In last week's blog post, I have alluded to the concept that pain left untreated has a potential of developing into chronic pain. If you missed last week post, you can catch up here: https://www.yongkangtcm.com/post/slipped-discs-and-low-back-pain
To be crystal clear right off the bat: chronic muskuloskeletal pain is treatable, is highly confused with pain related to aging and most importantly is not something that one has to live with.
How is chronic pain different?
The simplest way to explain chronic pain is through the sensation and perception system of the human body. Pain is type of sensation that is sent via the nerves to the brain, for the brain to receive and register the signals as pain.
Not all pain is physical - everyone of us has received bad news at some point, with emotions like shock, disappointment and heartbreak. The sensation of these emotions can sometimes elicit a pain response that is felt within the body. However, this does not necessarily mean that the body is physically injured and is in need of recovery or repair.
Similarly, chronic pain can manifest in the body when injury from a trauma, or an accident is left untreated. This can lead to the sensation system in the body generating pain signals when there aren't any actual physical damage or destruction present.
As humans it's only logical to think of a reason for a sensation that we have. Surely there must be a physical reason for a sensation that we feel. Feeling hot? The sun is causing heat. Feeling tired? Lie down and get some sleep. A sensation is almost always linked to a physical reason, and as humans we try to reason to find out the physical reason for a sensation.
What makes chronic musculoskeletal pain hard to treat, is that depending on the individual, there are a myriad of reasons that differ from person to person.
A thought exercise:
Schoolgirl in junior college who spends 8 hours sitting at a desk. Not active, more sedentary. Enjoys reading books in bed and spending time on devices chatting with friends and catching up on social media
Office worker who spends 3 days at work and 2 days at home for hybrid working. To maximise hybrid working, he plans his meetings such that he is able to spend time playing with his kids after they get back from school at the nearby park
Retiree who has recently left the workforce, and now wanting to lead the quiet life. Spending more time taking care of grandkids as they are at home more often
Imagine that these three individuals are suffering from chronic low back pain for about 2 years. Clearly, the treatment methods will differ from person to person, and will require different levels of communication and treatment approaches.
So...you are saying that chronic pain lives in my head?
The biopsychosocial model is a great way to understand how how biological, psychological and social factors can help with explanation and clinical reasoning of chronic pain.
The biopsychosocial model views pain and illness as results of the interplay between biological, psychological, and social factors, unlike the earlier biomedical model that focused only on physiological causes. Developed in the 1970s and 80s, it considers both the physical and mental aspects of patients, recognizing that pain can be influenced by various factors, including individual differences.
The model emphasizes the importance of a holistic and interdisciplinary approach to pain management, tailored to each patient's unique symptoms.
Biological component of pain refers to the physical structures that have the ability to feel pain and hence transmit pain messages to the brain. For example, if you have stubbed your toe on a coffee table, the nerves which are connected to the joints, muscles and ligaments of the toe send pain signals through the nerves to the brain indicating pain.
Fun fact: the somatosensory cortex over the brain has an enlarged network of nerve connections that are connected to the limbs, and therefore pain felt over the limbs are typically disproportionately higher and sharper compared to pain felt over the rest of the body, relatively speaking.
Psychological component of pain refers to the exacerbation of pain through the adoption of different thoughts and beliefs over the experience of pain. Think about it - if you are stressed with many things to handle with very little time and sleep-deprived, sometimes the physical pain that you feel can feel magnified. Over time, with chronic pain, what can happen is the development of maladaptive mental models or thought structures:
Catastrophising (apprehension/anticipation - whatever I do it will definitely cause pain so I will choose not to move instead)
Fear-avoidance (I know that bending causes pain, and over time I have learnt to avoid bending...I can live my life so far without bending so it's fine I won't bend any further)
Resignation (I am older so yup, definitely expecting to feel more pain, this is normal and I just have to live with it)
For this component, the patient simply gets 'psyched-out'. In my career, patients who deal with the psychological component of chronic pain often 'doctor hop' - that is to visit numerous doctors and healthcare professionals, which each one giving a different set of management strategies, exacerbating the patient's already anxious state, before the patient decides that it's best to do nothing at all and live with the pain.
Tip: In this day and age where huge amounts of information is at our fingertips, it is easy to be misled with healthcare advice. Always evaluate the explanations given for yourself within the context of the advice given, and do NOT expect quick fixes. The quicker the fix, the faster the pain comes back.
The final component of chronic pain is to do with social component of pain. Nope, this component of pain has little to do with your followers or chats on Whatsapp or Instagram, but more to do with the cultural, environmental factors that can affect how healthcare is utilised and provided.
For example in some Asian cultures, it is common to under-report pain, as having large (however large is defined in this culture) pain is seen as being less masculine, weaker or being perceived to be unable to take hardship. Another example is that if you live in a rural area in a country with a low population density, where the closest healthcare provider requires a half an hour drive away, this will have a significant effect on the timeliness and the channels of which you will receive healthcare.
Last fun fact: What makes healthcare is some cultures difficult as well, is that there is no consistent distinctions in language made for different types of pain sensations. In English, we have 'aching', 'throbbing', 'poking', 'shooting' types of pain. In Chinese, we have terms like 麻痛，酸痛，刺痛, where you can see overlapping terms but with uniquely different meanings and no direct translations.
How does Physiotherapy help with your condition? Check it out on our Tik Tok:
Yeah okay...so is it all doom and gloom from here?
Chronic pain is best managed in a couple of ways. You could have been in complicated life situations and not been able to receive timely treatment, or that you might have been more anxious, less patient about the recovery of your condition. Regardless, here are some perspectives I can offer you that you won't find on Google:
Do not second-guess your treatment plan
Having different alignment in goals and beliefs from your healthcare provider will result in anxiety, mismatched treatment expectations which can lead to the dreaded doctor hopping scenario. Assuming that the treatment plan, strategy, time-frames have been explained to you clearly and logically, it would be best for you to stick with a treatment plan until the improvements taper off before you consider getting a second opinion. After all, healthcare providers such as Physiotherapists and TCM physicians are licensed healthcare providers, which means that they have to undergo a rigourous structured education to obtain their licenses. We know what we are talking about!
Have and maintain clear channels of communication
Mismatched treatment and expectations can sometimes come from a lack of clarity. For example, keeping information from a Physiotherapist (not doing exercises but reporting that it has been done, or going back to running although specifically advised not to) can affect the way that the treatment progresses over the weeks. An experienced Physiotherapist might be able to note certain trends in improvements that are atypical, but as healthcare providers we try not to second-guess our patients.
The quicker the fix, the faster the pain comes back
There are no quick fixes for musculoskeletal injuries. This is so important, I will say this again: there are NO quick fixes for your pain that has lasted for 2, 5 even 10 years. In this modern age where 10 minute Youtube videos to learn something on a topic is considered way too long, and 15 second clips have been shrunk to even a looping 1 second clip, somehow the concept of receiving 4-8 weeks of rehab for recovery from pain seems absolutely absurd. Quick fixes, 'hackexercises', movements and techniques that offer instant relief usually offer short term pain relief. The name of the game of chronic pain treatment lies in long-term solutions, be it exercises, stretching, activity modification etc.
This blog post is rather technical, so congrats for making it all the way to the bottom! I hope you learnt something new from this and if you know someone who is dealing with chronic pain, forward this article to them!
References:
Bento, T. P. F., Genebra, C. V. D. S., Maciel, N. M., Cornelio, G. P., Simeão, S. F. a. P., & De Vitta, A. (2020). Low back pain and some associated factors: is there any difference between genders? Brazilian Journal of Physical Therapy, 24(1), 79–87. https://doi.org/10.1016/j.bjpt.2019.01.012
Bevers, K., Watts, L., Kishino, N. D., & Gatchel, R. J. (2016). The biopsychosocial model of the assessment, prevention, and treatment of chronic pain. touchREVIEWS in Neurology, 12(02), 98. https://doi.org/10.17925/usn.2016.12.02.98
Bolay, H., & Moskowitz, M. A. (2002). Mechanisms of pain modulation in chronic syndromes. Neurology, 59(5_suppl_2). https://doi.org/10.1212/wnl.59.5_suppl_2.s2
Comentarios