Why we feel pain in the first place
Chronic pain can show up as throbbing, stabbing, pinching, aching, or any number of uncomfortable sensations. Our bodies are built to feel pain when something is wrong or tissue is damaged, it’s part of the body’s defense mechanism, a signal to act and prevent further damage. Special nerves called nociceptors detect tissue damage and send signals along the spinal cord to the brain, which decides how to respond. Touch a hot surface, and a message travels through a reflex arc in the spinal cord, contracting your biceps and pulling your hand away before you’ve consciously registered the burn. Step on something sharp, and your hamstrings contract the same way, bending your knee to pull you off it.
Where acute pain ends and chronic pain begins
Pain is categorized as acute or chronic. Acute pain can be mild or severe, is usually short-lived, and signals that the body has been injured, the earlier it’s managed, the better the chance it resolves. Chronic pain, by contrast, is ongoing, typically lasting longer than six months, and is often the result of a condition that requires continued treatment.
Have you ever felt pain that seems endless, discomfort that persists no matter what you try? That may be chronic pain, and it seriously affects daily activities, social life, family, and overall quality of life. It’s recognized as a major public health problem with real economic and social costs. Chronic pain can affect a person biologically (through injury, trauma, infection, illness, cancer, or nerve damage), psychologically (through sleep disruption, fear, anxiety, depression, and coping difficulties), and socially (through work, family, and relationships), all of which can add up to a serious hit to quality of life.
Don’t ignore the psychological side
It’s common for patients to focus so heavily on relieving physical pain that they neglect its psychological effects, but ignoring the toll chronic pain takes on the mind is a mistake, since your mental state can aggravate physical pain and make it harder to manage. A few ways to cope with the mental side of chronic pain: learn about your condition to reduce fear of the unknown; practice meditation and mindfulness, focusing on the here and now; exercise as much as your clinician allows; consider talk therapy with a mental health counselor; and, when needed, medication for insomnia, depression, or anxiety.
What to avoid: self-medicating. Substances might temporarily numb physical or emotional pain, but they’re never a good long-term solution.
Physical therapy’s approach to chronic pain
Physical therapy treats pain in several ways. It can strengthen muscles and joints and teach you to move and perform daily activities without aggravating old injuries or risking new ones. It can treat inflammation and address the movement dysfunction at the core of much chronic pain. And it can help re-educate your central nervous system to make it less sensitive to pain signals altogether.
Treatments your physical therapist may use
Patient education: your physical therapist can’t be with you around the clock, so part of the work is empowering you to perform exercises correctly, move in protective ways, and make lifestyle choices that support recovery on your own.
Exercise: some is passive, with the therapist moving or stretching your body for you; some is active, done under your own power. Both strengthen muscles, improve flexibility, increase joint mobility, and stabilize weak or painful joints.
Manual therapies: hands-on treatments such as massage, which eases pain and promotes healing by relaxing muscles and boosting circulation; soft-tissue mobilization, which increases joint mobility by breaking up scar tissue and addressing myofascial adhesions; and direct joint manipulation to restore alignment and function.
Transcutaneous electrical nerve stimulation (TENS): a low-voltage current delivered through skin electrodes that intercepts pain signals from nearby nerves and may boost production of endorphins, the body’s natural painkillers.
Hot and cold therapies: applying heat or cold to a painful area to reduce inflammation, relieve pain, and promote healing.
Graded motor imagery (GMI): uses the brain’s own plasticity, through techniques like visualizing movement without moving, mirror therapy that tricks the brain into “watching” a weaker limb move, and left-right discrimination exercises, to recalibrate the parts of the brain involved in pain recovery and rebuild confidence in physical strength.
Sensory re-education: for pain that persists even after an injury has healed, because an overwhelmed nervous system keeps sensing pain regardless, this approach uses light stimuli on both the affected and unaffected areas so the brain can compare sensations and gradually reduce sensitivity in the affected area.
You don’t have to live with it
Many physical therapy interventions can treat, or even fully relieve, chronic pain without surgery or medication. If you’re living with chronic pain, don’t give up, with the right treatment, you can enjoy a life without pain again.