What is PAIN? Pain is an experience. And pain is always real. It’s the alarm system of the body, there to protect us. However, it is not an objective sensation from the body, reflecting directly what is happening in the tissues. Instead, pain is the brain’s interpretation of the level of threat the body is under, based on a multitudes of many types of information being perceived in each moment. Sometimes, this alarm system goes haywire and doesn’t reflect danger accurately.
The opposite of pain is SAFETY. In short, persistent pain treatment involves restoring a sense of safety in the nervous system and re-calibrating the alarm system.
A contemporary lexicon…
Nociceptive pain / Acute pain: Short-term pain directly related to a bodily injury or threat corresponding to tissue damage or threat. For example, pain caused by a paper cut, tennis elbow, or a broken bone. Pain from musculoskeletal injuries is healthy and a good thing. It protects you while you heal up. And can be addressed by osteopaths and physiotherapists. Sometimes, due to a variety of complex factors, the pain might shift towards the nociplastic end of the spectrum and stick around longer than expected.
Chronic pain: A broad term to describe any pain that lasts more than 3 months. This could be caused by an injury, overuse, or a pathological condition among others. An example would be pain from endometriosis that lasts years, pain from RSI that has been going on since starting a new job six months ago, or pain from a knee that underwent multiple surgeries and gets sore when running.
Persistent pain: Chronic pain that persists despite a lack of structural damage or long after healing. It doesn’t have a straightforward physical cause that can be identified. It is often linked to central sensitization. An example would be pain persisting two years after healing from a successful tendon repair surgery despite the MRI showing it’s healed well.
Nociplastic pain: Pain that sits on the spectrum of abnormal pain processing. CRPS is an example at the extreme end of this spectrum. A little niggle that has been there for fifteen years after healing from a broken toe is also on that spectrum. This kind of pain is the focus of KCO pain services.
Neuropathic pain: Pain that results from damage to a nerve. Management depends on the root cause (this could be a pathology like diabetes, nerve impingement like carpal tunnel syndrome, or hypersensitivity where a nerve has been severed). Our osteopathy and/or pain services will be involved among others in the multidisciplinary management in various ways depending on the situation.
Central sensitization: An increase in the sensitivity level of the central nervous system (brain and spinal cord), that results in a higher level of sensitivity of the body to different inputs resulting in disproportionate pain, and a variety of other symptoms across multiple systems (neurological, immune, endocrine, etc)
Neuroplasticity: Our nervous system’s ability to change and adapt throughout our life. It’s never too late to re-calibrate!
GMI: Graded-motor imagery, a modality that uses graded exposure to desensitize pain associated with moving a painful body part.
PNE: Pain Neuroscience Education, the in-depth learning of the pathophysiological and psychological processes involved in pain processing. Studies show that the more people learn about pain, the more they can improve their own!
Resources:
Dr Lorimer Moseley, “Why things hurt”: https://www.youtube.com/watch?v=gwd-wLdIHjs
Short video “Tame the Beast - It’s time to rethink persistent pain”: https://www.youtube.com/watch?v=ikUzvSph7Z4&t=7s
The gold standard of pain neuroscience education: https://www.noigroup.com/product/explain-pain-second-edition/
Evidence base for Graded Motor Imagery (GMI): https://www.noigroup.com/evidence-base-for-graded-motor-imagery/
Free mindfulness audios to calm the mind: https://www.freemindfulness.org/download
New Zealand Pain Society guide: https://www.nzps.org.nz/assets/2ee400518f/2204-Pain-Management-Resource-A5-FINAL-online.pdf
Introduction to persistent pain management by ACC: https://www.acc.co.nz/assets/im-injured/ffbf5eb703/acc6671-manage-persistent-pain.pdf