., Van Oosterwijck, J., van Ittersum, M., & Meeus, M. (2011). How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice guidelines. Manual Therapy, 16(5), 413-418. doi: 10.1016/j.math.2011.04.005

2. Treede RD, Rief W, Barke A, et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003-1007. doi:10.1097/j.pain.0000000000000160

3. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Eur J Pain. 2006 May; 10(4):287-333.