david_bioRecent Advancements in Pain Research
There have been significant advances in the field of pain management and theory in the past few years. Pain is simply a danger message keeping your body out of harm. Each person has their own unique interpretation and experience of these danger messages, which can be interpreted as pain. When the danger system does not function properly it can cause excessive or chronic pain. Many of these concepts are included in David Butler’s book, Explain Pain.

Here are some excerpts:
Pain is a very normal and protective response to stimuli that your brain determines to be a threat or danger. Many people have arthritic or degenerated joints yet have no pain whatsoever. Simply put, if you’re brain doesn’t perceive the tissue damage to be threatening, there will be no pain. Interesting!
The amount of pain that any of us experience isn’t necessarily related to the actual tissue damage present. A solider in the heat of war for example, may have a life-threatening gunshot wound that he/she hardly even feels at the time of the injury. Conversely, a tiny paper cut can be excruciating, yet isn’t life threatening at all!
Pain relies heavily on the context in which it is occurring and is influenced by social and emotional factors. For example, a musician (violinist is used in the book) might experience more pain in a minor finger injury than someone who doesn’t consider their hands and fingers as valuable to their line of work. Also, emotions can directly affect things like muscle tension and breathing patterns, both of which have an immediate impact on the pain experience.
Every body part is represented neurologically in the brain in what is called the virtual body that lets us know where our actual body is in space. Sometimes, pain can remain or exist in body parts that have been lost or amputated, a phenomenon known as a phantom limb pain.” So while pain is actually in our heads (brains), it doesn’t make it any less real. However, by understanding how the brain works, pain can be better controlled and even lessened.

This is a recurrent theme in this book.
Damage to tissues causes inflammation which helps to activate the immune system and promote healing. Tissue healing is dependent on blood supply. When tissues are chronically deprived of adequate blood (ischemia), healing is compromised. This is why prolonged inactivity or bed rest has been shown to be counterproductive and even harmful for things like simple back aches or sprains. Manual therapy treatment can help to improve blood flow and tissue mobility. If pain persists for longer than would be normally expected, the danger alarms system become more sensitive and certain pain producing nerves can become easier to trigger. This is the genesis of chronic type of pain syndrome in many people. Nerves can be mobilized with manual techniques to reduce the sensitivity of them and lessen pain responses.
As the chronicity of pain continues, thoughts and beliefs (including emotions) become increasingly more powerful in contributing to and perpetuating the problem of pain. (I won’t ever be better, I can’t do anything, I don’t know why I have pain)
Modern pain management models are less concerned with the tissue level, and more with the brain’s alarm system sensitivity as well as the fears, thoughts, beliefs, and attitude about their specific condition or situation.
How well one understands their problem and the basic science of pain will determine their coping strategies over time. Using pain only as their guide is a poor management tool since pain is often inaccurate as to the actual state of tissue health. Often pain can remain (in the brain) yet the injury is actually healed at the tissue level. The brain still thinks it is in harm however so the pain continues. Manual treatment and exercise therapy can help to make movement become less painful to allow function to increase over time. The key is to learn to gradually increase the activity level of a painful area while knowing that some pain and stiffness may occur. This requires patience and persistence to establish a slope of improvement over time. Some days will be better than others. The goal is a long-term reduction in pain and stiffness and improvement in function.
Pain is an extremely complex and different experience for everyone. A multifactorial approach generally works best. Thoughts and emotions can be controlled with patient education. Inflammation can be controlled with medications and/or diet. Healing can be improved with vitamins/minerals and healthy sleep patterns. Tissues such as nerve, fascia, viscera, muscles and joints can be mobilized with manual therapy. Proper posture and body mechanics can be relearned. Function can be improved though graded activity. Your pain can be changed if you are willing to learn and do something about it.
For further educational information please see:
Explain Pain by David Butler or
Taming Pain: Lessons from the Trenches by Cheryl Wardlaw

David Potucek, MSPT has been practicing orthopedics and sports physical therapy since graduating with a Masters Degree in Physical Therapy from Springfield College in 2004. David has worked in a variety of practice settings, treating a multitude of orthopedic, sports, and neurological patient populations. David joined the EHS Physical Therapy Team in 2008.

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