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Why it's important to understand your pain in your physiotherapy session
I always think its important to try and explain to patients what it causing them pain. Most importantly that their pain isn't always proportional to tissue damage. And thats why education and advice, in addition to exercises, is so important in the management of any musculoskeletal problem- especially neck and back pain and osteoarthritis.
The medical profession used to believe that pain was always a manifestation of an underlying injury or disease. Doctors focused on treating the cause of the pain, with the belief that the chronic pain would disappear once the injury or disease was cured. It is now known that pain is not a measure of the extent of tissue damage or of how well the tissue is healing but rather a measure of the need to protect the tissue. Think of it as an alarm system, the alarm goes off to protect the tissue which needs time to heal. The brain only gives the pain signal after it has evaluated the threat or danger from a stimulus (it still comes from the brain!).
BUT it has since been found that your pain doesn’t accurately represent the present condition of your tissue. Think of a paper cut or stubbing your big toe- maximum pain but minimal tissue damage. In the 16th century, the French philosopher and mathematician Rene Descartes proposed one of the original theories of pain. His theory proposed that the intensity of pain is directly related to the amount of associated tissue injury. For instance, pricking one’s finger with a needle would produce minimal pain, whereas cutting one’s hand with a knife would cause more tissue injury and be more painful. This theory, the "specificity theory," is generally accurate when applied to certain types of injuries and the acute pain associated with them (fractured bones, injured tendons and ligaments etc). And as the injury recovers and the threat of danger reduces then the pain resolves.
BUT if the pain persists longer than the time it takes for the tissues to heal, then increases in pain are far less likely to be related to tissue damage. This is because the threshold for this pain signal has been lowered. Now think of a false alarm where, rather than the burglar being in the building, a gust of wind rattles the window that sets the alarm off. To deal with this you have to reset the alarm and in the case of your pain you may need to retrain the brain to improve your symptoms. If your pain isnt consistent with an injury timescales then it could be coming from the nervous system.
Watch this brilliant video explaining chronic and persistent pain much bette than I can in a blog post!
Patients often come in to see me telling me that their pain is being caused by a disc prolapse, degenerative disc disease or other conditions found on XRAY: MRI etc. They have been told by medical professionals that the findings found in imaging explain their neck or back pain. But interestingly there is lots of research out that there is little direct correlation between reported pain and radiological (imaging) findings. Read this informative blog post from the Institute of Chronic Pain about degenerative disc pain.
This is also supported with people have findings on MRI scans but have no pain!
So going back to the point of this blog- education and advice and exercises to me are the most important part of any physio treatment but will only work for you when you understand your pain. It's why so many of my patients are happy with their treatment at Pegasus Physiotherapy!
