This pain can feel unrelenting. I can't do the things l like to do."
"I'm crabby and can't think straight. My friends don't want to spend time with me anymore."
"Work is such an effort."
These are the symptoms my clients tell me about.
Chronic pain affects people's lives on many levels. The classic definition of chronic pain as pain that lasts more than three to six months does not capture the experience.
For me, chronic or persistent pain is pain that causes people to change how they are living - doing less of what they like, whether it is work, sports, music or other hobbies.
However, the future of people with chronic pain is brighter with the work of two Australian physiotherapists, Lorimer Mosely and David Butler, and Canadian physiotherapist Neil Pearson.
Bringing creativity and understanding of the latest research on the nervous system, their research has included inflicting pain on each other while hooked up to a magnetic resonance imaging machine (MRI) to examine what areas of the brain are stimulated when people experience pain.
Their number one conclusion is that pain is not an indication of tissue damage. Chronic pain has more to do with the state of the nervous system (meaning the peripheral nerves, spinal cord and brain) than tissue damage.
The pain system is designed to act as a protective system, letting us know when we are in danger. In chronic pain, the nervous system acts as if more and more protection is needed all the time. As a result, pain ends up on speed dial.
Many people with chronic pain have experienced endless emotional ups and downs of further investigations and referrals to find out what is wrong with their back, neck, shoulder, etc,, without getting a satisfactory answer.
Sometimes the person in pain can feel as if everyone thinks they are making it up. Realizing the problem is in the nervous system could help direct these investigations.
Pain not being an accurate indication of tissue damage is a huge paradigm shift for both people with chronic pain and their health care providers.
The good news is it opens different avenues to address the persistent pain problem. Even without advanced technologies and equipment, we can address and change the hypervigilance of the nervous system.
The first, very important step is education. We can learn how the nervous system works and what kind of changes happen to the nerves and the chemicals - called neurotransmitters - that send messages from nerve to nerve when a person is experiencing chronic pain.
These changes, in turn, can cause changes in the endocrine system and the immune system, and how the muscular system functions.
The nervous system learns and practises chronic pain just as it changes when we learn a new skill, such as swimming. However, this unwanted "skill" can be unlearned by using the power of the nervous system in a targeted way.
Studies have shown the education component alone can change people's perception of pain. Understanding what is happening in their bodies and having options to change it reduces the threat of the pain.
Then, the student with pain learns effective techniques to calm the nervous system and retrain it into reactions that are more normal.
For example, exercise becomes about creating a positive experience for the nervous system instead of focusing on specific injury-directed exercises.
Techniques include breathing exercises, graded motor imagery, body scans, goal setting. Mirror boxes in particular have been used to help solve phantom limb pain, the most difficult of pain problems.
Retraining the nervous system to decrease pain is not easy. It requires time, commitment, practice and persistence, just like any skill. Knowing you can change your pain is very empowering and you may learn more about yourself in the process.
To learn more about chronic pain, two great resources are Understand Pain, Live Well Again, by Pearson, and Explain Pain, by Mosely and Butler.
Pearson's website, www.lifeisnow.ca, is also helpful. It is best to work through these resources with your physiotherapist to maximize the benefit.