Pain and the brain

What do you think the primary treatment option is in helping people recover from persistent pain (according to the most recent research)? Would you guess medicine or a specific pain drug? Relaxation techniques? The answer may surprise you. The following post explains some of the mechanisms behind the pain experience. Some of the concepts may seem counter-intuitive. That’s okay! We expect a certain amount of resistance when talking about these concepts due to the relative newness of the research. I know I was challenged, and physical therapy is my field of study.   

Let me begin with an analogy. If you sprained your ankle, would it hurt? Of course, I would lose all credibility right now if I told you, “Nahhh, ankle sprains aren’t painful; suck it up”. Let’s now pretend you are crossing the street with your ankle sprain, and an oncoming bus is headed straight for you. Do you run out of the way and forget the ankle, or do you continue to limp and grab your ankle sprain in pain? My guess is most of you would say, I would run out of the bus’ way and forget the ankle sprain for the moment. Why is this important? It shows that the body and brain are capable of decreasing pain presentation when another outside threat is more important. This analogy demonstrates how pain is based on perception of threat. ​


Now, let’s go back to my original question: What is the primary treatment option in recovering from persistent pain? Pain education is actually the number one and first line treatment we as physical therapists use to help you get rid of your pain. Surprised? If we can reeducate you in how your pain is perceived, we can actually treat, reduce, and often eliminate it! Let’s continue with some more reasons why pain education is so important.


Have you ever examined your body and noticed a random bruise? Do you remember how you got the bruise? My guess is that at some point you randomly bumped yourself. Now this creates local “tissue damage”, but does it hurt and bother you continuously? No! You are able to move on from it, and continue with your day-to-day life. This analogy demonstrates how tissue damage does not necessarily equal pain. Did you know two thirds of individuals over seventy years old have rotator cuff tears, and they don’t even know it because it doesn’t hurt? Likewise, there is only a 50% correlation between knee pain and arthritis. That means that the correlation is quite weak. Also, disc herniations are most often reabsorbed by 50% in 6 weeks, and completely healed at a year. The takeaway message from these examples is that tissues heal. It is encouraging to know that we can treat the arthritis and disc herniations with pain education, exercise and medicine, rather than surgery!

So where does that leave those who suffered an injury, and now years later are still in pain from it? It means there are treatment options. Starting with a comprehensive evaluation, a PT may be able to help decrease your pain, even in the presence of MRI findings like: bone spurs, osteo-arthritis, rotator cuff tears, meniscal tears, ACL ruptures, degenerative disc disease, disc herniations, and etcetera. Persistent pain works with your brain in a unique way that can be treated with pain education, exercise, relaxation and medicine. Often times calming persistent pain starts with calming your brain to body connection down. This is where education and exercise can help to turn down a ramped up system. The bottom line is, there is hope!

Please feel free to comment or email mikevanderlaan@hudsonvillephysicaltherapy.com and as always, thanks for reading!*

Author: Mike van Der Laan PT, DPT

Sources:
*Credit to the following for content and analogy use:
“Teaching People About Pain” by Adriaan Louw PT, PHD, CSMT
www.medbridgeeducation.com

---