Pain
Why are we in pain?
In most cases, especially when the pain is recent (acute), the pain is doing us a favor. Indeed, the nervous system is like an alarm system. It warns us of possible danger and helps us protect ourselves.
Acute pain, persistent pain, what are the differences?
Sharp pain
When pain lasts for less than 6 weeks, it is called acute pain. This recent (acute) pain is usually related to an injury (injury), such as a burn.
Persistent (chronic) pain
Persistent pain, also called chronic pain, is pain that lasts for more than 3 months.
Very often this pain is not or is no longer caused by an injury to the body. It was the nervous system that became hypersensitive. The alarm system is disrupted.
What happens in the event of persistent pain?
Several mechanisms can explain persistent pain. Depending on the mechanism, we speak of nociplastic pain, neuropathic pain or nociceptive pain.
Most often, there is no or there is no longer a lesion. It was the nervous system that became hypersensitive. We are talking about nociplastic pain. Persistent pain is frequently linked to this mechanism of hypersensitization of the nervous system;
If the pain is related to an injury or disease of the nervous system, it is called neuropathic pain;
If the pain is related to an injury or inflammation elsewhere than in the nervous system, it is called nociceptive pain.
Often, several mechanisms explain the pain. So even though there is an injury, the nervous system has also become hypersensitive. And it is very often this hypersensitivity, more than the injury, that is the cause of the pain.
A hypersensitive nervous system
The nervous system has become hypersensitive. Pain is not meant to warn and protect the body.
You continue to feel pain even though the lesion has healed;
The pain is not proportional to the injury: what you feel is exaggerated in relation to the injury.
Your pain is real, it’s not ‘in your head’. Just because there isn’t a lesion doesn’t mean there isn’t an explanation for your pain.
The functioning of the nervous system is modified by:
your physical activities;
your sleep;
stress and emotions (sadness, anxiety,…);
your social situation;
your attention to pain, or on the contrary, being busy with something else, especially if this activity makes you happy or is important to you;
your understanding of pain. This is why a therapist who is used to caring for people with persistent pain can explain the mechanisms of pain to you.
The pain you feel can affect:
your well-being;
your relationships with your family, your friends;
your job ;
your mood;
your sleep.
A vicious circle can therefore set in …
The good news is that your nervous system can adapt the other way around, too. You can act on your pain by acting on your lifestyle: physical activities, activities that are good for you, sleep, etc.
Are there many people who suffer from persistent pain?
Not all people with persistent pain see a health care professional. This makes it difficult to know exactly how many people suffer from persistent pain.
It is believed that 18 in 100 adults suffer from moderate to severe persistent pain. It is therefore a serious health problem.
How to recognize persistent (chronic) pain?
Has your pain lasted for more than 3 months?
So you are in persistent pain.
Is your pain related to an over-sensitivity of your nervous system?
This is probably the case if:
your pain has been present for a long time because there is a good chance your body has had time to heal
your pain changes places and tends to spread;
the intensity of your pain changes without an explanation. Sometimes over the same day or over an hour, a mild pain becomes severe, or vice versa;
stimuli which are not normally painful, such as light contact with the skin, cause pain;
your pain appears, without lesion, without activity.
How is persistent pain assessed?
In the majority of cases, a comprehensive approach is necessary to assess persistent pain. Your doctor will therefore often collaborate with other professionals.
Your doctor will look for the cause of your pain:
has your nervous system become hypersensitive?
Is there another possible cause for your pain?
He will work with you to think about what influences your pain.
He will assess the impact of the pain on your life.
Based on this discussion, your doctor may suggest:
to consult another professional for a more specific evaluation, for example a physiotherapist, a psychologist or a pain specialist, a rehabilitation specialist;
a complementary examination, for example:
a medical imaging examination (X-ray, scanner, etc.),
an examination of the functioning of the nervous system,
a blood test
This whole assessment will determine the best treatment for you.
What can you do ?
Persistent (chronic) pain can prevent you from carrying out your activities. If you stop exercising, it can have an impact on your physical condition, on your self-esteem and on your social life. Stopping your activities can also make your pain more persistent and more painful.
Moving is important
Move as much as possible, neither too much nor too little:
gradually increase your activities;
test and respect your limits;
alternate periods of activity and periods of rest.
Do you find it difficult? A physiotherapist who is familiar with patients with persistent pain can help. If necessary, ask your general practitioner for advice.
A healthy lifestyle is also important
get enough sleep;
do you suffer from stress? Talk to someone you trust, find ways that might help you;
eat healthy and watch your weight;
you smoke ? Smoking can have a negative impact on your pain. There are aids to quitting smoking.
Have a good time participating in physical activities and hobbies that make you feel good.
Try to keep working, possibly part time. You can discuss this with your general practitioner or your occupational physician.
If you need any medicine, talk to your doctor.
What can your doctor do?
Together with you, your doctor will work out a treatment plan. He discusses with the professionals you may have met (physiotherapist, psychologist, rehabilitation specialist, etc.).
This treatment plan takes into account:
your needs, depending, for example, on other illnesses such as depression, anxiety, diabetes, …;
your lifestyle;
how you experience pain;
your expectations;
possible goals for you.
In the majority of cases, this is multimodal care.
Multimodal support
Recovering from persistent pain can take time and very often requires multimodal management. This means that the treatment plan includes different means of action (modes of action).
It could be :
information about pain and what can influence it,
activities and exercises adapted to your situation,
advice on sleep,
activities that do you good,
exercises to relax you and relax your muscles,
techniques to help you manage your stress,
psychological support,
medicines that might help you.
It depends on your situation.
Medications
Medication may be helpful for you. Your doctor will then suggest medication to you based on your personal situation. It can be one of the painkillers below.
Classic painkillers
Paracetamol
this is often the first choice;
Anti-inflammatory (ibuprofen or naproxen for example)
instead of or in addition to paracetamol in certain situations;
Be careful, serious side effects on the stomach, kidneys and heart are possible especially if you are older. So,
the lowest effective dose possible;
as short a time as possible.
Specific painkillers that act on the nervous system, for example:
Medicine usually used to treat epilepsy (anti-epilepsy) (eg gabapentin or pregabalin);
Antidepressant (for example, amitryptiline or duloxetine).
Opioid painkillers (eg codeine or tramadol) are almost never recommended for persistent pain.
Always ask your doctor for advice.
Specific pain management program
If the means suggested above (physical activities, sleep, etc.) do not help you enough, the advice of a specialist may be useful, for example in physical medicine or in a pain clinic.
What can you do with your physiotherapist?
If you suffer from persistent pain, we advise you to be accompanied by a physiotherapist (if necessary, specialized in chronic pain).
Pain education
Your physiotherapist can give you information on:
what may explain your pain;
the factors that promote your recovery;
the importance of exercise and a healthy lifestyle.
Support and accompaniment
Your physiotherapist supports you and motivates you to move
as much as possible, neither too much nor too little, taking into account your possibilities and your pain.
Together you will see:
how to do activities and physical exercises that are suitable for you;
how to deal with fears that keep you from exercising;
which exercises and techniques are best suited to your situation:
relaxation exercises,
techniques for dealing with stress,
management of activities.
Together, you will decide on an exercise program that is right for you.
Manual therapy – Manual techniques
In some situations, in addition to pain education, support and guidance (see above), your physiotherapist may temporarily use manual techniques. It can mobilize (passive mobilizations) or manipulate (manipulations) certain parts of your body.