Mythbusting Chronic Pain

Wednesday, August 31, 2016

In my 8 years working as an Occupational Therapist, I’ve heard lots of misunderstandings and misinterpretations surrounding chronic pain. In order to debunk some common myths about chronic pain, I’ve channeled my inner mythbuster.

In order to get to the bottom of chronic pain, it’s important to understand what pain is. I usually refer to a few definitions to guide both my work, and also my client’s understanding of their current circumstances. Regardless of whether we are talking about pain or chronic pain, we need to start with the understanding that pain is complex.

Definition 1: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage1.

Definition 2: Pain is a multisystem output that motivates and assists the individual to get out of a situation that the nervous system perceives as dangerous2.

Definition 3:  Pain is whatever the person says it is, and wherever the person says it is3.

But what is CHRONIC pain then?

Chronic pain is pain without apparent biological value, lasting beyond three months, or beyond normal tissue healing time.  More simply stated – pain lasting longer than three months or pain persisting beyond the reasonable amount of time for an injury to heal.

Chronic pain may arise from an initial injury, such as a back sprain, or there may be an ongoing cause, such as illness. However, there may also be no clear cause. Other health problems, such as fatigue, sleep disturbance, decreased appetite, and mood changes, often accompany chronic pain. Chronic pain and fear of pain and re-injury may limit a person’s movements, which can reduce flexibility, strength, and stamina. Reduced tolerance for activities results in difficulty carrying out normal life activities, leading to disability and despair.

Now that we know what chronic pain is, let’s bust some myths and misconceptions around it.

Myth 1: A client will not benefit from ongoing therapies/treatment because too much time has passed.

Many people can continue to benefit from therapies and treatment, even years post-injury, I’ve seen it. For example, many people with chronic pain continue to move their bodies in ways that have helped them to lessen the pain.  These non-optimal compensatory postures that developed to protect the injured area can cause ongoing muscle and ligament weakness. With professional help, these issues can be slowly resolved, or at least improved.

Progress is often slow, but slow and steady wins the race, so to speak.  Many therapies also provide some short term pain relief, which allows people to function more easily and consistently, even though the pain relief is only temporary. Occupational therapists often assist people in pacing their activities so that they can gradually resume activities in a way that promotes improvement and decreases pain-guided activity, which generally leads to an overall decline in function.

Many chronic pain management programs help people in their recovery many years after their injury.  I’ve worked on a number of different chronic pain programs that had admission criteria varying from one to seven years post-injury.

Myth 2: They don’t look like they are in pain, so it must all be in their head.

It is. The brain has a big role to play in chronic pain. But that doesn’t make it any less of a real medical condition.

Are you surprised by my answer? Dr. Lorimer Moseley, Clinical Neuroscientist,  explains the linkage between pain and the brain: “Pain is the end result, pain is an output of the brain designed to protect you. It’s not just about the tissues of the body.”

Dr. Moseley explains “Why Things Hurt” in a TEDxTalk from a few years ago. I highly recommend that you take the 14 minutes to watch it, it’s very informative, and as a bonus, quite funny.

Myth 3: The client probably just needs to increase their dosage of medication, that is the best way to manage chronic pain.

Medications, when managed by a physician, can play a central role in helping a client’s chronic pain. These are not just limited to pain management, but anti-anxiety, anti-depressant, and sleep medications can also help to provide relief.

But medications are just one facet of overall chronic pain management. Proper nutrition, sleep hygiene, gentle exercise, and massage, physiotherapy, and occupational therapy can be wonderful tools to help clients feel better and resume living.  And these are just the tip of the iceberg, there are roles for meditation, mindfulness, yoga, psychological intervention…. I could go on all day.

Myth 4: Thinking a lot about pain won’t make it any worse.

Dwelling on pain can make people’s worlds feel smaller. It is not uncommon for people living with chronic pain to also experience depression and anxiety, some of which is rooted in isolation, loneliness, and grief for their previous pain-free lives. In turn, these thoughts can make people feel worse.

Research has indicated that dwelling on pain can make it worse, but can also increase an individual’s sensitivity to pain. Moreover, it has been shown that depression and chronic pain evolve simultaneously, or as a comorbid process for those of us who like to be technical4.

In these cases, it’s important to reach out to support networks, including medical professionals like family physicians or psychologists.

Myth 5: The best thing to do when in pain is to push through it and continue with day-to-day activities like nothing is wrong.

In fact, this might be the worst thing that someone can do. Many people get into the unhelpful pattern of doing as much as they can on a good day and then they end up paying for it with increased down time, or bad days.  Often referred to as the push-crash cycle, the overall pattern of pain-guided activity very often leads to less and less activity over time.  People can learn to break the push-crash cycle by implementing appropriate pacing strategies, as well as thoughtfully planning daily activities, including rest or break periods.  Even within one activity, people have to learn that it’s not helpful to push into their pain, but to push into their tolerance – stopping before the pain tells them to stop.  It’s a whole new way of listening to the body, responding to the pain, and retraining the nervous system.

Myth 6: I don’t see how s/he is in pain, they don’t look like they are in pain.

Many people with chronic pain have good days and bad days.  Some people hide their pain well from others.  Some people don’t.  On good days, people have a tendency to try to get things done or to enjoy themselves, which usually leads to over-doing it and crashing.  So, on a good day, when they can function better with less pain, one has to remember that this is usually part of a cyclical push/crash pattern that leads to less and less activity over time.  It’s hard to resist doing more when you’re feeling good!

Myth 7: Exercising or being active will just make pain worse.

Exercise can play a huge role in a client’s recovery. In addition to physical benefits, exercise can help people with chronic pain feel better emotionally. Gotta love those endorphins!

The key to exercising when living with chronic pain is to pace, be kind to yourself, and seek support. What I mean by that is not over do it (remember the push-crash I talked about earlier), participate in gentle exercise, recognize that your body may not respond to exercise in the same way that it used to, and seek guidance from fitness professionals experienced in working with people with chronic pain.

Not sure where to get started? Yoga, aquafitness, Tai Chi, or going on walks are all great options.

Myth 8: The client just needs to learn how to live with the pain.

Many people with chronic pain try to manage as best they can and are waiting for the pain to go away.  We don’t have a cure for chronic pain, but we can give people the tools that they need to improve their quality of life and the impact that pain has on their lives, so that they can start living again.

There are strategies that can be learned. There is relief to be had. There is hope.

Modern OT runs a multidisciplinary Chronic Pain Management Group that provides people the tools that they need to help live more engaged, healthy, and happy lives. Our next session is about to begin, space is limited. Contact us to find out more.

  3. McCaffery, M., Beebe, A., 1989. Pain : clinical manual for nursing practice. C.V. Mosby, St. Louis.