By: Susan Geiger, PT, DPT
By definition, pain is an unpleasant sensory and emotional experience associated with actual or potential damage to a structure in the body. (International Association for the Study of Pain). Pain is the brain’s protective mechanism to detect threats to the body and is NORMAL!
The majority of the people we treat as physical therapists are experiencing some form of pain, including acute after recent injury, subacute, or post-operative. This kind of pain is adaptive and should follow typical timelines of healing/recovery with several approaches to treat including modalities, exercises, manual treatments and education. Easy right? Well, it can be for some but unfortunately, as many people know firsthand, it is not always that easy.
When pain persists beyond those typical timelines of healing/recovery, it is then known as “maladaptive pain”. Musculoskeletal pain that persists into a chronic stage is the world’s most prevalent disabling health disorder leading to burdens that go beyond health into personal, social, and economic (Vos et al, 2012). Maladaptive pain occurs when our brain and nervous system continue to respond as if the injury persists. This leads to creation of stronger “pain pathways” even when there is no indication of continued damage or injury in the body. Often, imaging/assessment can show full healing of an injured body part or muscle, but the pain experience persists.
This strengthening of a pain pathway is similar to the process of learning a new skill. Picture a young child learning how to use a spoon for the first time to eat her cereal – it takes a lot of practice and a lot of effort initially! Eventually, this task becomes easier and easier with practice and now, the child is eating her cereal without actively thinking about it, able to direct her attention to other things at the same time. The “eating with a spoon” pathway has become stronger with repetition! This, of course, is an example of how that system works producing positive results so we can function more efficiently. This same process can be applied to painful experiences. With persistent pain comes negative reinforcement which becomes even more complicated with the addition of other negative emotions and experiences (think stress, anxiety, fear, etc.) that are often coupled with the initial injury or incident, creating a persistent pain cycle.
Now, what do we do about it? First and foremost, the big takeaway from this new understanding of persistent pain is that the pain you are experiencing is very much real, but it does NOT mean that there is damage or injury to your body. Our bodies are resilient, and a lot can be accomplished with re-education and gradual return to activity. Physical Therapists are movement specialists and are well-versed in pain science. They can help you address the persistent pain in a way to addresses the body parts involve. They will help you develop different “pathways” that help your nervous system and brain experience movement without pain. Schedule an appointment today to see one of our specially trained physical therapists who can develop a program that is specific and meaningful to you.