Chronic pain can be incredibly debilitating for those who experience it. Generally, it is defined as pain lasting over 3 months, but most importantly, beyond the body’s normal tissue healing times. Some common chronic pain presentations include, but are not limited to:
- Chronic lower back pain
- Fibromyalgia
- Osteoarthritis
- Chronic headaches
Even if experiencing only mild pain, it can become extremely exhausting when affected on a daily basis, and it can get in the way of doing the things you love. Over time, this can heighten your perception of the pain and take a toll on your mental well-being. It can even lead to a mental and physical downward spiral, if not managed and attended to correctly.
So, what does chronic pain mean, how does it come about, what are the self-management strategies and how can osteopaths help to better manage it?
Acute vs. chronic pain
Acute, or ‘nociceptive’ pain, as the name describes, refers to pain resulting from tissue injury. This could for example be a sprained ankle, a skin cut, or muscle ache after an intense training session. Depending on the injury, it may feel sharp and throbbing or achey. The reason why we feel pain in this acute phase, is because the injury triggers the release of inflammatory mediators. As a result, immune cells flood the injury site and increase the sensitivity of free nerve endings in the tissue (Want to know more? Feel free to refer to the blog post about inflammation!). The site of injury is therefore much more sensitive to touch, weight bear, and just generally sore. This makes a lot of sense knowing that all those mediators promote the area’s healing and further act as a protective system, warning the body of any further harm to an already injured site.
Only if the area is constantly sensitised, repeatedly aggravated or healing is otherwise hindered, do we run into the problem of ‘chronic pain’. This is where things get a lot more complex. Research has found that ongoing, prolonged pain, can actually alter the body’s neural pathways. This means that the brain might interpret something as painful that usually does not cause pain or otherwise misreads the signal, setting off constant ‘alarm bells’, that can cause immense frustration and overwhelming mental and physical strain.
What to do?
You can probably already guess by now, it is crucial to avoid an acute injury to develop into a chronic one, as this is far more difficult to live with and manage. This is where osteopaths can play a vital role. An example? - A sprained ankle, without appropriate care and treatment can easily turn into chronic ankle instability and reoccurring ankle sprains that can develop into chronic pain.
Some chronic pain presentations unfortunately can’t be prevented, such as genetic conditions like fibromyalgia or Ehlers-Danlos syndrome. With that in mind, let’s explore some tips on how you can manage your symptoms and when it’s time to seek help from your osteopath.
Self-management
- Stay as active as possible.
Research shows that moving your body is often key. Light strength training for example can improve function and reduce pain. If the pain does not allow for heavy exercise, doing walks can be just as beneficial. It will likely also have a positive effect on your mental health! However, this should not worsen your pain significantly, and definitely should not leave you bedridden for days afterwards. Please make sure you chat to someone before getting started. Your osteopath can help find the right balance, ensuring you don’t overdo it. More on that below.
- Find a relaxation routine.
Everyone relaxes differently. Some love to meditate and do yoga, others unwind best when listening to a true crime podcast! What matters most is that it helps you taking in a few deep breaths and release some tensions through the body. Find what works best for you, and make it part of your daily routine.
- Maintain a good diet and healthy weight.
Particularly with Osteoarthritis and other chronic joint pain, maintaining a healthy weight can significantly reduce pain and decrease the load on the joints affected. Again, this needs to be assessed on an individual basis and may require the help of a dietitian.
- Improve your sleep.
We’ve all experienced how much worse everything seems when you’ve had a night of poor sleep. Increased irritability and increased sensitivity are common on days when we’re not well-rested. If the pain interrupts your sleep, it can create a challenging cycle. To improve your sleep quality, consider incorporating mindfulness practices before bed, reducing screen time or enjoying a warm bath. Ultimately, find what works best for you!
How can an osteo help?
Chronic pain can present a unique challenge for practitioners due to its multifaceted nature. However, here are some key areas where an osteopath can assist you:
- Individualised stretch/ exercise program
Chronic pain sometimes means that moving can be almost too painful to do. This is where an approach comes into play that we call ‘graded exposure’. It involves finding the optimal balance where movement is manageable without causing excessive soreness afterward. It is all about finding that ‘sweet spot’ in between! This often involves starting with very low levels of activity and gradually increasing the amount and intensity. The key is to stop before the pain kicks in, in order to prevent setbacks. Again, it is very important to tailor this to the patient and their individual complaint.
- Facilitation of referrals and help with setting up the right care team
When managing chronic pain, it can be beneficial to have multiple people involved in the patient’s care. This might include your GP, a psychologist, exercise physiologist or dietitian. We can help with navigating the health care system and liaising with your GP to ensure you have the best possible support from your care team. You may be already aware, but patients with chronic pain are generally eligible for a ‘Chronic Disease Management’ (CDM) plan which provides Medicare subsidised allied health treatment for up to 5 sessions. This is subject to the individual case and is decided upon and established by your GP.
- Pain relief through manual treatment
Studies have shown that manual therapy can have a beneficial effect on nervous system and muscle tension, pain and stiffness. When combined with lifestyle advice and exercise, it can significantly reduce pain and improve overall quality of life.
….What is the take-home message?
Chronic pain can be extremely exhausting and frustrating to manage. While many forms of chronic pain take a long time to improve – and some even may never fully resolve – there are effective strategies to take control of your pain. By actively managing your condition, you can lead a more fulfilling and positive life despite the challenges. If you have any questions, reach out to our team and see how we can help you!
References:
Garnæs, K. K., Mørkved, S., Tønne, T., Furan, L., Vasseljen, O. & Johannessen, H. H. (2022). Mental health among patients with chronic musculoskeletal pain and its relation to number of pain sites and pain intensity, a cross-sectional study among primary health care patients. BMC Musculoskeletal Disorders, 23(1). https://doi.org/10.1186/s12891-022-06051-9
Kishikawa, Y., Tanaka, S., Iwanaga, K., Nakagawa, I., Shiotsuka, T., Tsuda, N., Kobachi, Y., Hirano, K. & Murakami, Y. (2022). Effects of pain-related catastrophic thinking, anxiety, and depression on pain intensity and quality of life in patients with knee and low back pain. Journal of Physical Therapy Science, 34(9), 625–629. https://doi.org/10.1589/jpts.34.625
Shepherd, M., Louw, A. & Podolak, J. (2018). The clinical application of pain neuroscience, graded motor imagery, and graded activity with complex regional pain syndrome—a case report. Physiotherapy Theory and Practice, 36(9), 1043–1055. https://doi.org/10.1080/09593985.2018.1548047
The Royal Australian College of General Practitioners (2019). Views and attitudes towards physical activity and nutrition counselling in general practice: National survey report. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/snap
Vergne-Salle, P. & Bertin, P. (2021). Chronic pain and neuroinflammation. Joint Bone Spine, 88(6), 105222. https://doi.org/10.1016/j.jbspin.2021.105222
Yang, J.-X., Wang, H.-F., Chen, J.-Z., Li, H.-Y., Hu, J.-C., Yu, A.-A., Wen, J.-J., Chen, S.-J., Lai, W.-D., Wang, S., Jin, Y. & Yu, J. (2022). Potential neuroimmune interaction in chronic pain: A review on immune cells in peripheral and central sensitization. Frontiers in Pain Research, 3. https://doi.org/10.3389/fpain.2022.946846
