Do I have chronic pain?

Chronic pain is a condition that affects millions of people around the world, including athletes and everyday people who are active. It is defined as pain that lasts for more than three months and can range from mild to severe. Chronic pain can be caused by various factors, such as injury, illness, mental health or a combination. In this blog, we will explore the causes and symptoms of chronic pain, as well as various treatment options that are available.

Causes of Chronic Pain

Injuries are one of the most common causes of chronic pain among athletes and active individuals. Acute injuries, such as sprains, strains, and fractures, can lead to chronic pain if not treated properly. Overuse injuries, such as tendinitis and bursitis, are also common among athletes and active individuals. These types of injuries occur when a particular muscle or joint is used excessively (doing too much too soon) or improperly.

Medical conditions can also cause chronic pain. Arthritis is a common condition that causes inflammation in the joints, leading to pain, stiffness, and limited mobility. 

Mental health can cause chronic pain - this is a more complex topic and could do with it's own blog post. But often it can contribute to making an existing, new or past injury more painful for longer. 

Symptoms of Chronic Pain

The symptoms of chronic pain can vary depending on the cause and severity of the condition. Common symptoms include:

• Pain that lasts for more than three months
• Pain that is continuous or intermittent
• Pain that is localized or widespread
• Stiffness or limited mobility in the affected area
• Fatigue, sleep disturbances, and mood changes

Treatment Options for Chronic Pain

There are various treatment options available for chronic pain, including medication, physical therapy, chronic pain specialists and possibly surgery (although this one be cautious of - we will discuss this more below).

Physical Therapy

Physical therapy is a form of treatment that uses exercises and other techniques to improve mobility, strength, and flexibility. It can be used to manage chronic pain by reducing inflammation, improving circulation, and strengthening the affected area. Physical therapy may include exercises such as stretching, strength training, and aerobic exercise, as well as techniques such as massage, heat therapy, and electrical stimulation.

Medication

Medication is often the first line of treatment for chronic pain. Over-the-counter pain relievers such as acetaminophen and non steroidal anti-inflammatory drugs (NSAIDs) can be used to manage mild to moderate pain. Prescription medications such as opioids may be used for severe pain, but they come with risks such as addiction and overdose. As a physical therapist, medication can be helpful and for some a life line to enable function - but as said above there are serious risks and contraindications to this. This should not be your first route to attempting to deal with your chronic pain, at best it is a band-aid over the symptoms and not fixing the issue. Additionally, often doses that reduced the pain initially will need to go up only making the risk of addition or overdose more likely. 

Lifestyle Changes & Mental Health

Lifestyle changes such as exercise, diet, and stress reduction techniques can also be used to manage chronic pain. I know, I know you have heard this before and doing this is SO MUCH HARDER. Exercise can help improve strength, flexibility, and circulation, as well as reduce inflammation and stress in the body. A healthy diet that is rich in anti-inflammatory foods such as fruits, vegetables, nuts and whole grains can also help reduce pain and inflammation in the bodies joints/tissues. Stress reduction techniques such as meditation, deep breathing, and yoga can help reduce stress and improve mood, which can in turn help reduce pain.

This exert below is from the American Psychiatric Associate and illustrates the link and the research between mental health and pain

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Chronic pain and mental health disorders often occur together. In fact, research suggests that chronic pain and mental health problems can contribute to and exacerbate the other.

People living with chronic pain are at heightened risk for mental health problems, including depression, anxiety, and substance use disorders. Chronic pain can affect sleep, increase stress levels and contribute to depression. An estimated 35% to 45% of people with chronic pain experience depression.¹ Pain can also be a common symptom among people with an anxiety disorder, particularly generalized anxiety disorder, according to the Anxiety and Depression Association of America (ADAA). Anxiety, depression, and other mood disorders commonly occur at the same time as chronic pain from conditions like fibromyalgia, back problems, migraines and arthritis.

Research using functional imaging suggests that mental health disorders and chronic pain share biological mechanisms, which contributes to the interconnection.² One example of the interconnection is that depression can make a person more sensitive to pain.

In a new report, Mental Health America used data from its online mental health screening program to analyze the intersection between mental health and chronic pain. Between 2015 and 2019, more than 160,000 individuals who used the Mental Health America screening program self-identified as living with arthritis or other chronic pain. People who reported having arthritis or chronic pain were more likely to have several mental health conditions, including severe anxiety, severe depression, bipolar and PTSD. For example, among people taking the screening for depression, 47% of those with chronic pain screened positive for severe depression compared to 36% of those without chronic pain.

The study found that older people more frequently reported chronic pain—about 60% of those age 65 and over reported they had chronic pain compared to 26% of those age 18 to 24. Among the population groups examined in the study, veterans and active duty military members and caregivers were more likely than others to have chronic pain.

Based on its analysis, Mental Health America provided a series of recommendations for improving care of these commonly co-occurring conditions. Among the recommendations:

• Primary care physicians should proactively initiate conversations about mental health and chronic pain with patients rather than waiting for patients to report symptoms.
• Care should be patient-centered and include the use of shared decision-making tools. The needs, goals and preferences of each individual patient must be recognized and included in the treatment plan.
• Bringing together peer support specialists, community health workers, and others into care teams could create more effective pain management.

When chronic pain and mental health disorders occur together, it is important to treat both conditions, according to mental health experts. Some treatments and approaches may help both mental health and pain conditions, including psychotherapy and relaxation techniques. Medications, including some antidepressants and some anticonvulsants, can be useful in treating both conditions. Lifestyle changes, such as exercise, good nutrition and sufficient sleep, can also be helpful for both managing pain and improving mental health symptoms." 

Surgery

Surgery is an option for chronic pain that is caused by structural problems such as herniated discs, arthritis, or nerve damage. Surgery may be used to repair or remove damaged tissue, reduce inflammation, or relieve pressure on nerves. However, surgery is not always effective and can come with risks such as infection, bleeding, and anesthesia complications. Additionally, people often think surgery is always the answer and even with a surgery that gets no complications such as mentioned above the pain is often the same. It is a risk you have to be willing to accept if you go down the surgical route, anatomy and pain are not always linked (I know, pain is complex). I don't mean to say no one should every get surgery but the more information you have regarding what to expect, what you have tried first, and the risks you can make a more informed decision. If you have done physiotherapy for a long period of time (12 months +), feel there is no mental health aspects affecting you, and have spoken to your doctor and surgeon regarding risks vs benefits then it may be right for you. Please be mindful however, that "not being able to commit to the time physio takes" is not a good excuse as following most surgeries your physio is even more important and at times intense. Skipping it after surgery will most likely lead to more pain and leave you in a worse situation. 

Preventing Chronic Pain

Prevention is key when it comes to chronic pain. Athletes and active individuals can take steps to prevent chronic pain by following proper techniques and precautions during physical activity. This includes:

• Ensuring proper progression when exercising and building up whether that is running, weight lifting, surfing, etc.
• Understanding proper techniques during exercise to avoid injury especially in sports that are more risky. 
• Be mindful of the other factors that contribute to injury such as lack of sleep, severe stress, poor mobility/strength and poor nutrition. Individuals who get injured frequently could have issues in these areas instead of their progression.

If you are struggling with this reach out to us at Made By Movement - we offer 1:1 online rehab, we have a library of physio education videos/exercises, and full physio led studio of yoga and Pilates classes. We are with you from mat to mountain.

See you on the mat and thank you for reading!