Persistent Pain
                            Part 1- What is it?                           

Pain. How can one four letter word be so multi-facet and complex? Despite all of the advances in today’s technology and medicine, our society as a whole seems to be struggling with the management of pain now more than ever. This seems to be especially true when it comes to chronic or persistent pain. For the purpose of this blog I will be referring to chronic pain as persistent pain since it has a more positive connotation attached to its meaning. You will learn the importance of such subtle positive changes in regards to pain in Part Two of my blog: Non-pharmaceutical management strategies for persistent pain.

Explanation of Pain

Before we discuss persistent pain in detail, it is important to dissect the meaning of the word pain. Pain can be defined as, “ an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage." (IASP definition) From this definition it is important to understand three points:

1) Pain is an experience and research shows that pain is purely a perception of the brain. (Butler, D. S., & Moseley, G. L, 2013 ) We do not touch a hot stove and automatically feel pain from the heat. Receptors in our hands and visual input from our eyes send signals to our spinal cord and brain.  It is here that such signals are interpreted as threatening or not. If the brain perceives such signals as threatening it sends messages down to the hands saying “DANGER! Take your hands off the hot stove”, and you quickly move your hands away. Yes, this all happens in seconds, but it is important to understand that the brain is the boss that determines if certain signals are threatening (painful) or not.

2) Pain is just not a sensory experience, but also an emotional experience as well. This means that pain is not purely physical and has many other influences such as emotional, biological, and social factors.

3) It is also important to note that pain is associated with actual or potential tissue damage; meaning that just because you experience pain, doesn’t necessarily mean you have damaged any tissues. For instance, people who have their legs amputated sometimes experience phantom limb pain which consists of painful sensations in the part of the limb that is no longer there. Therefore, it is important to keep in mind that pain does not directly correlate with tissue damage.

Acute vs. Chronic Pain

Acute pain serves as an important warning system to our bodies to let us know that our tissues are actually or could potentially become damaged. Examples of acute pain include pain experienced after spraining an ankle or wrist. Acute pain lasts for approximately 3 months, which is the time the body takes to heal its tissues. (Bruns et. al, 2016) Pain lasting longer than 3 months is considered as persistent (chronic) pain.   

You may ask, how can someone feel pain once the body’s tissues have healed? Well, the more frequent the brain perceives potential threats as pain, the better it becomes at detecting potential threats– meaning that it can start interpreting less threatening signals as pain. Think of it this way, the more you drive a snowmobile down a path, the smoother and easier the path is to travel. The same scenario occurs in the brain, the more the brain experiences/perceives pain, the easier it is for threatening signals to be interpreted as pain. This in combination with past experiences of pain, social factors, biological factors, and psychological factors all contributes to why individuals have persistent pain. The question is, what can people do to help manage persistent pain? You will have to wait and see. Stay tuned for part two of my blog on pain: Non-pharmaceutical management strategies for persistent pain.

In the mean time for further explanations of pain click on the links below

https://www.youtube.com/watch?v=C_3phB93rvI – “Understanding pain in less than 5 minutes”

https://www.youtube.com/watch?v=gwd-wLdIHjs – Lorimer Mosley “ Why things Hurt”

References:
Butler, D. S., & Moseley, G. L. (2013). Explain Pain 2nd Edn. Noigroup Publications.
Bruns et. al, 2016. Managing Chronic Pain. American Psychological Association.
Jam, B (2018). Advanced Physical Therapy Persistent Pain Certification Program. APTEI
IASP, 1994. Part III: Pain Terms, A Current List with Definitions and Notes on Usage (pp 209-214). Classification of Chronic Pain, Second Edition, IASP Task Force on Taxonomy, edited by H. Merskey and N. Bogduk, ISAP Press, Seattle, 1994. http://www.iasp-pain.org.

Author- Brittany is a physiotherapist who graduated from Dalhousie University in 2016 with a Master’s of Science in Physiotherapy. Her main clinical interest is neuro science and restoring functional movement patterns. She is a firm believer in the mind-body connection and enjoys incorporating this throughout her treatment sessions. Her treatment philosophy is to help people become more aware of their bodies, their physical stressors and abilities in order to help them get back to their work, family and activity.