What Is Chronic Pain?
According to The International Association for the Study of Pain (IASP), pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Chronic pain describes pain which lasts for a duration of 3 months or more. Chronic pain can cause physical decline, limited functional ability and emotional distress.
Common causes of chronic pain are joint arthritis, trauma, neck pain and low back pain. There is often complex and dynamic interaction between a range of physical, psychological and social risk factors which is conceptualised within a biopsychosocial clinical framework. Sometimes, poorly treated pain can lead to central sensitisation in which a normal or sub-threshold nociceptive (painful) input will amplify pain perception in the brain.
Chronic pain and depression
Chronic pain and depression often coexist. Uncertainty about when one can ever become pain-free again, or the pain getting worse can often lead to feelings of anxiety, sadness, grief and anger. The psychological and physical distress associated with persistent pain, in additional to social vulnerability may precipitate an individual to an episode of major depression.
Common Treatment For Chronic Pain
Over the counter pain-killers
Panadol, neurofen are common over the counter pain-killler available.
Prescribed pain medication
Your doctor will assess and prescribe appropriate pain medication to alleviate your pain symptoms. These medications include but not limited to cortisone injection, opioids, codeine and other adjuvant analgesics such as antidepressants and anticonvulsants.
CBT (Cognitive Behavioural Therapy)
Cognitive behavioural therapy helps an individual to identify unhelpful negative thinking patterns and to develop effective challenges. It encourages the individual to generate realistic and helpful alternatives to take back control of their lives, to do more and feel better despite the pain they experience.
How Physiotherapy Can Help With Chronic Pain?
Cognitive Behavioural Therapy
A physiotherapist trained in CBT can help and empower an individual to relate differently to their thoughts, physical sensations, emotions and behaviours so that they don’t get caught up in them in problematic ways.
There is evidence to support the use of dry needling by physiotherapists to treat myofascial trigger points in musculoskeletal pain. Dry needling to trigger point will evoke a local twitch response (LTR) which promotes local circulation which “flushes out” nociceptive chemicals such as substance P and CGRP (Calcitonin Gene-Related Peptide) which were found in higher concentrations in areas of pain. Needle insertion also activates large mechanoreceptor nerves (Aβ) stimulating the pain gate theory effect. This pre-synaptic inhibition in lamina 1 & 2 of Aδ & C fibres via the γ-Aminobutyric acid (GABA) system reduces the on transmission of nociception signals to the brain.
In a single-blind randomised control study, it was suggested that dry needling can be an effective treatment for reducing pain, number of trigger points, sensitivity, and kinesiophobia (fear of movements) in patients with chronic low back pain caused by lumbar disc hernia (https://doi.org/10.1589/jpts.29.1502).
It is however, further studies are necessary to establish the long term benefits of dry needling to other chronic pain conditions.
Physiotherapist can prescribe specific therapeutic exercises, in the form of aerobic and endurance component. The modulation of pain may be related to increase in pain threshold and tolerance in addition to reduction of pain intensity rating during and after exercise. Exercise induced Hypoalgesia (EIH) is believed to be due to the activation of the central opioid system stimulated by increased discharges from mechanosensitive afferent nerve fibers A-delta and IV (C) arising from skeletal muscles secondary to rhythmic muscle contraction during exercise.
Progressive muscle relaxation
Your physiotherapist will guide you through the progressive muscle relaxation technique to help you relax physically and mentally. You will lie down comfortably on your back with enough space to move comfortably with minimal environmental disruption. You breathe in, then tense up your muscle groups gently in a sequential order, without cramping and hold for a few seconds, then you breathe out and relax them immediately and completely.
Breathing control and strategies
Physiotherapists have been teaching breathing control and relaxed postures to patients with cardiorespiratory conditions to help them breathe with efficiency and less effort and promote relaxation to manage stress and anxiety associated with breathing difficulties. An individual with chronic pain issue will often present with anxiety and stress. Learning to adopt a more relaxed posture, in addition to having breathing control over hyperventilation during panic attack will allow an individual to gain control over their psychological and or emotional distress.