What Do You Say to Someone in Chronic Pain?

What do you say to people in chronic pain? The right advice can help them to get better. In part two of our Know Pain, Know Gain! series, Paul discusses how having a better understanding of pain can help you to move better and feel better.

Pain is an unpleasant sensory or emotional experience based on actual or potential tissue damage. When the brain receives a “danger message” it interprets the message’s “threat value”. If the message is interpreted as a sign of actual or potential tissue damage then pain is perceived. It is how our brains interpret potentially painful events that determines whether or not pain is perceived. The saying “no brain, no pain” is used to illustrate this fact.

A study was undertaken to measure the effect of pain neurophysiology education on people with chronic low back pain.

The experimental group was educated about the nervous system. Its basic structure was explained, with an emphasis on how the nervous system processes events that have the potential to or do cause tissue damage.  Pain pathways were illustrated. This group was educated about how nerves “talk to each other” via synapses, how this communication is influenced by a “volume knob” and how specialized nerves act as “danger messengers”. How the plasticity of the nervous system changes its functioning in a chronic pain state was explained. (The nervous system becomes “more practiced” at producing pain perceptions, and with this practice it becomes more likely to “play the pain tune”.)

The control group was educated about the anatomy and physiology of the bones and joints of the lumbar spine. Normal spinal curves, how intradiscal pressure changes with different postures, lifting techniques, ergonomics and exercise were explained.

The results favored the experimental group. This group became less likely to seek care when in pain. Its members were more likely to believe that they could control their pain, and less likely to believe that pain is indicative of tissue harm. They perceived themselves as less disabled. They even demonstrated improvements in their ability to bend.

What messages should we be sending to people with chronic pain?

• Stop telling people “if it hurts, don’t do it”. This advice can make people fearful of moving, which is counterproductive to a successful recovery. 
• Do tell people with chronic pain that when they feel a hurt it does not necessarily indicate that harm has occurred. For example, someone that has a stiff shoulder may feel pain when they reach with that arm. That pain often improves with continued, appropriately graded use of the arm. 
• Do tell people not to take back pain lying down. One often cited study shows that people treated with two days of bed rest did better than those who were treated with five days of bed rest. Some experts choose to interpret those findings as two days of bed rest being less harmful than five. 
• “Don’t flare up, but don’t freak out if you do.” When someone with chronic pain begins to increase their activity level they will likely experience an increase in their symptoms. Remember, this typically is not an indicator of tissue damage. This increase in symptoms should resolve with some time. A flare up is when the increase in symptoms is severe to the point where it impairs that person’s typical level of (limited) activity. Flare ups can be counterproductive. 
• Focus on graded activity, which begins with a low level of activity that someone with chronic pain can do without flaring up their symptoms. That low level of activity is repeated frequently each day. As a person improves they will note a new “baseline”. That is, they will become capable of doing more without flaring up. They should then increase their level of activity accordingly.