Anyone living with chronic pain knows how debilitating it can be. It’s defined as pain lasting more than three months, or in many cases, beyond average healing time. If you or someone you know is living with chronic pain, here are some things you need to know…

1. All pain is real

Pain is a very real, and often a very unpleasant, personal experience. Pain is as real as any other sensory experience, such as fear, hunger, thirst, and fatigue. While the experience of pain is very real for the person experiencing the pain, pain is not necessarily an accurate reflection of the damage at the level of the tissues.

‘All pain, no matter where or how it is felt, is produced by the brain.’

2. Pain is multidimensional

Many factors influence how much pain a person may experience. Any information you and your brain sense as a threat may influence pain. Factors such as damage to the tissues, beliefs about pain, fear of movement, poor coping, physical inactivity, and emotional factors can all affect how much pain you may experience.

‘Personal beliefs and environmental factors can make a big difference to how we experience pain and how likely it is that pain will persist.’

3. Pain is an alarm

Pain is the brain and body’s alarm system. It’s designed to protect us from doing damage. For example, you feel pain when bending and lifting a heavy load. When you have had pain for a long time, your system becomes over-protective—for example, increasing pain while bending and lifting a smaller amount.

‘Pain alerts us to tissue damage or the threat of tissue damage. Pain motivates us to seek care. The pain stops us competing, keeps us seeking a cure, motivates us to prioritise pain relief above almost everything else.’

4. Pain is not a measure of damage

It’s a protector when we have tissue damage or the brain senses the threat of damage to the tissues. Pain motivates us to protect ourselves from further damage, e.g. limping on our sprained ankle. If the brain decides there is something more important than saving a body part, it may decide not to produce pain, e.g. feeling no pain during a shark attack.

‘Pain can occur in a body part that is not damaged. Damage can occur in a body part that is not painful.’

5. Pain can be helpful and unhelpful

Acute pain (lasting less than three months) is helpful as it encourages us to protect the area following injury. This prevents further tissue damage and allows time for the injured tissues to heal, e.g. making it painful to walk following a sprained ankle.

Persistent pain (lasting greater than three months or the expected healing time) is unhelpful as there’s no longer the need to protect the injured area, yet the pain persists. For example, someone has had constant low back pain for the last ten years.

‘Persistent pain is less to do with an injury in our bodies and more with our central nervous system.’

6. No brain, no pain

Pain is an output of the brain, not an input to the brain. The brain decides how much pain or protection is required. Factors unrelated to tissue damage (e.g. pain beliefs, fear of movement) tend to become more relevant as prolonged pain persists.

‘Remember, every pain problem, acute or chronic (persistent), has a thinking, reasoning and emotional brain attached to it.’

7. More than meets the eye

Pain does not show on scans. Both people with and without pain will have signs of tissue damage on a scan. These are often ‘normal age-related changes and are not the whole explanation for why a person may be experiencing pain.

‘There is a high prevalence of ‘abnormal’ findings on MRI (of the low back) in pain–free populations.’

8. Know the pain

Making sense of pain is the first step in moving forward. This starts with the understanding that pain does not equal damage. Moving is safe; you don’t have to be completely pain-free to start being active again. From this understanding, you can overcome a fear of pain and movement and gradually return to what you enjoy.

‘The way you think about pain is significant. If you understand your pain more, you feel more in control, make better decisions and experience less pain.’

9. Motion is lotion

Getting to move again is the second step in moving forward. Similarly to topical pain relief products, exercise is essential in feeling stronger, more in control, less scared of moving, more endurance, more confidence, and less pain.

One form of exercise does not appear superior to another for most persistent pain. The activity you enjoy and associate with achieving your goals will help you stick with it.

‘With increased activity and confidence, people experience less pain, leading to positive changes.

10. Focus on function

Goal setting is essential for sufferers of persistent pain. The goal setting should focus on improving function and returning to what you are not doing because of your pain instead of being pain-free. You should be ready to embark on a recovery journey instead of a quick fix.

‘Start focusing on personal goals instead of how to ‘fix’ the pain.’

Once you start approaching your body with curiosity rather than with fear, everything shifts. ―Bessel A. van der Kolk

Where can you get help?

At Evolve are well-positioned to assist those who suffer from persistent pain. We can help educate, set goals, and prescribe safe and effective exercise solutions.