Most of us think we have a pretty good idea about pain. We experience it throughout our lives and so we should kind of know how it works, right? WRONG! The basic model of pain we have been taught over the past one of two thousand years was described by Descartes. This model of pain says that tissue damage = pain. It is based on an old view of pain that is the prevalent model of pain used in medical and physical therapy schools. This is called a biomedical model
Let me describe an alternate model of pain. This model is more complete and explains how pain
An important fact to understand is that injured tissues heal in predictable and consistent time frames. Assuming the tissues healing is not being interfered with, it will heal completely during these time frames. We would expect pain to resolve as tissues heal, but for some people this does not happen. For example, the majority of disc bulges heal in 9 months. Tendons heal in 3 to 6 months, ligaments heal in 6 to 9 months. But many people still have pain after these tissues have healed. When you consider that all tissues heal in a predictable way, why do so many people have pain that persists even after healing? Current research indicates the problem lies in the nervous system and how the brain responds to the information it receives from the body.
Let’s review what happens when injury occurs in the body
However in about 25 percent of people as the body heals the alarm does not go back down. The alarm (nervous system) stays extra sensitive. So if pain last beyond the normal healing time, it is likely due to an extra sensitive alarm system. We now believe this extra sensitive alarm system is the reason for chronic pain, limited movement and sensitivity that many people develop.
What does this mean for people with chronic pain? It means that before their injury, surgery or disease process started their nervous system allowed them a lot of room for activity. They could do all the things they love, their hobbies, sports, recreation and work without pain. Now their nervous system has become like a helicopter parent, WAY TOO PROTECTIVE. They now get pain with normal activities that aren’t dangerous or damaging. They have little room to for activity, for their life. It’s like home security system going off any time a leaf tumbles by outside.
Why does this happen in 1 in 4 people? Why does the alarm system stay extra sensitive? It has to do with everything that people may go through during their pain experience. For example, being in pain everyday can cause stress at home and work. Treatments that fail can contribute to fear and stress. Different explanations of what is wrong can confuse and contribute. When people are stressed, afraid or confused during recovery the alarm system can become extra sensitive.
In the next post in this series I will delve deeper into some of the other factors that contribute to developing a sensitive nervous system and what can be done about it. For those of you who would like to learn more about the sensitive nervous system and chronic pain may I recommend a book for you to buy. Why Do I Hurt by Adriann Louw was written to describe this process to the lay person.
The pictures and information in this post are taken from “Therapuetic Neuroscience Education: Teaching Patients About Pain” by Adriaan Louw and Emilio Puentedura.
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