Questions you may find useful to understand your pain
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How do I know if my pain system is being over protective?
If you have had pain for more than a few months then your pain system will be more efficient at producing pain. This is what happens over time – your system becomes more sensitive. It learns pain.
You will know this is happening when your body starts to feel more sensitive than it did previously. Or activities that used to cause a little pain now cause a lot of pain. Instead of improving as your injury heals, the pain might continue to get worse. This can feel like your injury is getting worse, but that is very unlikely.
Other signs your pain system is becoming over protective include:
- Your pain might spread, or it might move from one side of your body to the other, or from one location to another.
- The pain of old injuries returns again.Movements or activities that were not previously painful start to be painful. Sometimes, all movement seems to be painful.
- You might have muscle spasms. They can be frightening, particularly if you don’t understand them or know what caused them. They are another way your body protects a painful area. They are not a sign that you have damaged something.
- You might start to find small things – for example some sounds or smells, become and more intense and start to annoy you or put you on edge. For some people, even the touch of clothing on the skin can become painful.
When your pain system is overprotective, pain can be heavily influenced by your thoughts, feelings and other things going on in your life – things that actually have nothing to do with the painful body part! Pain scientists understand how this works. Many people don’t understand it – even some health professionals. But be assured that an over protective pain system is not a sign you have a weak personality or a weak mind; it does not mean you are going crazy and it does not mean your injury is getting worse or your body is falling apart. It means your body is doing too good a job of protecting itself.
Our pain system is over protective when it stops us doing the movements, activities and other things and that are actually necessary for recovery.
How can I train my pain system to be less protective?
There are actually many ways to retrain your pain system, but they all begin with understanding your pain. In fact, understanding that pain is much more complex than a signal from damaged tissues is one of the best things you can do to start your journey to recovery – many people say that their pain began to reduce as soon as they understood it better. We have listed some resources you can use to increase your understanding of your pain.
The goal is to re-train your pain system back to providing protection when you need it, but not when you don’t. It is good to know that injured tissues heal, even if they don’t look the same as they did before your injury. And it is good to know that your body can adapt back to being stronger and fitter and less painful.
Start by developing an accurate understanding of your pain system. Understanding is important because it changes the meaning of pain, and this will give you the confidence to move - even when it hurts. A good coach will help you identify the things that make your pain worse and things that make it better. A great coach, with training in pain science for example a current thinking physiotherapist, will teach you how to plan your recovery, one week at a time, and encourage you to persevere and ‘train smart’. Remember your coach can guide you, but this is a journey that you have to take.
You can start without a coach too - moving just a little more than you normally would and doing something that lifts your heart rate – little by little – is actually the best way to train your system to be less protective. You might have to be patient – sometimes it is slow going and you can have set-backs – but remember pain is protecting you, not telling you that you have damaged yourself.
Two things the brain loves are surprises and wins, so build them into your training whenever you can. Mix it up. Set attainable goals. Your coach can help you with suggestions and ideas, but spontaneity is also good. Combine your movement and exercise with things that make you smile, even if they are memories!
Never forget that your brain is always looking out for you. Even thoughts and feelings, social interactions, and life’s day-to-day events can powerfully influence your pain. Remember too, the trick is not to avoid all life’s challenges but to retrain your system to cope with them.
Sounds challenging right? Well it is, which is why you might need some coaching. Take a long-term approach – this is a journey. Build a support network that can help you if things get tough.
How do I know if I am safe to move?
Movement is the most critical pathway to recovery and it is almost always safe to move. A health professional will be able to tell you if you are the very rare case for whom it is not safe to move. A health professional who understands modern pain science can talk you through why it is safe for you to move even though you have pain. They can tell you how much you can push it, and how you can best negotiate the pathway to recovery.
Get a health professional to check you over and give you the ‘OK’ to move. They can also help you understand that many things found on scans are perfectly normal and common, even in people who do not have pain.
It is usually best to start gently with a simple movement such as walking, because you need to retrain your pain system, which will be trying to protect you.
Injuries heal, and your body’s tissues adapt amazingly well to the demands of life. Even if things don’t heal perfectly, they nearly always return to close to normal function. That doesn’t mean we stop hurting. In fact, back pain can be severe even when there is no detectable tissue damage at all!
Did you know an injured ligament in the ankle is much less likely to become a persistent pain problem than exactly the same injury in the back?
Did you know that ‘disc bulges’ are so common in people without back pain that many scientists think they are not abnormal but a common and normal part of ageing? 50% of 40 year olds without back pain have a disc bulge!
If you were injured more than three months ago then a vast amount of healing has already happened. Don’t underestimate how magnificent and irresistible this healing capacity is.
It does not mean that your body – inside and out - will look exactly the same as it did before injury, but it does mean that your tissues have found strength in their new state.
Knowing and believing that you are safe needs repetition and practice, and 'stacking up the wins', as you prove to your overprotective pain system that it does not need to be so protective.
How do I know my health professional understands modern pain science?
Ask them these questions (they should say yes to each one!):
- Do you understand and believe the biopsychosocial model of pain?
- Have you ever heard of Explaining Pain?
- Can you help me understand my own pain system?
- Can you teach me how to manage my own recovery?
- Can you give me skills to master my situation?
Here are some more questions that we hear from people who are ready to take the journey to recovery.
Perhaps you relate to them?
Will I re-injure myself?
An over protective pain system reduces your risk of re-injury. This is because your pain system will alert you to danger much sooner than a normally protective pain system would.
An over protective pain system gives you a big buffer between when your pain system cuts in to protect you and when your body actually needs the protection. That is the whole point of your body learning pain.
No one can completely eliminate all risk of injury – we can’t control everything. But if you are not very unlucky or very stupid, then your chances of injuring the painful body part are very low. Remember, even if injury does occur, then your body is perfectly capable of healing and re-adapting again. Consider sportspeople who have multiple injuries and re-injuries, and yet in most cases return to their sport.
As you begin to challenge yourself physically it is important to realise that an increase in pain does not mean an increase in injury. An over protective pain system will often alert you as you try new tasks, but remind yourself that it is protective, not a sign of damage. If a flare-up lasts longer than usual, or you have had a significant accident and you are concerned, ask your health professional to give you the all clear.
Rest and avoiding activity and movement tends to make an over protective pain system even more protective. The chance of ongoing pain is higher if you stop moving – your system adapts to being stationary. Exercise and movement are the best way to reduce your pain. As you load your tissues you will become stronger, and your stronger body will be more resilient to injury. Exercise and movement turns down your protection setting.
Will I get better?
Many people don’t realise how much patience, persistence and courage it takes to get better. But if you stick at it, remain patient, and be brave when you need to be, then all the evidence we have tells us that you will slowly get better. Belief in this, and building your own sense of optimism about the future, are important for your recovery.
The most common reasons that people don’t get better is that they avoid everything that hurts or they do everything regardless of how much it hurts, until they give up because it is too horrible. The is called the ‘avoidance pathway’. The second is called the ‘boom-bust cycle’.
The third way is the best. Understand your pain. Get a plan to slowly increase what you are doing and stick to it. Be patient. Be persistent. This is the best thing you can do to recover.
How can I speed up my recovery?
Your body has an in-built recovery system – you just have to help it along. To make it as quick as possible is more about avoiding things we know slow it down. For example:
Don’t go looking for a quick fix magic pill or injection or online gimmick to fix your body for you – you need to retrain your system and no one else can do that.
Eat fresh fruit and vegetables and limit your sugar. Vegetables are anti-inflammatory. Sugar slows down recovery.
Get enough sleep and get a good sleep habit. Sleep is anti-inflammatory. Poor sleep slows down recovery.
Learn new ways to reduce stress. Anxiety and depression slow recovery. A good psychologist can give you effective methods to reduce anxiety and depression.
Stick to your plan.
Ask your doctor ‘Can you help me slowly reduce my pain medications?’ Some pain medications actually slow your recovery.
Keep testing your new sense of what’s possible. Aim to be active on most days - even if just a bit. Track your progress, set some goals, and think about the things you will be able to do when your pain is better. People recover at different speeds, with persistence, most people will get better.
Is all this learning new skills and information really helpful?
Amazing as it sounds, learning new things – skills and information – is anti-inflammatory! Keep up your journey of understanding of pain by reading new things, watching (good!) YouTube clips like those listed below. Keep learning!
Read blog posts and books. If you don’t read – that is ok - listen to podcasts or audiobooks and watch videos to stay fresh on the information – but choose your information carefully. Look for information that is backed by good quality research.
Usually a website that has “.org” or “.gov” in it is likely to have more accurate information. These sources will paint a positive picture for your recovery.
How do I help others?
Once you start to understand pain and you notice you are recovering, then you might want to spread the word that recovery is possible. You might want other people to know what you now know. You might want to inspire the millions of people out there still suffering. Well we say – Do it! You can do this via social media, via volunteering at your local pain clinic, helping out at public events etc
People who have been through it make great coaches. No matter where you live, there is likely to be some way you can ‘give back’. The coolest thing about this? Giving back keeps your system fit, lively and healthy.
Did you know that volunteers live longer? :)