The Role Of Movement In The Treatment Of Pain

Movement

What is the role of movement in the treatment and management of pain?

We know physiotherapists have long time incorporated exercise(s) into their practice, but now osteopaths, chiropractors and other remedial therapists have started introducing exercise and movement as part of their treatment approach to pain.

Does this improve outcomes for people in pain?

As someone who has an exercise background, and a practice based in a gym (with a large number of patients who are active themselves), I’m a big proponent of empowering people with active management strategies to both help manage pain and improve health and fitness.

Large scale research projects have confirmed that an active, movement based approach is superior to a passive treatment approach for the management and treatment of many pain conditions.

Whilst the many benefits of exercise and movement are commonly known and widely promoted, the message can be misconstrued when context is not provided.

To understand the role of movement in the treatment of pain requires an understanding of pain.

Unfortunately, many people do not learn about pain when they seek treatment for pain, which leads to incorrect ideas and beliefs, that can make their pain worse.

The Dark Side of Exercise Therapy for Pain

In general, encouraging people to take an active role in their recovery from pain is a good thing.

Problems arise when exercise and movement is billed as being the treatment or “fix” for pain.

Unfortunately, nothing can “fix” pain, not manual therapy, not exercise, not medication, not surgery.

The reason being, pain is not a thing, pain is an experience, an active process. All of those methods create a change within your body and brain, so that your brain can resolve things.

So, as always, the context in which anything, including movement, is performed to help with pain is paramount.

What’s the big deal?

Many times, I have seen people who have been told to stand/walk/move in a certain way, because if they don’t “their pain will get worse”.

Others, rightly or wrongly, interpret their failure to improve as their fault, if they have been made to believe that exercise is what is needed to fix their pain, due to poor compliance. I often view poor compliance as not as the fault of the client, but of the therapist.

If someone can’t do something, then what has been given to them is too much for them at that point in time.

And yes, people still need to take responsibility for their actions, but the job of a health practitioner is to show the path in actionable steps, not unload a volume of information onto their patients (they could use google for that).

What’s In A Name?

Throughout this post, I have used “movement” and “exercise” interchangeably.

Whilst it is true that exercise is movement, it is also true that not all movement is exercise.

Exercise is purposeful physical exertion/activity performed to create a physical adaptation.

Movement is a preferred term, because it doesn’t have the connotations to exertion.

You shouldn’t need to exert yourself (physically) to overcome pain.

Mechanisms of Movement in the Treatment of Pain

We don’t actually know exactly what happens when pain resolves.

To clarify, we know that pain is an emergent property, that is, it has biological, psychological and social/environmental components, but it is not any one of these, nor does 1+1 = 2.

This means, that treatments for pain can be specific only up to a certain point.

Why does spinal surgery improve outcomes for some people, but not all? If pain were only physical, then surgery would always work, but we are not bodies, but people, and this needs to be considered in the treatment of pain.

That’s not to say we have no idea what helps pain, we do, generally, but what helps pain for any specific person at any specific time is going to vary.

One thing we do know, is that “all pain is neurogenic”, that is, all pain originates in the nervous system.

So for any intervention to help in the resolution of pain, it must have some effect on the nervous system.

Thankfully, we know that movement has a great effect on the nervous system.

Novel Input

Our brains crave novel sensory input. It is why we are generally attracted to “new and shiny”.

When we experience pain, it is an output of the brain, based on all the current sensory inputs from both the body and the brain itself (confusing? read this).

In theory, by providing novel sensory inputs, we can alter the outputs, including pain.

With movement, if we can “show” the brain a different way, then sometimes that is what is needed to “teach” it how to produce the desired output.

For example, let’s say you experienced low back pain that hurt when you bent forward.

If we change the context of your bending by having your feet in a split position and bending to the side, that might be enough of a different sensory input to change the output of pain.

Cortical Mapping

Our body is in our brain. We have a “map” of our body within our brain, such that when certain peripheral nerves are stimulated, a corresponding brain area is activated.

Conversely, stimulating that brain area with electrodes will cause a vague sensation in that region of the body.

When we have pain, we know that our “body map” is impaired. That is, we can’t clearly recognise our affected body parts like we can the unaffected ones.

Deliberate movement can help with cortical mapping, once again, by increasing the amount of information coming from an affected area.

Touch can help, but we seem to have a better response to active movement, likely because more brain areas are involved, resulting in a more pronounced stimulus.

Neural Mobilisation

This is little bit easier to understand for many people, because it is more of a direct mechanical effect.

Nerves are everywhere in our body. We have km’s of them.

They pass through “tunnels” of soft tissue all over the body.

They can get stuck or deformed.

When they are stuck of deformed, they will fire more rapidly and strongly.

Movement, can either directly, or indirectly mobilise the nervous system, freeing up your nerves to slide and glide freely, which is exactly what they want to do.

Descending Modulation

Our brains are pretty cool.

In addition to being able to recognise a bunch of pixels lit up on a screen into shapes (letters) as meaningful, they can produce a whole host of chemicals that can block pain at the level of the spine.

Aside: there are 3 levels where you can block pain. Peripheral, spinal and brain.

Movement can facilitate the production of pain relieveing chemicals, like endogenous opoidids. Much better than buying them at the pharmacy, because your brain is never going to get the dose wrong.

Improved Mood

There is a correlation between mood disorders like anxierty and depression and pain.

Regular and meaningful movement is correlated with improved moods, as is exercise.

You can probably see where I’m going with this.

So Movement is Medicine After All?

Definitely.

But just as taking the right medication, in the right dose for the right problem is paramount, using movement as an intervention for pain is the same.

More is not better if all you are doing is reinforcing the same behaviours that lead to or maintain your pain.

Think of it like this: there is the skill to perform a movement, and the capacity to perform it. If you have the skill, but limited capacity, you need to improve your capacity and vice versa.

Conclusions

Movement is important in treatment of mechanical pain.

Active movement is superior to passive movement in most cases.

The mechanisms of how movement affects pain are not specifically known, but there are plausible ideas, all of which must involve the nervous system.

These effects are what would be called “non-specific effects”. Whilst there are potentially “specific effects” occurring as well, we don’t know enough as yet to harness these more precisely.

In terms of pain: inputs + processing = output (pain).

To change pain, we are attempting to change our inputs, be it movement, education, cognitive behavioural therapy, manual therapy or something else.

Whatever it takes to get a change is what “works” for that person, in that moment.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

 

References

Coming soon!

Stop Blaming People For Their Pain

Blame

This post is directed at the friends, families and health professionals of chronic pain sufferers: stop blaming people for their pain.

It is really common, whether overt or subtle, for people suffering from chronic pain to be blamed for their pain.

I would argue that this stems from a lack of visibility (you can’t see low back pain or migraines) and a lack of understanding, which I’m hoping to change.

Previously I have posted about both personal responsibility and pain as well as mindset and pain.

In these posts, I am not blaming people for being in pain.

Rather, I am urging people to take responsibility for their actions in the face of their pain, because that is the only way things will ever improve for them.

Chronic Pain Is Nobody’s “Fault”

Whilst you can definitely contribute to, or even cause your pain in certain circumstances, when it comes to chronic pain, it isn’t anyone’s fault that they have become “victims of their own nervous system”.

Let’s look at how most chronic pain arises:

  • Post surgical
  • Post physical trauma
  • Post major stressful event
  • Secondary to disease (e.g. rheumatoid arthritis, cancer, dengue fever etc.)

Now, we don’t know why certain people develop chronic pain whilst others don’t, despite having the same experience.

All we know is that each person has a unique psychological, emotional and physical makeup.

And that there is something about the event’s effect on that individual that sets their nervous system off on a path of persistent pain.

We can look at factors that are correlated with chronic pain, but again, very little is predictive.

In fact, in terms of pain epidemiology (which is the study of health and diseases across populations), it seems the two biggest correlates are out of anyone’s control:

  • Age
  • Gender (females suffer from more chronic pain than males)

So whilst we can definitely control how we act and react in the face of pain, we can’t control the onset or presence of chronic pain.

It’s Human To Judge

It is a human instinct to judge others, based on our own perceptions of the world and experiences with people.

Equally, it is important to recognise that all of us have limited experiences, and our judgements are made on limited (if any) factual information, and lots of assumptions.

We have evolved this way for survival reasons, but it can often get us into trouble when dealing with humans – we don’t know what’s going on in our own “unconscious mind”, let alone others’.

Considering this, it is easy for our brains to lump people into categories and assign blame – it makes our worldview “neater” and simpler, but it does so at the cost of making things simplistic, when often that is not the case.

Whilst you can’t (and shouldn’t) stop judging, you have to acknowledge the limitations that are inherent within our judgements and use your cognition (yes, you’ll have to think), before you act and speak.

What To Do Instead

You’re probably thinking, “gosh, this is hard, I’m going to feel like I’m walking on eggshells any time I have to talk to someone with pain”.

When someone is constantly complaining about their pain, they are expressing a need.

This need can be for attention, care, acknowledgement or reassurance.

Pain is rooted in fear; our brains have decided that there is danger (real or not), and that pain is the best motivator for change.

Unfortunately, chronic pain is the dark side of neuroplasticity (the ability of the brain to change), where the brain has become more efficient and skilled in the pain response, and so pain is not indicative of any damage within the body, but rather a heightened sensitivity to normal stimuli.

Instead of blaming someone with pain, try practicing empathy – that is, understanding what that person is experiencing, from their point of view.

It could be a loss of independence, a frustration at lost capabilities, a fear for the future, a combination of all three or something else entirely.

Conclusions

Pain is a normal part of the human experience.

We will all experience pain at different points in our life, and we hope that it is brief and not serious.

However, for many people, pain is not brief, but daily and ongoing, and a great disruption to their lives and their personality.

The vast majority of sufferers of pain have not done anything to “deserve it”, and so should not be blamed for their condition.

Instead, practicing empathy and acknowledging someone’s suffering is a better approach, without dwelling on pain and making it a focal point of your interaction.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) McMahon, S.B., et al, Wall and Melzack’s Textbook of Pain, Elsevier Saunders, Philadelphia, 2006

(2) Chronic pain epidemiology and its clinical relevance

(3) Preventing chronic pain following acute pain: risk factors, preventative strategies and their efficacy

(4) Risk factors associated with the onset of persistent pain

Pain and Personal Responsibility

The Mind Is Key

When it comes to persistent/chronic pain, taking responsibility for your thoughts, emotions and actions is paramount to achieving any semblance of a normal life.

If you’ve ever experienced any intense or lasting pain, there’s a big chance you’ve said to yourself at least once “I don’t deserve this”.

Unfortunately, the world is not a fair place, and bad things happen to good people, but, viewing yourself as a victim of pain helps no one, least of all yourself.

This post isn’t about blaming your (or anyone for your pain), but rather to encourage you to take responsibility for the things you can control, in order to give yourself the best possible chance of living a fulfilling and meaningful life.

Is It Your Fault You Are In Pain?

The most commonly accepted model of pain is Melzack’s “neuromatrix model” (1). This model says that pain is an output of the brain, based on multiple sensory inputs, including:

  • Cognitive: memories, attention, meaning and anxiety
  • Sensory: inputs from skin, musculoskeletal tissues and the viscera (organs)
  • Emotive: inputs from the limb system

With this in mind, it is fair to say that any time you experience pain, you probably aren’t at fault based on anything you were consciously aware you were doing, because so much of the pain experience is generated unconsciously.

It is also fair to say that you can influence your pain based on what you think and do when you experience it.

So, to answer the question, in general, the answer is no, it’s not your fault you’re in pain.

However, as always, there are a few exceptions:

  • Acute pain is your fault if it stems from an injury that occurred because you did something stupid – think alcohol related injuries or playing a game of pick-up football knowing you haven’t been active in years.
  • Gradual onset pain stemming from overuse type injury (work, exercise etc) is very preventable with appropriate workload management.
  • Acute, non-specific pain is often the result of psycho-emotional components, more so than any tissue trauma, thus if you constantly put yourself in stressful situations and don’t know how to manage your thoughts and emotions, then you are probably playing a big role in your pain.

No One Can “Fix” You

One of the biggest examples of not taking personal responsibility for your pain, is the misguided notion that someone, or something, will fix you.

There is a growing body of research demonstrating that people with the highest expectations about making a recovery from pain do so. (2)

Combined with the large (and growing) body of research that suggests passive approaches to managing chronic pain aren’t very effective, it is obvious to see that there is a big role for you to play in your own recovery.

This doesn’t mean more passive therapies are useless. It just means the appropriate context has to be set.

What we can boil this down to is as follows: if you can find a knowledgeable practitioner that your like and connect with on some level, who inspires confidence in your ability to recover and gets you involved in the process, then you probably will.

Now, before you think that you have found and done all of that and you’re still in pain, it’s important to define “recovery”.

Defining Recovery

Most of the data on chronic pain comes from specialist chronic pain clinics. These are often public funded and run in, or in association with hospitals. They are typically “end of the line” treatments for people who have not responded to any other form of pain management.

The results these clinics achieve are “fair” when taken objectively, often decreasing a persons self-rated pain by a couple of points on a 10 point scale.

But, when we take into account that nothing has worked before, this improvement is quite impressive.

Additionally, when people are asked to rate their quality of life, measuring things like anxiety, depression and fear of the future, things are generally even more positive.

This gives us good insight into what is realistic for chronic pain sufferers.

If “end of the line” sufferers can improve this much, then good management earlier in the timeline can theoretically achieve even better results.

One of the biggest differences between those who succeed in managing their pain and those who don’t, is that they take action despite their pain.

Don’t Wait For Your Pain to Get Better to Start Living Well

In personal finance circles, there is a lot of talk about developing the habit of saving money, no matter your income.

That is, if you are on the minimum wage, and can only afford to save a few dollars each week, it is still important to do so, even though the amount across a year might not be very much, the habit developed carries on with you throughout life, as you (hopefully) increase your income.

A similar approach can be taken when you are in pain.

Instead of thinking “when I feel better, I can finally do x”, try shifting your mindset to “how can I find a way to do x, despite my pain”.

Now this is often easier said than done, but a good practitioner will be able to guide you through the process. Many times the limitations are self imposed, and a graded exposure approach can work wonders.

What Can You Do About Your Pain?

  • Accept your circumstances, rather than looking for someone or something to blame.
  • Seek out an excellent health practitioner to work alongside you and help build a team around you.
    • Don’t be afraid of medications. Used appropriately, they can be life changing. It goes without saying that you should talk to your doctor before starting or stopping any medications for your pain.
    • Consider working with a psychologist who specialises in chronic pain, in Australia there is an excellent Medicare rebate for psychology – discuss it with your doctor.
  • Outline functional based goals, rather than pain based goals. For example, saying “I’d like to walk my dog for 45 minutes” as opposed to saying “I’d like to walk completely pain free”.
  • Focus on processes, rather than outcomes. Processes are the things you do, outcomes happen based on what you do, but they are always variable (because of factors beyond your control).
  • Start small and build up slowly. 
  • Don’t “let pain be your guide”. Chronic pain is an unreliable guide of what to do or not do. Some days or weeks are worse than others. The challenge is to persist through the bad weeks as much as you can, and enjoy the good weeks without being fearful.
  • Stay positive. I know this can sound like throaway type advice, but there is evidence to suggest that if you can get through your pain, your brain returns to normal – the changes associated with pain are not permanent! (3)

Conclusions

It can seem like an impossible journey at times, and a completely isolating one, but you are definitely not alone.

People have gone before you and conquered pain. Others going on to live full lives despite their pain. Both, in no small part, due to their determination to make their lives better.

This doesn’t mean that you can will yourself better, but it does mean that there is hope.

There are dedicate professionals out there who study hard and work even harder to help people in pain live better lives.

Sometimes you have to work to find them. Sometimes you have to travel to reach them.

But you must, you owe it to yourself, because, the right advice, the right words at the right time, the right actions in the right amount, can change your life.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



References

(1) Melzack and Katz, Pain

(2) Expectation and low back pain recovery

(3) Brain structure during and after pain

 

Does Sitting Cause Low Back Pain?

Sitting And Low Back Pain

Sitting is the new smoking. – everyone

You’ve heard it. You’ve read it. Somewhere in your brain is the meme that sitting is the new smoking.

Yes, sitting for long periods without moving is unhealthy, mostly from a metabolic point of view, but does sitting cause low back pain?

In reality, like all things related to pain, it’s complex, and as a result, the research seems to be mixed, which is a far cry from what you’ll read in most health articles posted online, in newspapers and magazines.

What Does The Popular Media Say?

It’s really common for articles in the popular media, both online and offline, to say that sitting causes low back pain. (1,2)

Most say that the incidence of low back pain has increased because of increased sitting time or via mal-adaptive processes (like muscle shortening) as a consequence of sitting.

You will read about how sitting shortens hip flexors and hamstrings, about how sitting compresses the spine and the discs and about how sitting weakens “the core”.

Because these mechanisms sound plausible, and because they are repeated so often, they are gradually accepted as fact, without much further questioning.

Unfortunately, what makes sense in theory doesn’t always pan out to work in the real world, which is why we use the scientific method to try and determine cause and effect.

This is important for two reasons:

  1. If we determine that sitting causes or doesn’t cause low back pain, then we can act on this information accordingly.
  2. If we determine a causal relationship between sitting and low back pain, we can then look at why this might be happening, in order to better treat it.

What Does The Research Say?

When we look at the research around sitting and low back pain, the results are mixed.

One study (3) took a group in 1993 and followed up at 5 year intervals until 2012. They looked at mental health, metabolic health and musculoskeletal health. They found no association with occupational sitting and low back pain.

Another study (4) I looked at objectively measured sitting time as a risk factor for low back pain. This is important, because most studies rely on self-reported data, which is typically inaccurate. The authors found that total sitting time (most studies just measure occupational sitting time) was associated with low back pain intensity, when other factors were controlled for. This means that the more these people sat, the more intense low back pain they experienced.

The third study (5) I looked at wasn’t a study, it was a review. A review is when researchers look at all the studies on a certain topic that meet certain criteria, and then compile their results.

Aside: a meta-review is when researchers review all the reviews on a topic to get an idea of what “works”. This is regarded as the best form of research evidence, because it is more robust and has more statistical power (is more likely to be correct).

In this review the authors reached the following conclusions:

Although occupational physical activities are suspected of causing LBP, findings from the eight SR reports did not support this hypothesis. This may be related to insufficient or poor quality scientific literature, as well as the difficulty of establishing causation of LBP. These population-level findings do not preclude the possibility that individuals may attribute their LBP to specific occupational physical activities.

So as you can see, from my small sample, one showed a link, another showed no link and the review found no link, but also acknowledged potential issues as to why this is so.

So, Does Sitting Cause Low Back Pain?

As you can see, the results were not conclusive. Even if increased sitting time is associated with low back pain, it doesn’t mean it causes low back pain.

This is because, pain is emergent, not dependent.

An emergent property is a property which a collection or complex system has, but which the individual members do not have. A failure to realize that a property is emergent, or supervenient, leads to the fallacy of division.

What this means, is that pain arises based on many factors, that are unpredictable, so to try and isolate one variable, like sitting, as the cause, is impossible.

No one thing causes pain.

A “More” Plausible Explanation?

If we look at why somebody might experience pain after sitting, we have to ask:

Was it the sitting, or something the sitting did?

Do people who experience low back pain from sitting also experience low back pain from other activities?

What about positions that replicate sitting, but aren’t sitting?

If they do, then what do these activities have in common?

Finally, is there ways they can sit that don’t cause them pain?

Most of the time, we will find that sitting is not the sole cause of low back pain, and when it is apparently so, it’s likely that there are still other factors at play.

One way to explain why we get pain in certain positions, is to understand the sensitivity of peripheral nerves.

When we occupy any position, particularly when pressure on the body is involved (sitting, lying etc), there is a compression of body tissues taking place, including the peripheral nerves.

When we apply pressure to peripheral nerves, they deform.

This deformation causes altered neural blood flow – rabbit models show a reduction of up to 70% of their blood flow when a strain of only 8.8% is applied.(6)

This could feasibly be a driver of nociception (bearing in mind that pain is produced by the brain, there are no “pain signals”) which could result in a pain experience.

So instead of thinking that sitting causes low back pain, it is probably better to look at the function of your body as to why you don’t have the capacity to sit for extended periods, and address those issues.

Conclusions

Just because sitting doesn’t necessarily cause low back pain, doesn’t make it harmless. Sitting has many pronounced negative effects on our metabolic functions, and movement has many pronounced benefits, including reduced incidences of pain (7).

Additionally, if you understand that no one thing causes pain, you will be in a much better position to deal with pain when it happens.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) Heal your lower back pain with these 5 yoga poses

(2) Proper sitting

(3) Occupation sitting and cardiometabolic, mental and musculoskeletal health

(4) Sitting time (measured) and low back pain

(5) Occupational physical activity and low back pain

(6) Structure and biomechanics of nerves

(7) Physical activity and chronic pain (in mice)

How To Manage Pain Flare Ups

Nature Helps Calm Stress

Pain flare ups are a common occurrence with both acute injury or chronic pain. Knowing how to manage them well can be the difference between being able to maintain a high quality of life or not.

Pain flare ups, simply put, are a normal part of being a human in pain. Sometimes, they are related to something you have or haven’t done, but many times, there is no discernable cause for a pain flare up.

Most pain flare ups are short term – be it a few days or weeks – which can, at the time, seem like they will never end, leading you to pursue options for relief that are ineffective, costly and possibly even dangerous.

Instead, with this article, I hope to show you some strategies you can use immediately, or store away for reference in the (unfortunate) event of a pain flare up.

Why do pain flare ups occur?

Biological systems are non-linear, complex systems. Whilst it is easy to think of recovery as a straight line from injury to repair, in reality, things are a lot more up and down. (2)

In fact, I wrote about this in the last newsletter (you can subscribe at the end of this post, so you won’t miss any future issues).

This fact alone means pain flare ups are an expected, yet unpredictable phenomenon, but beyond saying that flare ups are inevitable, there are more issues at play.

Sensitisation

Sensitisation is the increased sensitivity of the nervous system to stimuli, whether it is at a peripheral level (nerve endings throughout the body), a spinal level or in the brain itself (3).

Because of this process, what was once a pain free task can become painful over time.

Biologically this is designed to protect us from further harming an injured area, which works well in acute injuries, but with chronic conditions, where pain and tissue damage become poorly correlated, it’s not so useful.

Lowered tissue tolerance

Whilst similar to sensitisation, lowered tissue tolerance occurs when you do not use/load body tissues appropriately over time and they decondition.

Whereas sensitisation is purely neurological, tissue tolerance is related to structural changes as well as a heightened sensitivity. The two often go hand in hand.

An easy way to understand this is with the example of muscle wasting caused by immobilisation. There is a reduced tolerance for load, and exceeding this can cause pain.

With both acute injuries and chronic pain, often the loading on the affected area is decreased, either consciously or unconciously, which leads to decreased tolerance of the tissues to loading.

Expectation

Often people with pain, whether acute or chronic, expect certain things to hurt them.

I was wearing heels all day yesterday because I had a wedding, so I knew I’d be sore today.

What’s interesting about expectation, is that is a self-fulfilling prophecy.

If you think something will hurt, it probably will, thus confirming your thoughts.

That’s not to downplay the involvement of the activity in question, but there are studies that show simply priming  (3) someone with “old” words and thoughts causes them to walk more slowly, without even realising it.

With this in mind, if you are expecting the worst, then chances are you’ll get it. (4, 5, 6)

What to do about pain flare ups

Every strategy to manage pain needs to be individualised to the individual – no one thing works for everyone, nor does anything work the same from person to person.

Acceptance

Acceptance and Commitment Therapy (ACT) is becoming more and more popular in treating/managing pain, because it is so effective (7).

What is so powerful about ACT, is that accepting flare ups will happen, and that you will be in pain, takes away their biggest weapon – frustration and disappointment.

In ACT, thoughts and feelings are not considered to be “helpful” or “unhelpful”. This is important during pain flare ups, because pain can cause us to think negatively, painting situations into worse than they are within our minds.

In essence, ACT is a form of mindfulness.

This is probably the most challenging thing to master, but when you do, the results are profound, both in the context of pain, but also in the greater context of your life.

Modify your activities

Whilst in the long term, avoidance strategies aren’t very successful, because they simply reduce what you are capable of, in the short term, as a management strategy, modifying or even ceasing activities that hurt is a viable option.

Ideally, you will continue as best you can, with what you want/have to do, but it is completely reasonable to put things off.

This makes intuitive sense: if you have low back pain and it hurts to bend, then you will likely avoid bending when it hurts.

However, as mentioned, simply avoiding bending forever is not a solution, and actually makes things worse.

A better approach is to see if you can modify how you bend, and how much you are bending in the short term, whilst working to restore the ability to bend freely in the long term, using a graded approach.

Use pain relieving techniques that work for you

When in pain, it’s natural to want to get rid of it as soon as possible, no matter the cost.

Unfortunately, there is no one medication/therapy/product that can effectively eliminate pain in everybody, all the time.

So, instead of chasing a magic bullet that drains all your time, money and energy, it makes sense to stick with proven strategies.

Once you have found your “recipe” for relieving pain, you can seek to optimise it, with less conventional methods, if they are safe.

Things you can try, which do have effectiveness to varying degrees are:

Focus on what you can do

It’s really hard to stay positive during pain, the whole point of pain, from a biological perspective, is to over-ride our consciousness to take alternative/evasive action from our current situation.

This means a stress response, and a stress response, physiologically, is designed for action, black/white thinking.

What this can do, is cause you to focus on negative thoughts and emotions, setting of a vicious cycle making things worse over time.

If you focus on what you can do – with both a macro and micro perspective – then you completely shift the way you are living.

After all, if you can’t control whether you experience a pain flare up, wouldn’t you at least want to control your thoughts and activities?

BONUS TIP: Spend time in nature to calm stress

Just as I was editing this, I realised it was hard to find pictures of “pain flare ups”, so instead I went for a calming picture of nature, because spending time in nature is quite beneficial for a multitude of reasons, but simply put, time in nature calms our bodies and our minds, which is a massive key for anyone in pain.

Conclusions

Pain flare ups are a massive challenge for patients and practitioners alike, for many reasons.

As with most things, there is no quick fix, but you can definitely improve your experience of pain flare ups in the short term, whilst in the long term, a tailored pain management strategy can help reduce or even eliminate them.

 

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) Complex systems theory

(2) Neurobiology of pain

(3) Priming

(4) How expectations shape pain

(5) The subjective experience of pain

(6) Expectation of pain enhances response to non-painful stimuli

(7) ACT