Written by Raina Hawthorne
Registered Physiotherapist
So, all your tests are clear, but you're still in pain. While it may be reassuring to know there aren't significant physical issues, it can also be incredibly frustrating to experience pain without a clear diagnosis or effective strategies for relief.
This is something I hear often from the clients I work with as a Physiotherapist trained in persisting/chronic and complex pain issues. The good news is that there are things that can help get relief from the pain.
Our pain system is complex, and as our understanding of it has evolved, so have the strategies we use to address pain. When it comes to managing persisting (chronic) pain, it's important to grasp how our pain system works. This knowledge can help us find more effective ways to manage and reduce pain, even when traditional treatments haven't worked.
The Three Key Components of Pain
Our pain system has three main components: tissues in the body (like muscles, tendons, and ligaments), nerve structures that transmit pain signals, and the brain, which interprets those signals. Historically, pain management has focused heavily on the first component—our tissues. While it's important to address physical injuries or conditions, focusing only on the tissues leaves out two critical areas: the nerves and the brain.
Acknowledging these other parts of our pain system does not mean that pain is "all in our heads" or that a positive attitude will solve everything. But for many people, the pain system has become so protective that they aren't able to make meaningful and necessary changes to the tissues, at least not without pain flaring up and setting the process back. Often, by addressing these other areas, we can make real progress in reducing pain and improving function, allowing us to then build strength and resiliency in the tissues.
Understanding Pain: Pain ≠ Tissue Damage
One of the most important things to understand about pain is that we don’t actually have “pain nerves” in our bodies. Instead, we have nerves that send information about changes in the body, like stretching or pressure, temperature (hot or cold), and chemical changes such as inflammation. Some of these nerves detect harmful levels of these changes, known as noxious stimuli, and send a 'danger' signal to the brain.
For example, if you're running your hand under water and the water starts to get dangerously hot, specific nerves in your skin called nociceptors are activated. These nociceptors send a signal to your brain, alerting it to the potential danger. The brain then tells you to quickly move your hand away from the danger by giving you a pain signal. This response is part of a protective system to help us avoid injury. (It's not very helpful to just be told after-the-fact that you burnt your hand!)
Why Does Pain Persist?
When pain persists long after an injury has healed, it can become more about the nervous system's heightened sensitivity than about actual danger or tissue damage. The brain and nervous system are often on high alert, like a house alarm that goes off when someone simply rings the doorbell. While there may be danger, sounding the alarm to the doorbell is too soon and too big of a response. This ramping up can happen if the nerves have adapted and learned to send danger signals more easily. This adaptation can happen in as little as three months of being in pain. The brain can also become more protective, responding differently when danger signals are received.
The good news is that this heightened sensitivity can be reversed. However, it takes time, patience, and the right strategies.
Reversing the Cycle: Managing Chronic Pain
To effectively manage persisting (chronic) pain, it’s essential to focus on all three components of the pain system. Before we can effectively treat the tissues in the body, we often need to retrain the nervous system to calm down and respond more accurately. Without addressing the nervous system's sensitivity, it can be difficult to make progress with traditional treatments like strengthening exercises or muscle relaxation techniques. Techniques like neural retraining, mindfulness practices, and gradual exposure to movement can help reset the nervous system and reduce pain sensitivity.
It’s important to remember that pain is a real experience, even if there’s no clear tissue damage. Our pain systems are complex, and the way we experience pain can change with the right support and strategies!
Reach out if you're struggling with persisting (chronic) pain. You can also check out reliable sources like the NOI group (https://www.noigroup.com/about/) for resources to support your care or work independently.