Persistent Pain (More Than 3 Months)

It’s well recognised that persistent pain can be really tough to manage. You’re not alone. Especially if it’s stopping you from doing what you’re used to, or stealing your happiness. About seven million people in the UK are in this situation; the chances are you know someone else similar.

This persistent pain section of the website is designed to get you started on a way back from this. There’ll be some explanations, definitions, links to other resources and tips on how to move forwards. Persistent pain research is an expanding area, so we’ll tell you evidence based stuff as much as we can, and keep all the jargon to a minimum.

The content of this site has been designed by clinicians who are experts in working with those with pain. The other expert here (although you may not really realise it yet) is you. You know how you tick, what works, & who you’d pick for your dream support team. The best results happen when experts get their ideas together. So get ready. We’d ask you to bring the following:

Pencil & paper for making notes

Thoughts about what works for you

Ideas about what you’d like to do a little more of

A Brew

A curious mind

(Brew optional)

A good starting point is knowing how persistent pain works….

Acute Pain Persistent Pain
Lasts for less than 3 months Lasts for more than 3 months
Predictable Often worse or better for no reason
Usually from damage (e.g. a broken bone) Damage usually has healed
Goes away Stays
Often easier to treat Needs complex treatment
Part of ‘normal’ warning for us No warning needed any more – pain centres have stopped,working properly

 

Ok. So far we’ve talked about how acute pain works. Persistent pain is different. This is pain that outlasts the normal healing time (usually 3-6 months). There’s lots of changes that occur in our nervous system to cause persistent pain. These changes can happen in the sensors first detecting pain in our skin, muscles, bones etc, or in the nerves carrying the information to the spinal cord & brain, or in the spinal cord & brain themselves. This is one of the things that makes the causes of persistent pain quite complicated to diagnose. These changes aren’t visible on scans or X-rays, but are related to how the nervous system functions rather than what the structure looks like. Its a bit like looking at a photograph of a group of people. We might be able to see in good detail what the people look like, but it doesn’t tell us how well they work or get along with each other.

Each of the nerves joining into the spinal cord carry many millions of nerve fibres within it. It’s a bit like a cable that’s made up of lots & lots of wires. Each nerve fibre-end buries itself into the spinal cord. At this point the message sent from an individual nerve fibre gets processed by the spinal cord. The cord can either stop the message in it’s tracks (in which case we won’t feel it), send it up to the brain at normal volume, or send it up to the brain at a different volume (louder or quieter). In the development of persistent pain, the volume control for each individual nerve fibre gets mixed up – usually much louder. In this case we feel the pain more intensely, for longer periods & often with no let up.

The third piece of the puzzle is what happens when the pain signals reach the brain. The brain is a hugely complex mass of electrical connections & chemicals; the chemicals can change how the brain functions. They can make us happier, more irritable, more relaxed, more sensitive to sensory information – in fact our whole nervous system is governed by this chemical balance.

In persistent pain we know that there is chemical change making our pain system more sensitive. This translates to pain information being lots louder than it was intended to be. For example stubbing a toe is painful, but when we have a sensitised nervous system it can be agonising for hours or days after.

The huge number of connections in our brain mean that different systems can talk to each other (like a computer network). Our sensory system links to our emotional networks very strongly. Whether its convenient for us or not, a sensory input like pain generates an emotion. We can do our best to ignore it, but it does exist. This is why the definition of pain describes an emotional component too.

So. Summarising:

  1. Sensors in our body decode stimulation & send electrical signals down nerves.
  2. These sensors can normally get sensitive if we injure ourselves
  3. Sensors ordinarily go back to normal sensitivity after injuries heal – if they don’t they can get persistently sensitive
  4. Nerves from these sensors plug into the spinal cord, which processes sensory inputs
  5. The spinal cord can make messages up to the brain louder or quieter
  6. If the spinal cord gets irritated with constant barrages of pain signals, it can get sensitive itself & turn the volume up on messages sent to the brain
  7. The brain also can make sensory input louder or quieter depending on things like the chemical balance, intensity or duration of pain, or how we find ourselves emotionally.

There are lots of mechanisms to control how loud our pain is. Sometimes these volume controls go haywire & it all gets louder.

How we feel our pain is dependant on so many factors..

The development of persistent pain sounds quite complex. It is, but this also means there are lots of ways we can interfere with the amplifiers, and try to turn things down a bit. Most of the strategies we use in pain clinics are designed to try and desensitise the nervous system. Everyone’s pain is individual, so to manage pain effectively, we ofter need an individualised plan. As persistent pain is so complex, we normally need a few strategies. It can be frustrating being in pain & not finding just one thing that fixes the problem. Lifestyle can play a hugely important part in managing pain. A well managed lifestyle can minimise flairs, maintain fitness & function, and wellbeing.