Chronic pain – treatment and management

Chronic pain is an unpleasant sense of discomfort or pain associated with actual or potential tissue damage where the pain has been present for more than three months. Chronic pain can be described by sufferers as continuous or intermittent and it may vary from mild to very severe.

Chronic pain sufferers can experience more than one type of pain. The pain can be defined as being:

  • Neuropathic (nerves causing numbness or weakness) or myofascial pain (muscle and soft tissue pain)
  • Inflammatory pain (infection, chemical imbalance)
  • Visceral (organs)
  • Mechanical ( back and neck pain are commonly related to muscle/ligament strain/sprain, degeneration of disks )

The Pain Gateway and factors that affect our experience of pain

The way people experience pain is very complex. One way to understand how the body acknowledges pain is the pain gate theory.

To keep it simple, nerves spread from the spinal cord throughout the body. In the spinal cord, imagine a series of gates into which messages about pain arrive from all over the body. These gates can sometimes be much more open than at other times. This is important because it is through these gates that messages from your body pass towards your brain. If the gates are more open, then more pain messages pass through to the brain leading to a likelihood of experiencing a high level of pain. If the gates are more closed then fewer messages get through and you are less likely to experience pain.

All sorts of factors influence our experience, including our thoughts and feelings. This particularly rings true with chronic pain sufferers. Again, keeping it simple, imagine you suffer from chronic pain regularly. If you experience pain daily then it is more likely when you wake up in the morning you will expect to experience pain. If you are increasing your focus to experience pain then it is more likely you will feel it. Some of the physical and mental factors that seem to open the gate to pain:

Chronic pain image

To close these gates to pain people need to think and feel about their pain differently; almost, to a degree, embracing and accepting their pain in order to take control of it as opposed to the pain controlling them. Generally speaking, feeling more optimistic has been found to help to close the gates to pain. Exercise can also reduce or manage pain symptoms. With exercise hormones called endorphins are released (we like to think these are our happy pills!). Being involved and taking an interest in daily activities will increase your concentration on the task at hand and distract you from pain.

Treatment of chronic pain

When it comes to treating pain, especially treating chronic pain, it depends on numerous factors like the conditions of the pain, and symptoms. Chronic pain can be managed by treatment and rehabilitation including:

  • Pain relief creams, like zostrix, contains capsaicin which works by reducing transmission of a pain.
  • You can experiment with what opens and closes the gates. You might not be able to remove the pain but you can change the way you think, feel and your daily activities.
  • Joint manipulation can help to relieve the pain and improve range of motion by applying manual pressure.
  • Massage has been shown to ease the chronic pain by speeding up the flow of oxytocin, a hormone that relaxes muscles and encourages feeling of calmness and contentment.
  • Acupuncture can improve the body’s function and promote the flow of energy which keep the yin and yang forces balanced. For example, if the flow of energy (Qi) gets blocked, like water getting stuck behind a dam, the disruption can lead to pain, lack of function, or illness. Acupuncture therapy can release blocked energy (Qi) in the body and stimulate function, evoking the body’s natural healing response through various physiological systems.
  • Regular physical activity and exercises are important part of a healthy lifestyle. Exercise boosts the production of feel-good endorphins, including dopamine, reduces chronic pain and improves function. Physical fitness also benefits people with arthritis, heart disease and diabetes. It helps with managing high blood pressure, balance problems and difficulty walking. A study proposed that 15 minutes a day of moderate intensity exercises might be of benefit in improving quality of life and longer life expectancy.

Physical rehabilitation is one of the basic core principles for managing patients with chronic pain.

When treating a patient, it is important to determine which type of pain they are experiencing, as this will affect the treatment provided. For example, with myofascial pain the treatment will be focused towards restoring muscle balance and function through physical therapy techniques. However, the aim is always to provide the patient with the tools for managing pain and restore function, such as increasing physical activity, improving sleep, setting personal goals, decreasing or managing pain and managing stress.

Elite Therapy is a multidisciplinary sports therapy and physiotherapy clinic in Coventry. We treat a range of injuries both sporting and non-sporting as well as back, neck and musculoskeletal pain. Elite Therapy’s services include assessment and diagnosis, physiotherapy, sports therapy, massage therapy, taping and ultrasound. There is also an on-site rehabilitation gym, and a studio for Pilates and yoga classes.