Persistent Pain
“How you think about your pain can change the way it feels” – Professor Lorimer Moseley; pain scientist.
1 in 4 people experience persistent pain (pain which lasts longer than 3 months). Professor Lorimer Moseley suggests that pain lasting longer than 3 months is not an indication of damaged tissue, rather the brain and nervous symptom’s response to sensitivity; having experienced it for so long.
Pain acts as a warning signal from the brain telling you to protect your body. This is very necessary when we have an injury. However, these warning signals can persist and cause stubborn pain. The body’s ability to become conditioned to or develop a learnt response is reflected in the case of Pavlov’s dog. In an experiment designed to showcase conditioning, every time Pavlov’s dog was shown food, it salivated. At the same time that the food was shown, a bell was rung. This was repeated each and every time the dog received food. With time, the dog began to salivate at the ring of a bell, without food present. Pain can be conditioned in a similar format. The longer you experience it, the better the body becomes at producing it. If you’ve had pain for more than 3 months, the pain system becomes well practiced and eventually causes structures to become more sensitive and hence accustomed to responding in learned ways- making pain a habitual response.
Fortunately, all is not lost. It is suggested that the pain system can be retrained, regardless of how long it has been over sensitised. Current literature suggests that retraining thought processes, emotions, diet and lifestyle, and physical activity can reverse the effects of persistent pain.
Commonly, people behave in one of two ways when they have persistent pain; they either avoid movement or they excessively over-do it, regardless of the pain experienced. Ultimately, both lead to an unsustainable lifestyle of fluctuating pain levels. A method known as the pacing cycle has been suggested to help counteract this and target the pain.
The suggested cycle includes getting to know your pain 1-2-1 and forming a plan to slowly increase what you can currently do.
-Pacing suggests first figuring out your baseline- How long you can complete a specific desired activity (i.e. housework, or a daily commute) without experiencing symptoms or flare ups.
-Step two incorporates doing this activity once a day, 7 days a week for the period of your baseline.
-Once manageable, step 3 suggests that you should attempt to increase your baseline for that activity by a small amount (even if it’s an extra minute).
-Step 4 encompasses gradually increasing the activity week by week, day by day.
-For step 5 gradually break the activity down into small bouts and repeat multiple times during the day to build up a tolerance.
-Once you’ve got the hang of this, you can begin setting further goals.
Remember, always take the rests you feel you need! If you’ve managed to increase walking from 10 minutes to 20, but still require a 5-minute break in between, that is still progress and is still needed. Begin decreasing the rests once adapted. See the table below for an example.
If you need help with motivation, adherence, safety with movements, risk of injury or require further advice and support, Physiotherapy is a great place to begin! Here we can discuss your individual situation, assess and screen your movement patterns and tailor a personalised rehabilitation programme for you where you will receive individualised support from day one; helping ensure you remain on track and in control of your recovery.
| Activity | Baseline | Can do on a good day | Will aggravate |
| Walking/Daily commute | 10 minutes | 15 minutes | 20 minutes |
| Housework | 15 minutes | 15 minutes | 20 minutes |
| Playing with the children/pets | 5 minutes | 10 minutes | 15 minutes |
| * | Week 1 | Week 2 | Week 3 |
| Walking/Daily commute | 10 minutes | 11-15 minutes | 12-20 minutes |
| Housework | 15 minutes | 16-20 minutes | 27-25 minutes |
| Playing with the children/pets | 5 minutes | 6-10 minutes | 7-15 minutes |
* Remember, only focus on one key component for the first few weeks until you have reached your goal
