Pain Part Two:
Non-pharmaceutical Management Strategies for Persistent Pain.

If you have missed the first part of my blog on pain, please feel free to read; it will help explain pain and will also provide insight to the information that is to follow. However, a good recap is important for learning, so here are the most important points from part one of my blog on persistent pain!

 1. Research shows that pain is purely a perception of the brain. Meaning that the brain receives stimuli from receptors in our tissues and visual input from our eyes, it then perceives such input as threatening or not. If deemed threatening, the body feels pain. (Butler, D. S., & Moseley, G. L, 2013)

2. Pain is not solely physical and has many other influences such as emotional, biological, and social.

3. Pain does not always directly correlate with tissue damage.

4. Persistent pain is pain that lasts longer than 3 months. This is when the brain becomes hypervigilant in interpreting stimuli as threatening/painful. The brain becomes an overprotective parent.

Now since we have revisited some important points, we can get into management strategies for persistent pain. The following are in no order of significance, they are equally as important!

Strategy 1 – Add more positivity to your daily life

If you take a minute to think about it, persistent pain is predominately associated with negative emotions, negative experiences, can be a driving factor in social isolation, and ultimately can control how we live our lives. If persistent pain is linked with such negativity, what can we do to change it? Add more positivity to our daily lives! Think of a positive and negative see-saw, if pain is the main weight weighing down the negative side of the see-saw, there needs to be more positive weight added for the see-saw to be balanced. Things as simple as going for a walk, reading a favorite book, curling up on the couch with a hot drink, taking a minute to relax and breathe, appreciating the beauty of nature, or anything else you enjoy, can help balance the positive/negative seesaw. Balancing such seesaw can again add boulders to paved pain pathways helping to decrease the sensitivity of the nervous system in interpreting stimuli as threatening/painful. (G.L. Moseley and D.S. Butler, 2013) Ultimately, helping the overprotective parent (i.e. the brain) calm down.

Strategy 2 – Change the way you think about pain

In addition to adding more positive aspects to our daily lives, changing the way we think about pain is also very important. Even subtle changes like using the word persistent instead of chronic to explain pain can affect how an individual perceives pain and allows pain to fit into their everyday life. Dealing with persistent pain can be challenging, so keeping a positive outlook and remembering that we have the ability to control how pain influences our daily lives is an important management strategy. It is essential to focus on the activities you can do, and not dwell on the activities that you are limited in doing due to your pain.

Strategy 3- Mindfulness

Mindfulness is something everyone can benefit from, especially those dealing with persistent pain. Interrupting the chatter in the brain can help add speed bumps or boulders to paved pain pathways, helping to decrease the sensitivity of the nervous system in interpreting stimuli as threatening/painful. There are many forms of mindfulness that can be practiced. The following are a just a few techniques: yoga, focusing on deep belly breathing in a quiet environment, listening/signing along with your favorite music. Anything that helps interrupt your thoughts so that you are fully aware in the present moment can be a form of mindfulness.

Strategy 4:  Having a good support team

Persistent pain is different for everyone and in order to fully understand what may be contributing to an individual’s persistent pain, it is crucial to take a step back and look at your lives in detail. Since pain is multi-factorial, things like past mental/physical trauma, diet and other health habits, sleep habits, and how pain has an effect on your social life can contribute to persistent pain. Therefore, it is important to know that just like persistent pain, the management should be multi-dimensional. Meaning that health care professionals should work together to provide expertise in their area to aid in the management of persistent pain. Health care professionals that can help manage persistent pain include, but are not limited to: family physicians, psychologists, nutritionists/dietitians, occupational therapists, neurologists, physiotherapists, social workers, etc. Beyond health care professionals having good support system of family and friends is also very important.

Conclusion

You may have heard the saying, “knowledge is power”. I truly believe patient education is essential within the medical community, especially in the management of persistent pain. Therefore, I hope my blogs provided you with some helpful information on persistent pain. If you are interested in learning more about non-pharmaceuticals management strategies of persistent pain check out the link below.

Persistent Pain Management (An educational resource for patients) -https://www.youtube.com/watch?v=L0jdUv1e7e0

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.

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
Bohlmeijer, E., Prenger, R., Taal, E., & Cuijpers, P. (2010). The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. Journal of psychosomatic research, 68(6), 539-544.